Migraine vs Tension Headache

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A migraine is a form of vascular headache. Migraine headache is caused by a combination of vasodilatation (enlargement of blood vessels) and the release of chemicals from nerve fibers that coil around the blood vessels. During a migraine attack, the temporal artery enlarges. (The temporal artery is an artery that lies on the outside of the skull just under the skin of the temple.) Enlargement of the temporal artery stretches the nerves that coil around the artery and cause the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the artery magnifies the pain.

Tension headaches account for nearly 90% of all headaches and are probably experienced by most people at some time during their lifetime. These headaches are frequently associated with fatigue and stress, and generally respond to simple measures such as rest or over-the-counter pain medicines. The pain from a tension headache usually occurs on both sides of head and consists of a dull, steady ache.

Comparison chart

Migraine versus Tension Headache comparison chart
	Migraine	Tension Headache
Characteristics of pain	Deep throbbing and pulsating pain	Dull and pressure-like pain in the head. It may also produce a feeling of pressure similar to the sensation caused by the placement of a vice or a tight band on the head and/or around the neck.
Gender predominance	More common in women	More common in females
Sensitivity to light or sound	Typical	Rare
Location of pain	Deep stabbing pain around the temple or the eye.	The pain is typically generalized, with areas of more intense pain in the scalp, forehead, temples or the back of the neck. Usually bilateral.
Severity of pain	Ranging from moderate to quite severe	Mild to moderate in severity
Time of onset	Long; headache gradually peaks in around 4-24 hours	Pain develops gradually, fluctuates in severity and then can remain for several days
Triggers	Bright lights, loud noises, changes in sleep patterns, exposure to smoke, skipping meals etc.	Stress
Prodromal aura before headache	Present	Absent
Nausea or vomiting	Common	Rare

Signs and Symptoms

Tension-type headache

Duration of 30 minutes to 7 days.
No nausea or vomiting (anorexia may occur).
Photophobia and/or phonophobia.
Minimum of 10 previous headache episodes; fewer than 180 days per year with headache to be considered “infrequent”.
Bilateral and occipitonuchal or bifrontal pain.
Pain described as "fullness," "tightness/squeezing," "pressure," or "bandlike/viselike".
May occur acutely under emotional distress or intense worry.
Insomnia.
Often present upon rising or shortly thereafter.
Muscular tightness or stiffness in neck, occipital, and frontal regions.
Duration of more than 5 years in 75% of patients with chronic headaches.
Difficulty concentrating.
No prodrome.

Migraine

Throbbing or pulsating headache on one side of your head.
Moderate to severe headache intensity.
Worsening of your headache with routine physical activity.
Nausea, vomiting, or both.
Sensitivity to light and noise, and sometimes smells.

Prevalence

Frequency

In the US: Headache is the ninth most common reason for a patient to consult a physician. Physicians classify 90% of headaches reported to them as muscle contraction or migraine headaches.
Internationally: No literature suggests that headache frequency is different in other regions of the world.

Gender predominance

A female preponderance exists in both Migraine and tension headaches.

Triggers

Migraine

According to the National Library of Medicine's Medical Encyclopedia, Migraine attacks may be triggered by:

Allergic reactions
Bright lights, loud noises, and certain odors or perfumes
Physical or emotional stress
Changes in sleep patterns
Smoking or exposure to smoke
Skipping meals
Alcohol or caffeine
Menstrual cycle fluctuations, birth control pills
Tension headaches
Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans),
monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods

Tension Headaches

Stress - Usually occurs in the afternoon after long stressful work hours
Sleep deprivation
Uncomfortable stressful position and/or bad posture
Irregular meal time (hunger)
Eyestrain

Diagnosis

Migraine

The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":

5 or more attacks
4 hours to 3 days in duration
2 or more of - unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
1 or more accompanying symptoms - nausea and/or vomiting, photophobia, phonophobia

Tension headaches

By clinical signs and symptoms
Lab Studies:
1. Laboratory work should be unremarkable in cases of tension-type headache. Specific tests should be obtained if the history or physical examination suggests another diagnostic possibility.
2. Head CT scan or MRI is necessary only when the headache pattern has changed recently or neurologic examination reveals abnormal findings. Such history or physical exam evidence would suggest an alternate cause of headache.

Treatment

Over-the-counter NSAIDs, such as Advil and Aleve, may provide relief for less severe tension headaches and migraines. Tension headache sufferers may also benefit from a combination drug therapy, which couples NSAIDs with a sedative; some such drugs are available over-the-counter. Migraine sufferers often make use of anti-nausea drugs as well, since many experience nausea or vomiting during a migraine.

Triptan drugs are used for more severe tension headaches and usually for migraines; on rare occasion, narcotics, like opioids, may be temporarily prescribed. Triptan drugs, such as sumatriptan and zolmitriptan, are usually prescribed in the form of injections and nasal sprays; sometimes tablet forms are available, as is the case for zolmitripan.

Preventive treatment may be recommended. Lifestyle or dietary changes may be recommended, and medication is often prescribed. Those who suffer from frequent tension headaches or migraines, for example, are often prescribed tricyclic antidepressants, as these have been shown to help prevent episodes. Cardiovascular drugs may prove a good preventive medicine for some migraine sufferers, too.

And though Botox is typically associated with its cosmetic purposes, Botox injections have also been found to be useful in treating chronic migraines.