What’s the Difference Between a Tension Headache and a Migraine?

Tension-type headache is typically mild to moderate. It often feels like pressure, tightening or a band around the head, is frequently felt on both sides, and generally is not worsened by routine physical activity such as walking or climbing stairs. Nausea and vomiting are generally not features of tension-type headache.

Migraine is different. Migraine is a neurological disorder, not simply a severe headache. Attacks are often moderate to severe, may be throbbing or pulsating, and can worsen with activity. Migraine may be associated with nausea and with sensitivity to light, sound or smells, and some people also experience migraine aura — temporary neurological symptoms such as visual changes, tingling or speech difficulty that can come before or during an attack.

Symptoms can overlap, and some people experience both types of headache at different times. For that reason, headache diagnosis depends on the overall pattern — how often headaches occur, how long they last, what the pain is like and what accompanies it — rather than on one symptom alone.

Related patterns can also be mistaken for migraine, including cluster headache, which causes short, extremely severe one-sided attacks. Many people also ask whether migraine can cause a stroke.

A neurological evaluation is often helpful when headaches are frequent or disabling, when the pattern is changing, when initial treatment is not working, or when acute headache medications are being used often enough to risk rebound headache from overuse. A headache and migraine evaluation reviews the headache history and examination, considers whether testing is needed, and builds an individualized plan. Treatment recommendations are made during an appointment, not through this website.