Migraine vs Tension-Type Headache: How to Tell the Difference
A clinician's guide to the two most common primary headaches: how migraine and tension-type headache differ in symptoms, triggers and what each responds to.
- •Tension-type headache is pressing, bilateral, mild–moderate, and doesn't stop you doing things.
- •Migraine is throbbing, often one-sided, moderate–severe, and usually comes with nausea or light/sound sensitivity.
- •Many people get both — the difference matters because they respond to different management.
- •Tracking each attack individually is the most reliable way to tell them apart.
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Why the distinction matters
Migraine and tension-type headache are the two most common primary headache disorders, but they respond to very different management strategies. Treating one as the other is a common reason people don't get relief.
Tension-type headache
- Pressing or tightening (non-pulsating) pain, often described as a band around the head.
- Mild to moderate intensity — usually doesn't stop you doing things.
- Bilateral (both sides).
- Not aggravated by routine activity like walking.
- No nausea; light or sound sensitivity is mild if present at all.
Migraine
- Throbbing or pulsating pain, often one-sided.
- Moderate to severe — often stops you doing things.
- Worsened by routine physical activity.
- Nausea, vomiting, or sensitivity to light and sound.
- May include aura — visual disturbances, tingling, or speech changes — before the headache.
Overlap and mixed patterns
Many people experience both. Distinguishing them requires looking at attacks individually rather than averaging across weeks. A diary that captures each attack — duration, character, triggers and what helped — is the most reliable way to see the pattern.
What each tends to respond to
Tension-type headaches often respond to postural awareness, paced activity, neck and shoulder mobility work, and stress regulation. Migraine management combines trigger identification, lifestyle pacing, and where appropriate, medical treatment. Both benefit from consistent sleep, hydration, and avoiding medication overuse.
Key takeaways
- ✓Character, severity, and associated symptoms separate the two.
- ✓Migraine is worsened by routine activity; tension-type is not.
- ✓Aura (visual or sensory changes) points strongly to migraine.
- ✓A per-attack diary beats trying to remember 'the average week'.
Frequently asked questions
Related guides
From general guide to your own pattern
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Medical disclaimer: This article is for educational purposes only and is not a substitute for medical advice. Always consult your GP or specialist for diagnosis and acute care.
On medication: HeadacheRecovery takes a non-pharmacological, tracking-based approach. Where research on medicines is mentioned it is background context only, not a recommendation. Any decision to start, stop or change a medicine belongs with your prescribing clinician.
