Tension Headache vs. Migraine

Medically Reviewed by Shruthi N, MD on August 27, 2024
Written by Marisa Cohen
7 min read

Whether you've had headaches for years or you started getting them recently, it's important to know what type of headache you're dealing with. That way, you can get the right treatment.

A tension headache is the most common type of headache. Up to 78% of Americans will get them at some point. You might have them every once in a while, and they may disappear within a few hours. Or they may happen more often and last all day. They can be uncomfortable and distracting but usually aren't serious enough to keep you from doing your everyday activities.

Migraine headaches aren't as common. About 15% of adults in the U.S. get them. But they can be much more painful and disruptive. They usually last between 4 and 72 hours.

The kind of symptoms you get, how long they last, and the intensity of your head pain can be very different for tension headache vs. migraine.

What are the symptoms of a tension headache?

Tension headache symptoms include:

  • You feel pain on both sides of your head.
  • The pain isn't very intense.
  • You have a feeling of tight pressure rather than throbbing. It might feel like your head is being squeezed in a vice or like there's pressure all the way around it. You may also feel soreness in your temples and tightness in your neck and shoulder muscles.

Migraine symptoms

You're more likely to have a migraine headache if:

  • You have moderate to serious throbbing pain that may be worse on one side of your head.
  • The pain gets worse the more you move around. Lying down may help.
  • You have pain around your eyes or temples.
  • Light, sounds, and smells hurt or make you feel uncomfortable.
  • You're nauseous.
  • You see things such as wavy lines, dots, or flashing lights. About 1 in 5 people with a migraine have this.
  • Your arm or face tingles just before your headache starts.

Tension headaches are often brought on by stress, worry, or being tired. This causes the muscles of your scalp, neck, and jaw to physically tighten, and that leads to pain. In fact, they're sometimes called stress headaches.

Other things that can cause them include:

  • Holding your head in the same position for too long, such as while working at a computer
  • A cold, flu, or other illness
  • Eye strain
  • Drinking alcohol
  • Too much or too little caffeine
  • Clenching or grinding your teeth

The exact cause of migraine headaches is unclear. Both your genes and your environment are thought to play roles, though. You get a migraine headache when changes in nerves within your blood vessels send signals that increase inflammatory chemicals in your brain. Migraine headaches can be brought on by triggers such as sleep loss, changing hormone levels, or bright lights.

Tension headache treatments

Self-care and over-the-counter (OTC) medications are enough to treat most tension headaches.

OTC painkillers.If you get tension headaches occasionally, you can treat them with over-the-counter drugs such as:

  • Aspirin (for adults only because of the chance of Reye's syndrome in children and teens) 
  • Acetaminophen
  • Ibuprofen
  • Naproxen

Medicines with caffeine. Caffeine also may help. Many OTC headache medicines include it as an ingredient.

Prescription medications. If you have chronic (long-term) tension headaches that don't get better with OTC medications, see your doctor. Sometimes, doctors prescribe antidepressants to treat these headaches. You don't have to have depression or anxiety for these meds to help your pain.

Migraine treatments

If certain things trigger your migraine attacks, avoiding these things is the first step in getting relief. It may help to keep a headache diary so you can track possible triggers such as:

  • What you eat and drink
  • How much you sleep
  • Activities you do
  • Weather changes

Abortive medications. You may be able to stop a migraine attack once it's started with headache drugs called "abortive medications." You take these as soon as you feel a migraine headache coming on. Drugstores carry OTC medications specifically for migraine headaches.

Preventive medications. If other treatments don't work and you have more than four migraine headache days a month, your doctor may suggest preventive medicines. You take these regularly to make your headaches less frequent and less intense. They include seizure medicines, blood pressure medicines (such as beta-blockers and calcium channel blockers), and some antidepressants.

CGRP inhibitors. This is a newer class of preventive medicine that your doctor may recommend if other medicines don't help.

Migraine devices. Your doctor might also prescribe a medical device to help you feel better. These are some of the devices that may help prevent or treat migraine:

  • Cefaly, a headband-like device that stimulates a nerve on the forehead linked to migraine. 
  • GammaCore, a handheld gadget you can place on the vagus nerve in your neck. It interrupts nerve signals linked to migraine.
  • SpringTMS (transcranial magnetic stimulator), a device you hold against the back of your head. It gives off a pulse of magnetic energy into part of the brain.

A smartphone-controlled wearable device called Nerivio is also available.

