Migraine vs. Headache: How to Tell the Difference

A headache can make your day more difficult.

The pain of migraine and tension headache are similar and tend to be mild, moderate, or severe in nature. The pain for each type of headache may be located on one side of the head or on both sides of the head.

The differences between the pain of migraine and headache are that migraine pain has a throbbing quality, and many people report even slight physical exertion (such as walking up a flight of stairs) may worsen their pain.

In contrast, the pain associated with tension-type headaches tends to be more chronic and steady. Many people with tension headache describe a band-like tightness or pressure.

If your are experiencing a headache very different in quality or severity (the worst headache of your life) than your usual headaches, or which is associated with unusual symptoms, or is associated with an elevated temperature, you need medical evaluation immediately to exclude serious underlying causes.

Headaches are one of the most common health problems doctors and other health care professionals treat. Although many people describe all moderate to severe headaches as “migraine,” there are specific criteria used to identify migraine, tension, and other less-common headache varieties. Doctors and other health professionals consider most headaches painful, annoying, or even transiently debilitating to a patient, but they cause little risk.

• Tension headache, also known as tension-type headache, is the most common form of headache. Most people have experienced a tension headache at some point in their lives.
• Migraine headache or migraine pain is also common, but occurs far less frequently than tension headache. The pain associated with migraine headache is different from tension-type headache and can help determine which type of headache a person is experiencing.
• Cluster headache, chronic daily headache, and medication overuse headache occur much less frequently than tension and migraine headache.

Migraine headaches tend to have some marked differences from other headaches, which helps your doctor determine which type of headache you have. There are also several different types of migraine headaches. Migraine with aura and migraine without aura are the most common. An aura is a neurological symptom such as vision changes, numbness, tingling, or even difficulty speaking which precedes the onset of the headache.

Although many people believe that any moderate to severe headache is a migraine, there are specific criteria regarding the type of pain and associated symptoms, which lead to the diagnosis of migraine.

The only similarity between a migraine and a headache are that both cause pain. The headache may come on gradually or suddenly.

Migraine is different from other headaches because it may cause symptoms including:

• Nausea or vomiting
• Sensitivity to light, sound, or smells
• Worsening of the headache with slight physical exertion

These symptoms are often considered to be an acute migraine attack.

Tension-type headaches may be associated with tenderness of the muscles of the head, neck, and shoulders. If you have this type of headache, you do not have a change in pain with physical activity, and there are no associated sensitivities to light, sounds, or smells.

Doctors believe the underlying cause of migraines is related to changes in the blood flow in certain areas of the brain, with subsequent alterations in the blood vessels in that region. Chemical reactions may lead to swelling and irritation of the blood vessels (thought to contribute to the characteristic “throbbing” quality of a migraine headache).

The specific cause of tension-type headache is unknown. Doctors believed at one time that chronic muscle tension was the underlying factor, but there now appears to be a more complicated combination of factors that are involved.

Certain factors are common migraine triggers, including:

• Foods like red wine, chocolate, peanut butter, dairy products, and citrus fruits.
• Hormonal swings associated with menstrual cycles or pregnancy.
• Weather changes
• Certain smells
• Lack of sleep
• Gluten can be a migraine trigger for people who have true celiac disease. If you are concerned about this issue, eliminate gluten from your diet for a test period and keep a log for a possible trigger.

The cause of tension-type headache tends to be related to stress and associated tightness or tension in the muscles of the neck or scalp.

Although there are no specific tests for migraine headaches, your doctor may order tests to exclude other conditions or problems that are triggering your headaches. This may include blood work or different brain imaging, such as CAT scan or MRI. In rare cases, your doctor may order a spinal tap to exclude causes of more serious, severe headaches.

A doctor who is experienced in treating various headaches can help differentiate the type of headaches that you have. A sinus headache (caused by sinus infection or allergic rhinitis) often mimics some signs and symptoms of migraines.

Monitoring the duration of your headache can provide important information that can help diagnosis the type of headache you are experiencing. Migraine headaches may last a few hours to three days, while tension headaches may last only 30 minutes or linger for up to a week.

• Keep a headache diary to help identify triggers that lead up to the onset of the headache, for example, menstrual cycles for women, hormone treatments, and alcohol intake.
• Keep track of when a headache begins, the severity of the pain, any associated symptoms, how long the headache lasts, and any medications that you have taken.
• If there does not seem to be any clearly identifiable cause for your headaches, maintain a diet diary, and keep track of any foods or drinks that you may have consumed the day before a headache to identify possible triggers.

Treatment of migraines often focus on reversing the inflammatory changes of the blood vessels thought to be the source of the migraine pain.

Triptans are a class of drugs effective at helping reduce inflammation and decrease the swelling of the inflamed vessel, which tends to lead to decreased head pain in a relatively short time. Many of these medications also can reduce the associated nausea, light-, and sound - sensitivity that occur with migraines. Examples of triptans include sumatriptan (Imitrex, and Sumavel DosePro), eletriptan (Relpax), zolmitriptan (Zomig), and rizatriptan (Maxalt). These drugs are available as a pill, nasal spray, or injection.

Botox. If you have chronic migraines (defined as migraine headache occurring more than 4 hours in one day and more than 15 days for 1 consecutive month), Botox® (botulinum toxin) may help you to decrease the frequency and severity of your migraines. This treatment has not been shown to be of benefit in treating other types of frequent headache.Erenumab (Aimovig) is a new class of drug called a calcitonin gene-related peptide receptor (CGRP-R) antagonist approved in 2018 for the preventative treatment of migraine. It is a monthly injection used to prevent migraines.

Some people with frequent migraines find that avoiding eating certain trigger foods can help alleviate some of their headaches. For others, consuming products high in magnesium, riboflavin, and omega-3 fatty acids (spinach, whole grain or enriched breads, almonds, salmon) helps decrease some migraine frequency.

Essential oils are a home remedy used to treat migraines and other types of headaches. Some people benefit by using lavender oil and peppermint oil as aromatherapy. You can even apply the oils to your scalp. Other home remedies include basil oil, feverfew, , buckwheat, and flaxseed. Consult your doctor before using any home remedies.

Migraine headache and tension-type headaches can occur frequently, even daily. If you have a headache for at least 15 days each month, your doctor or other medical healthcare professional may recommend daily medication. These may include:

• Antidepressants
• Anti-seizure medications
• Certain types of muscles relaxants, depending on the underlying headache.
• Botox® injections for people with chronic migraine headache.

Patients who experience migraine headache often will respond extremely well to therapeutic intervention, and their ultimate prognosis (which is good) is no different from patients who experience other types of headache.

Although it may be tempting to treat headaches at home, repeated or recurrent use of medication can lead to a condition known as Medication Overuse Headache, a condition in which headaches occur near daily.

If you are experiencing frequent headache or head pain, it is important to seek appropriate evaluation and treatment. Doctors trained in identifying different types of headaches, for example, internal medicine specialists, neurologists, or allergists, can help diagnose the cause of your headaches.