differentiating migraine and tension headache

Last reviewed 01/2023

The main challenges to the primary care physician are:

• to identify those who have sinister or secondary headache
• to differentiate migraine from other most common headache types:
  • tension headaches (the most common form of primary headache)
  • cluster headaches (1)

 

	Migraine	Tension-type headache
Pain features of acute attacks	throbbing, unilateral head pain worsening of pain with movement	boring or squashing, bilateral head pain no effect of head movement
Associated features	nausea and vomiting may occur phonophobia or photophobia may be associated	none
Trigger factors	altered sleep patterns (too little or too much sleep may precipitate migraine) overexertion skipping meals changes in stress level - may be too much or too little relaxation excess of afferent stimuli e.g. bright lights changes in the weather may precipitate migraine attacks menstruation chemical trigger e.g. delayed headache after glyceryl trinitrate or alcohol	psychological stress

Therefore:

• migraine is therefore a head pain head pain with associated features (contrasting with tension-type headache which is featureless head pain)
• migraine is often associated with onset after confrontation to particular triggers

Reference:

• (1) Peter J Goadsby. Recent advances in the diagnosis and management of migraine. BMJ  2006;332:25-29