What is a tension-type headache, and how is it different from migraine?

According to the International Classification of Headache Disorders (ICHD-3), a tension-type headache is usually a pressing or tightening pain on both sides of the head, of mild or moderate intensity, that does not get worse with routine physical activity and does not come with nausea. Migraine is typically one-sided, pulsating, of moderate or severe intensity, worse with routine activity and accompanied by nausea or by sensitivity to light and sound. Only a doctor can make the diagnosis.

Facts checked on · Written by Alfonso Matos, the developer of MyGrain.

What a tension-type headache feels like

The WHO describes tension-type headache as pressure or tightness, often like a band around the head, which may be related to stress or to musculoskeletal problems in the neck. The ICHD-3 criteria describe episodes lasting from 30 minutes to 7 days with at least two of these four features: pain on both sides, a pressing or tightening (non-pulsating) quality, mild or moderate intensity, and no worsening with routine physical activity such as walking or climbing stairs. There is no nausea or vomiting, and at most one of sensitivity to light or sensitivity to sound.

How migraine is different

For migraine without aura, ICHD-3 describes attacks lasting 4 to 72 hours with at least two of these features: pain on one side, a pulsating quality, moderate or severe intensity, and worsening with routine physical activity (or avoiding it because of the pain). During the headache there is nausea or vomiting, or sensitivity to both light and sound.

  • Location: both sides in tension-type headache; often one side in migraine.
  • Quality: pressing or tightening; pulsating in migraine.
  • Intensity: mild or moderate; moderate or severe in migraine.
  • Physical activity: does not make tension-type headache worse; makes migraine worse.
  • Nausea: absent in episodic tension-type headache; common in migraine.

Episodic and chronic

ICHD-3 calls tension-type headache frequent episodic when it occurs on 1 to 14 days a month on average for more than 3 months, and chronic when it occurs on 15 or more days a month for more than 3 months. The WHO notes that episodic tension-type headache is reported by more than 70% of some populations, and that the chronic form is more disabling than the episodic one.

Having both, and why a diary helps

ICHD-3 notes that frequent episodic tension-type headache often coexists with migraine without aura, that both should be identified, preferably with a headache diary, because their treatments differ considerably, and that learning to tell them apart helps avoid medication overuse. In MyGrain you can log each episode with its type, intensity, symptoms and the treatment you took, and take that record to your appointment. MyGrain does not diagnose: the diagnosis is your doctor's.

Frequently asked questions

Is a tension-type headache a kind of migraine?

No. The International Classification of Headache Disorders (ICHD-3) lists them as two different primary headaches: migraine in chapter 1 and tension-type headache in chapter 2.

How long does a tension-type headache last?

ICHD-3 describes episodes from 30 minutes to 7 days. The WHO notes that episodes usually last a few hours but can go on for several days.

Does a tension-type headache cause nausea?

Episodic tension-type headache does not come with nausea or vomiting, according to ICHD-3. In the chronic form there may be mild nausea, but not moderate or severe nausea or vomiting.

Can I have tension-type headaches and migraine at the same time?

Yes. ICHD-3 notes that frequent episodic tension-type headache often coexists with migraine without aura, and recommends a headache diary to identify both.

Sources

Classification criteria and the WHO, re-read on .

Medical disclaimer. MyGrain is a self-tracking diary, not a medical device. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or another qualified health professional with any question about a medical condition.
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