Most people get headaches from time to time, but not all headaches are the same. The two most common types, tension-type headache and migraine, feel different, have different triggers and respond to different treatments. Knowing which one you have is the first step toward effective relief.
Quick comparison
| Feature | Tension-type headache | Migraine |
|---|---|---|
| Pain location | Both sides, like a band around the head | Often one side, but can be both |
| Pain quality | Pressing or tightening | Throbbing or pulsing |
| Intensity | Mild to moderate | Moderate to severe |
| Effect of activity | Not made worse by routine activity | Worse with walking, climbing stairs or bending |
| Other symptoms | Usually none | Nausea, vomiting, sensitivity to light and sound |
| Duration | 30 minutes to several days | Usually 4 to 72 hours untreated |
| Aura | No | In about a quarter to a third of people with migraine |
What is a tension-type headache?
Tension-type headache is the most common headache. It typically feels like pressure or tightness across the forehead, temples or back of the head and neck. Many people can carry on with daily activities.
Common triggers
- Stress
- Poor posture and muscle tension in the neck and shoulders
- Lack of sleep
- Skipping meals
- Eye strain from screens
What is migraine?
Migraine is a neurological condition, not just a bad headache. Attacks can be disabling and often include more than head pain.
Phases of a migraine attack
Not everyone has every phase.
- Prodrome: hours or a day before, some people notice yawning, food cravings, mood changes or a stiff neck.
- Aura: temporary nervous system symptoms, usually visual, such as flashing lights, zigzag lines or blind spots. Some people have tingling or numbness. Aura usually lasts 5 to 60 minutes.
- Headache: throbbing pain, often on one side, with nausea and sensitivity to light, sound or smells.
- Postdrome: feeling drained, foggy or washed out for a day or so afterwards.
Common migraine triggers
- Hormonal changes, such as around menstrual periods
- Stress, or the let-down after stress
- Changes in sleep
- Skipping meals or dehydration
- Alcohol, particularly red wine
- Too much caffeine or caffeine withdrawal
- Bright or flickering lights, loud noise and strong smells
- Weather changes
Migraine is about three times more common in women than in men and often runs in families.
Treatment for tension-type headache
- Over-the-counter pain relievers, such as ibuprofen, naproxen, aspirin or acetaminophen, usually work well for occasional headaches.
- Self-care: rest, a warm or cold compress, gentle neck stretches, staying hydrated and taking breaks from screens.
- For frequent headaches, a clinician may suggest preventive medicine such as amitriptyline, as well as stress management, physical therapy or cognitive behavioral therapy.
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Treatment for migraine
Acute treatment (to stop an attack)
Treatment works best when taken early in an attack.
- Pain relievers and NSAIDs such as ibuprofen, naproxen or aspirin, sometimes combined with caffeine
- Triptans, such as sumatriptan and rizatriptan, which target migraine pathways
- Gepants, such as ubrogepant and rimegepant, which block the CGRP pathway and can be an option for people who cannot take triptans
- Lasmiditan, another option for people who cannot use triptans
- Anti-nausea medicines
Resting in a dark, quiet room and applying a cold pack can also help.
Preventive treatment
Preventive treatment may be recommended if you have frequent or disabling attacks. Options include:
- Certain blood pressure medicines (such as propranolol), anti-seizure medicines (such as topiramate) and antidepressants (such as amitriptyline)
- CGRP monoclonal antibodies, given as monthly or quarterly injections or infusions
- Rimegepant taken every other day, or atogepant daily
- OnabotulinumtoxinA (Botox) injections for chronic migraine (headache on 15 or more days a month)
Avoid medication overuse headache
Taking pain medicines too often can make headaches more frequent. This is called medication overuse headache. As a general rule, limit simple pain relievers to fewer than 15 days a month, and triptans or combination pain relievers to fewer than 10 days a month. If you need acute medicine more often than this, talk to your clinician about prevention.
Helpful habits
- Keep a headache diary of when headaches start, what you were doing, what you ate and what helped.
- Keep regular sleep and meal times.
- Drink enough water.
- Exercise regularly.
- Manage stress with relaxation techniques, yoga or mindfulness.
- Keep caffeine intake moderate and consistent.
When a headache is an emergency
Call 911 or seek emergency care for:
- A sudden, severe “thunderclap” headache that peaks within a minute, or the worst headache of your life
- Headache with fever, stiff neck, confusion or a rash
- Headache with weakness, numbness, vision loss, trouble speaking or confusion
- Headache after a head injury
- A new headache pattern after age 50
- Headache that wakes you from sleep and is getting steadily worse
The National Institute of Neurological Disorders and Stroke has more information on migraine.
Frequently asked questions
Can you have both types?
Yes. Many people with migraine also get tension-type headaches.
Is a sinus headache really a migraine?
Often, yes. Many people who believe they have recurring sinus headaches actually have migraine, especially when there is no fever or thick nasal discharge.
Can children get migraine?
Yes. In children, attacks may be shorter and stomach pain or vomiting may be more prominent.
The bottom line
Tension-type headaches cause a pressing, band-like pain and usually respond to simple measures. Migraine causes throbbing pain with nausea and sensitivity to light and sound, and benefits from targeted treatment. If headaches are frequent, severe or changing, see a clinician.
This article is for general information and is not a substitute for advice from a qualified healthcare professional.