Migraines vs. Tension Headaches: Knowing the Difference

Tension headaches are the most common type of primary headache, which means the condition is not caused by an injury or other underlying disorder.

Tension headaches also don’t typically cause nausea, vomiting, stomach pain, weakness or numbness, which can occur with severe migraines or other conditions. Although some people experience sensitivity to light or sound with tension headaches, these symptoms are not as common as they are with migraines.

“The two main types of headaches that make up 90 percent of these conditions are tension headaches and migraines,” says Felipe De Los Rios, M.D., medical director of the Stroke Program at Baptist Health Neuroscience Center. “Migraines can be from moderate to severe in intensity and can be accompanied by other issues, such as nausea, vomiting or high sensitivity to light or noise.”

Episodic tension headaches can last from 30 minutes to a week and happen less than 15 days a month for at least three months. Tension headaches are considered chronic if they occur more than half the time (more than 15 days per month) in a three-month time frame. Many people who experience chronic tension headaches have pain constantly on both sides of the head and their scalps can feel tender. The pain from chronic tension headaches are usually more intense.

When to See A Doctor
What type of headache requires medical attention? See a doctor if headaches are new and persistent, worsen over time or are accompanied by fever and other body pains. Also seek medical treatment if tension headaches disrupt your life or if you need to take medication for your headaches more than twice a week.

“Other signs that can be alarming are headaches that occur when someone changes position,” says Dr. De Los Rios. “For example, you may get a headache when you lay down, but not when you’re upright.”

Migraines occur less often than tension-type headaches, but they can be much more severe and debilitating. They are six times more common in women than men.

Migraines are commonly diagnosed as chronic if they occur over at least 15 days per month for more than 3 months. Although a migraine can hit without warning, it is often set off by a trigger. The triggers that set off a migraine vary, but a migraine sufferer usually remains sensitive to the same triggers. Those triggers can include certain odors, fasting, changing weather, lack of sleep, fatigue, stress, loud noises, wine, cheese and other foods.

When to Seek Emergency Help
If a headache doesn’t seem routine at all and comes on suddenly and overwhelmingly, then you may need to call 911. Unruptured brain aneurysms are often asymptomatic. These aneurysms are typically small in size, usually less than one half inch in diameter. However, large unruptured aneurysms can occasionally press on the brain or nearby nerves.

Any individual experiencing some or all of the following symptoms, regardless of age, should undergo immediate and careful evaluation by a physician.

• New severe, worsening or persistent headache.
• Sudden onset of very severe headache over a few minutes.
• Confusion.
• Headaches that are occurring more and more frequently.
• Headache that worsens with changes in head position (sitting up or lying down).
• Headache that wakes you up from sleep.
• If the headache is associated with nausea and vomiting upon awakening.
• Headache worsened by bearing down, coughing, sneezing, or with sexual-activity systemic symptoms.
• If there is blurred or double vision.
• If the headache is associated with other symptoms in the body, such as weakness,  numbness, changes in how the person speaks, or other body pains.

“Unruptured aneurysms can occasionally press on the brain or the nerves stemming out of the brain and can result in various symptoms, including a localized persistent headache,” explains Dr. De Los Rios. “A person may dismiss this as a normal headache. But the brain aneurysm can rupture days later and cause sudden symptoms, including a severe headache that usually peaks as a worse headache of life within a minute of the onset. This requires an immediate trip to the emergency room.”