Headaches: How are tension headaches and migraines different?


The causes and symptoms of the two main types of headaches, explained.

Most of us get headaches once in a while—you know, the mild to severe pain in one or more parts of your head, as well as the back of your neck. But you might not have realized there are many different types of headache, with different patterns of pain and other related symptoms. Headaches also have a variety of causes.

Headaches are painful and annoying in the moment, but there’s good news: the majority of headaches are benign. They’re typically not a sign of a serious disorder and, if they are not a persistent problem, can often be relieved by simple over-the-counter medicines or simple lifestyle changes.

What causes headaches?

There is no single cause of headaches. A number of causes have been identified which fall into two general categories.

Tension headache

A tension headache is the classic type of run-of-the-mill headache. Tension headaches happen when you (unintentionally) contract your head and neck muscles. It’s the most common type of headache, accounting for 70 per cent of all headaches.

Tension headaches can occur in people of either sex and at any age, but it’s most common in adults and adolescents.

Tension headaches usually occur in isolated incidents but can become chronic for some people.

Possible causes of muscle contraction associated with tension headaches include:

Migraine headache

Migraine is the cause of 20 per cent of all headaches.

The underlying problem that leads to migraines is still not clear, but there are several theories. Experts believe migraines are likely the result of a series of complex changes in the nerves, blood vessels and chemical signalling within the brain.

Migraine usually brings about a throbbing pain on one side of the head with an associated feeling of sickness and sensitivity to light and sound. However there are various types of migraine:

  • Migraine with aura:an aura is a warning symptom or sign that develops before the headache itself. Auras include flashing lights and visual changes, and neck stiffness. One in three people with migraine have auras.
  • Migraine without aura
  • Migraine without headache: Although migraines are a type of headache, some people find they get all the other symptoms, especially an aura, but no headache. This is also called a silent migraine.

Migraines affect three times women than men and are often chronic. In extreme cases they may totally disrupt a person’s daily life.

Below are some of the factors that have been identified as being associated with migraines:

  • family history of migraine
  • prolonged muscle tension and stress
  • alcoholuse
  • smokingor exposure to tobacco smoke
  • lack of sleep
  • for women, menstrual periodsand the use of oral contraceptives
  • certain foods such as chocolate, nuts and fermented or pickled condiments, as well as foods containing the amino acid tyramine (aged cheese, red wine, smoked fish) and foods containing preservatives and artificial sweeteners are linked to migraine. It was thought they might contain chemicals that could trigger a migraine, but other research suggests that one of the early symptoms of a migraine might be a craving for foods such as these.

What are the symptoms of tension and migraine headaches?

Tension headache

  • Pain is often felt in the generalised area of the head and neck as opposed to on one side.
  • Pain may also be situated in the back of the head and neck and feel like a tight band.
  • Sometimes accompanied by muscle tightness in back of neck.
  • Of relatively short duration if treated in time.

Migraine headache

Migraine symptoms tend to follow four stages:

  • Prodrome: this comes before the headache (often hours or up to two days before) and varies from person to person. Prodromal symptoms include generally feeling unwell, low mood, extremely tired, changes in appetite, craving certain foods, yawning and temperature changes in the extremities (such as hot ears or a cold nose). Many people with long standing migraine can recognise their prodromal stage even if they can’t fully describe what they feel is wrong.
  • Aura: about one in three people get an aura – a warning symptom just before the headache starts which lasts 10 to 15 minutes. These aura often include visual symptoms such as flashing lights.
  • Headache
  • Postdrome: many people recognise certain symptoms once the headache has gone, especially exhaustion but sometimes hunger too.

When should you consult a doctor about headaches?

Most people with isolated tension headaches usually manage to control their symptoms with over-the-counter pain relievers and anti-inflammatories, such as paracetamol or ibuprofen, or simple self-treatment such as relaxation and sleep.

However, those with chronic headaches should be checked out by their GP to consider possible causes and prevention.

If any of the below symptoms are present your GP should be contacted immediately.

  • A sudden, severe headache accompanied by nausea and vomiting.
  • Persistent and recurring headaches accompanied by memory problems, difficulty concentrating and tiredness.
  • A high fever with neck stiffness (unable to bend the chin down to the chest).
  • Convulsions (fits).
  • Persistent vision disturbances (light flashes).
  • Trouble controlling arms and legs.
  • Loss of feeling in the arms and legs.
  • Tiredness and apathy with difficulty communicating.