Home remedies for tension headaches

Aside from medication, some things you can do at home to ease tension headaches include:

  • Get some rest.
  • Put an ice pack or hot pack on your head and neck, or take a hot or cool shower.
  • Massage your scalp, temples, neck, and shoulders.
  • Do some gentle neck-stretching exercises. 
  • Practice relaxation techniques such as deep breathing or mindfulness medication.

Some people find that acupuncture, in which a trained practitioner inserts small needles into certain points on your body, helps ease tension headaches.

Home remedies for migraines

Some of the same things that work for tension headaches may help reduce migraine pain, though they probably won't stop it entirely. These include:

  • Hot or cold compresses
  • Gentle scalp massage
  • Resting in a dark, quiet place

Drinking a beverage with a small amount of caffeine or just hydrating yourself with water might help, too. If you have nausea, you might try drinking some ginger tea or eating a little candied ginger.

 Some alternative treatments that may help with migraine symptoms are:

If you feel like you're getting a mix of migraine and tension-type headaches, and you get them often, you might have a condition called chronic or transformed migraine. This is when you get headaches 15 or more days a month, and on at least 8 of those days, it feels like you're having a migraine attack.

People with this condition usually start getting occasional migraine attacks in their teens or 20s and then start having headaches more often — daily even. As the headaches become more frequent, the pain often becomes less intense.

Along with pain, you may also have migraine symptoms such as nausea and sensitivity to light or sound. But these usually become less frequent and intense over time, too.

Chronic migraine causes

A variety of things can make you more likely to get chronic migraine. Research shows that almost 80% of people with the condition took pain-relief drugs for their headache symptoms too often. Other things that can raise your odds of chronic migraine are:

  • Having more than one migraine attack a week
  • Getting migraine headaches for a long time
  • Obesity
  • Asthma
  • Snoring
  • Lots of stress in your life
  • Being a woman (or assigned as female at birth)
  • Having less education, income, and job opportunities
  • A head or neck injury

Chronic migraine treatment

If you think you might have chronic migraine, talk to your doctor or headache specialist. They may prescribe preventive medicines to help you get fewer headaches, like:

  • Onabotulinum toxin A (Botox)
  • Certain classes of antidepressants
  • Anti-seizure drugs
  • Certain classes of blood pressure meds

Your doctor may tell you to cut back on any pain-relief drugs you've been taking. They might also talk to you about making healthy lifestyle changes, such as:

  • Getting enough sleep
  • Improving your diet
  • Exercising regularly

Lots of people with chronic migraine also have symptoms of depression and anxiety. Boosting your mental health might be part of your treatment plan.

Tension headaches cause feelings of pressure and tightness and usually aren't painful enough to keep you from your everyday activities. Migraine headache pain tends to be one-sided, throbbing, and more intense. Migraine also comes with other symptoms such as nausea and sensitivity to light. Lifestyle changes, medication, and self-care may help ease either type of headache.

What are the main differences between migraines and tension headaches?

Some of the main differences include:

  • A tension headache feels like tightness or pressure on both sides of your head.
  • Migraine pain tends to be throbbing, and you may feel it more on one side of your head.
  • Migraine includes other symptoms such as nausea, sensitivity to light, and sometimes sensory disturbances like seeing flashing lights.
  • Migraine pain gets worse when you move around.

How can you identify tension headache vs. migraine?

The character and location of your head pain, and whether or not you have other symptoms, can help you identify whether you have tension headache vs. migraine. You'll probably still be able to do your normal daily activities with a tension headache, while a migraine attack is more disruptive. It's possible to have a tension headache and a migraine headache at the same time.

What are the common treatments for migraine and tension headaches?

Common treatments for tension headaches include:

  • Rest
  • Hot or cold packs
  • Over-the-counter pain relievers

Common treatments for migraine include:

  • Over-the-counter pain relievers for milder headaches
  • Prescription medications that stop a headache once it's started
  • Prescription medications that prevent migraine attacks

Can lifestyle changes help in managing migraine and tension headaches?

Healthy lifestyle habits can help prevent both migraine and tension headaches. They include:

  • A regular sleep schedule
  • A healthy diet that avoids foods or drinks that trigger your headaches
  • Regular exercise
  • Stress management

How to cure stress headaches

Many tension headaches respond to over-the-counter pain relievers. Other ways to get relief include:

  • Gentle massage
  • Hot or cold compresses
  • Neck stretches

Relaxation techniques such as deep breathing or mindfulness medication may help both prevent and stop tension headaches.

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