Tension Headache vs. Migraine: How to Tell the Difference

Medically Reviewed by Jennifer Robinson, MD on September 20, 2023
Written by Marisa Cohen
5 min read

Whether you've had headaches for years or you started getting them recently, it's important to know what type of headache you're dealing with. That way, you can get the right treatment.

A tension-type headache is the most common headache. Up to 78% of Americans will get them at some point. You might have them every once in a while, and they may disappear within a few hours. Or they may happen more often and last all day.

Migraine headaches aren't as common. About 15% of adults in the U.S. get them. But they can be much more painful and draining. They usually last between 4 and 72 hours.

The kind of symptoms you get, how long they last, and how intense they are can be very different for migraines and tension-type headaches. Here's what you need to know.

You may have a tension-type headache if:

  • You feel pain on both sides of your head.
  • The pain isn't severe.
  • You have tight pressure rather than throbbing. It might feel like your head is in a vice or like there's pressure all the way around it. You may also feel soreness in your temples and tightness in your neck and shoulder muscles.

You're more likely to have a migraine headache if:

  • You have moderate to severe throbbing pain that may be worse on one side of your head.
  • The pain gets worse the more physically active you are. Lying down may help.
  • You have pain around your eyes or temples.
  • Light, sounds, and smells feel uncomfortable or hurt.
  • You're nauseous.
  • You see things like wavy lines, dots, or flashing lights. About 1 in 5 people with a migraine have this.
  • Your arm or face tingles just before your headache starts.

Tension-type headaches usually are brought on by stress, worry, or being tired. They cause the muscles of your scalp, neck, and jaw to tighten, and that leads to pain.

The exact cause of migraine headaches is unclear. Your genes and environment may play roles, though. You get a migraine when certain chemicals in your brain increase. 

Migraine headaches can be brought on by triggers, which can include changes in your hormone levels or bright lights.

If you get these headaches occasionally, you can treat them with over-the-counter drugs like:

Caffeine also may help. Many headache medicines include it as an ingredient.

If you have chronic (long-term) tension-type headaches that don't get better with OTC medications, see your doctor. Sometimes doctors prescribe antidepressants to treat these headaches. You don't have to have depression or anxiety for these meds to help your pain.

Acupuncture and self-relaxation techniques may also help ease tension-type headaches.

It's important to find out what your triggers are and avoid them. It may help to keep a headache diary so you can track possible triggers like:

  • What you eat and drink
  • How much you slept
  • Activities you do
  • Weather changes

You may be able to stop a migraine with headache drugs called "abortive medications." You take these as soon as you feel a migraine coming on. Drugstores carry over-the-counter ibuprofen medications specifically for migraine headaches. If they aren't enough to help, your doctor may prescribe stronger meds.

If other treatments don't work and you have more than four migraine headache days a month, your doctor may suggest preventive medicines. You can take these regularly to make your headaches less frequent or severe. These meds include seizure medicines, blood pressure medicines (like beta-blockers and calcium channel blockers), and some antidepressants.

CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines don't help.

Your doctor might also prescribe a medical device to help you feel better. These three devices may help prevent or treat migraines:

Cefaly. This headband-like device stimulates a nerve on the forehead that's linked to migraines. 

GammaCore. This is a handheld gadget that you can place on the vagus nerve in your neck. It interrupts nerve signals linked to migraines.

SpringTMS (transcranial magnetic stimulator). You hold this device against the back of your head, and it gives off a pulse of magnetic energy into part of the brain.

A smartphone-controlled wearable device called Nerivio is also available.

Some other things that may help with migraine symptoms are:

If you feel like you're getting a mix of migraines and tension-type headaches, and you get them often, you might have a condition called chronic or transformed migraine.

This is when you get headaches 15 or more days a month, and on at least 8 of those days it feels like you're having a migraine.

People with this condition usually start getting occasional migraines in their teens or 20s, and then start having the headaches more often -- daily even. As the headaches become more frequent, the pain often becomes less severe.

Along with pain, you may also have migraine symptoms like nausea and sensitivity to light or sound, but these usually become less frequent and severe over time, too.

A variety of things can make you more likely to get chronic migraine. Research shows that almost 80% of people with the condition took pain-relief drugs for their headache symptoms too often. Other things that can raise your odds for chronic migraine are:

  • Having more than one migraine a week
  • Getting these headaches for a long time
  • Obesity
  • Asthma
  • Snoring
  • Lots of stress in your life
  • Being a woman
  • Having less education, income, and job opportunities
  • A head or neck injury

If you think you might have chronic migraine, talk to your doctor or headache specialist. They may prescribe preventive medicines to help you get fewer headaches, like:

  • Onabotulinum toxin A (Botox)
  • Certain classes of antidepressants
  • Anti-seizure drugs
  • Certain classes of blood pressure meds

Your doctor may also suggest some migraine-prevention medicines.

They may tell you to cut back on any pain-relief drugs you've been taking. Overdoing it with those meds is linked to chronic migraine.

Your doctor might also talk to you about making healthy lifestyle changes that can help, like:

  • Getting enough sleep
  • Eating healthy
  • Exercising

Lots of people with chronic migraine also have symptoms of depression and anxiety. Boosting your mental health might be part of your treatment plan.