How does the doctor make a diagnosis?

An accurate history of any previous illnesses, family background, diet and lifestyle is crucial to help the doctor decide whether to perform further tests and to advise on treatment.

The doctor will ask for information about the headache, its length, duration, location, associated features, quality and causative factors.

Bear in mind that the vast majority of headaches, even persistent ones, are not sinister.

However, when symptoms suggest that the headaches may be related to a chronic or more serious disorder, the following diagnostic procedures might be performed, usually following assessment by a specialist.

What kind of headache treatments are available?

If you’ve been struggling with headaches, start keeping a diary that notes when the pain started and how long it lasts, what you’ve been eating and drinking, what medicines you’ve been taking, the weather conditions, your daily activities, stressors, and if you’re a woman, the stage of your menstrual cycle. Keeping a diary like this will be useful for your doctor to spot trigger factors and figure out what kind of treatment is most appropriate for your specific circumstances. Keep up the diary for between one and two months so that any patterns can be identified. By establishing what triggers the headaches, it is possible to learn to avoid factors that cause them.

While each person will require their own form of treatment, generally over-the-counter pain relievers, such as paracetamol (eg Panadol)aspirin (eg Aspro clear) and ibuprofen (eg Nurofen), are quite helpful in relieving the symptoms of tension-like headaches.

Prescription medicines may be helpful for other types of headache pain such as chronic migraines.

In migraine, it’s very helpful to start by getting an explanation of the problem and identifying and avoiding trigger factors. Drug treatments may then be used to either treat an acute attack or prevent further headaches.

There are various treatments available for relieving acute attacks, starting with simple over-the-counter (OTC) painkillers such as paracetamol or ibuprofen. These are most effective if taken as early as possible into the attack, preferably in a soluble form.

Some OTC medicines designed specifically for migraine also contain an antisickness medicine such as cyclizine.

If OTC painkillers are ineffective your doctor may prescribe alternative treatments containing different antisickness medicines, stronger painkillers, or one of a group of antimigraine medicines called triptans, eg sumatriptan (Imigran) or zolmitriptan (Zomig)which are not painkillers but work on blood vessel changes which occur in migraine.

Sumatriptan can now be bought OTC under the guidance of a pharmacist. However, triptans don’t work for everyone.

NICE (National Institute for Health and Care Excellence) has recently approved a new treatment for migraine called transmagnetic stimulation (TMS).

It involves holding a small electrical device to your head which delivers magnetic pulses. Although its not really clear how this works, it does seem to reduce the severity of symptoms. For now it is only available in specialist centres.

If your migraines are particularly frequent, your doctor may prescribe a preventive treatment.

Your doctor may prescribe a preventive treatment if migraine attacks are especially frequent.

These might include beta-blockers, such as propranolol (eg Inderal LA), amitriptyline or anti-convulsant drugs such as sodium valproate (eg Epilim), which is usually used for treating epilepsy.

Some people suffer from frequent and severe migraine. Referral to a specialist migraine clinic may be helpful.

For people experiencing severe indigestion with burning sensations in the stomach or for those already diagnosed with a stomach ulcer, NSAIDs such as ibuprofen and medicines containing acetylsalicylic acid such as aspirin should be avoided because of the risk of bleeding from the gut.

Aspirin should not be given to children under 16 years of age, unless on the advice of a doctor.

NOTE: The above mentioned medicines should not be given to children unless you are advised to do so by your GP.

What can you do to help yourself?

If the doctor has examined you without finding any serious cause for the headaches, these tips should prove helpful.

  • Avoid excessive use of alcoholand tobacco.
  • Engage in correct posture while sitting and working. The type of chair you use is important. It should be one that maximises comfort and good posture and may need to be adjusted to suit your needs.
  • Perform relaxation techniques on a consistent basis.
  • Get plenty of fresh air and exercise.
  • Avoid triggers like being over-tired or intensely hunger.
  • Some people find that taking the natural herbal treatment Feverfew is very effective at reducing or preventing their headaches occurring. This needs to be taken daily – even if no headache is present – to have an effect.
  • Consult your GP before starting this.

For migraine headaches, symptoms may be reduced by:

  • resting in a quiet room with the lights turned off
  • avoiding food or drink in your diet that have been identified as possible factors associated with migraine headaches
  • avoiding other triggers as listed above.


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