Head Pounding? How to Tell the Difference Between Migraines and Tension Headaches

Most of us are familiar with the feeling of a throbbing headache, the pain right at the temples that makes you want to close your eyes, take some ibuprofen, and maybe sleep it off. We tend to brush off these common afflictions with nothing more than "Oh, it's just a headache," but what if it's a migraine? Telling the difference between a migraine and a tension headache is important because it can mean faster relief through more effective treatments, plus the ability to prevent future headaches by getting to the root of the cause.

A tension headache is a type of common headache, and its pain tends to spread across both sides of the head, starting at the back of the neck and head and creeping forward. According to the National Headache Institute, founded by the internationally recognized Dr. Payman Sadeghi, MD, "Tension headaches are among the most common headache disorders we encounter." Also referred to as stress headaches, "the causes of tension headaches are not accurately known. It is believed that in some people, these headaches are caused by some kind of internal or external stress — troubled personal or professional lives, work pressures, child birth, lack of sleep, and being overworked. Thankfully, the headache manifests itself in mild to moderate pain and usually doesn't hamper the daily activities of an individual."

Along with stress, Penn Medicine also cites "eyestrain and hunger" as other common causes of tension headaches, and states that they can be chronic, while the Mayo Clinic adds muscle strain and anxiety to the list of factors to watch out for when monitoring tension headaches.

According to Dr. Sadeghi, "tension headaches are the most common headache disorders in the US, affecting women more than men at a ratio of five to four," and are split into two classifications. These include episodic tension-type headaches (ETTH), which last from 30 minutes to several days, and are bilateral, of mild to moderate intensity, and occur less than 15 times a month. Meanwhile, chronic tension-type headaches (CTTH) are of severe intensity and occur more than 15 times a month.

If the symptoms and causes of tension headaches do not seem familiar to you, it is important to not jump to the conclusion that you're dealing with migraines. Other kinds of common headaches include sinus headaches, which occur with sinus-infection symptoms such as a stuffy nose and facial pressure, or cluster headaches, which are severely painful and occur on one side of the head, coming in "clusters" (long spells of headaches followed by headache-free periods in a cycle). That being said, whether you believe you have a common headache or something else, it is always the safest bet to consult your doctor.

Apart from the various forms of common headaches, more often than not exemplified by tension headaches, we also have the infamous migraine. Migraines are "a neurological disease that involve nerve pathways and chemicals," according to Penn Medicine, and headaches are simply a symptom of the changes in brain activity that affect the blood in the brain and the surrounding tissues. Dr. Sadeghi states that "patients suffering from migraine pain can feel the effects not only physically, but also through the loss of work, family time, and personal day-to-day pleasures." Migraines involve "intense, frequent and debilitating headache pain" which may cause "a serious impairment in the ability to perform daily tasks," and are associated with disorders such as sleep disruptions, anxiety, epilepsy and stroke. The pain of a migraine is typically more severe than a common headache, and can be accompanied by other symptoms prior to the actual migraine including depression, irritability, and neck stiffness.

The four phases of a migraine headache are the prodrome phase, the aura phase, the headache phase and the resolution phase. According to Dr. Sadeghi, the symptoms of the prodrome phase, which precedes the migraine by up to 24 hours and affects 60 percent of migraine patients, include "mood shifts, increased yawning and thirst, bloating, neck pain, excessive urination, constipation, and diarrhea. Increased sensitivity to lights and sounds is also common." The aura phase comes next, experienced by 15 percent of patients, which includes seeing "flashing or shimmering lights" or feeling "abnormal numbness, tingling, or burning." The headache phase begins on one side of the head, but can become bilateral if the pain moves to another section of the head. In migraines, the "throbbing and pulsing pain can increase due to cranial pressure" such as coughing or sneezing, and secondary symptoms include "nausea, vomiting, dizziness, phonophobia and photophobia." Lastly, the resolution phase includes "exhaustion, mood shifts, and irritability" which continue to affect patients even after the head pain has diminished.

When it comes to treatment for both of these types of headaches, Dr. Sadeghi states that "tension headaches are not difficult to treat, and they are known to respond favorably to the right treatment method." This can involve nondrug treatments such as stress management or relaxation therapy, or on the other hand, antidepressants and anti-inflammatory drugs. For migraines, a more tailored approach is needed, preferably at a clinic specializing in headaches where you can work one on one with a doctor to both alleviate and prevent future spells.

Dr. Sadeghi points out that his "approach to headaches is that they are a symptom, not a disease. To properly treat any kind of headache, no matter the type, the underlying cause must be discovered and treated. Whether it's a sinus headache, tension headache, cluster headache, or migraine, no headache can be properly treated without finding the cause first." All in all, consulting a physician when dealing with headaches, and being aware of underlying causes, is crucial to living your best life, pain free.