Migraine is usually a one-sided, throbbing pain that increases with movement; nausea, vomiting and discomfort from light may accompany it. Tension-type headache, by contrast, is described as a feeling of pressure or tightening around the head, and these symptoms are generally absent. The distinction is made through examination.
Headache is a common complaint. The World Health Organization (opens in a new tab) reports that, as of 2021, headache disorders affected approximately 3.1 billion people worldwide (40% of the population). The same source states that in 2021 migraine ranked third in the burden of neurological disease.
Because it is so common, headache can come to be treated as something ordinary. Yet determining the type of pain directly changes the path to be followed.
Comparison table
| Feature | Migraine | Tension-type headache |
|---|---|---|
| The nature of the pain | Throbbing, pounding | A feeling of pressure or tightening (like a band around the head) |
| Site | Usually one-sided | Usually on both sides |
| Duration | 4–72 hours | Variable (may last from minutes to days) |
| Relation to movement | Usually increases | Usually does not change noticeably |
| Nausea, vomiting | May accompany it | Usually absent |
| Discomfort from light and sound | May accompany it | Usually absent |
| Common triggers | Irregular sleep, hunger, the menstrual period, certain foods | Stress, tension in the neck and shoulder muscles |
| Age at onset | Usually begins in adolescence (most frequently seen between the ages of 35 and 45) | Variable |
| Distribution by sex | More common in women | More common in women (by about 1.5 times) |
The World Health Organization (opens in a new tab) states that tension-type headache may be related to stress or to musculoskeletal problems in the neck region. The same body (opens in a new tab) reports that neck pain affects 222 million people worldwide, which is why the two are assessed together.
The distinguishing questions are how long the pain lasts, whether it is one-sided, whether it changes with movement, and whether nausea and sensitivity to light accompany it.
What is asked during the examination?
- The description of the pain. Throbbing or more like pressure? One-sided or on both sides?
- Duration and frequency. How long does an attack last? On how many days a month does the pain occur?
- Accompanying symptoms. Nausea, vomiting, discomfort from light and sound, visual symptoms before the pain.
- Triggers. Sleep routine, skipping meals, the menstrual period, stress, screen time, neck posture.
- The painkillers being used. Which medicine, how often, and for how long?
- Co-existing conditions. Blood pressure, thyroid, sleep disorder, neck problems.
Keeping a pain diary (date, duration, severity, trigger and the medicine used) makes the assessment markedly easier.
In which patients is it assessed differently?
In the situations below, the assessment proceeds differently.
- In patients who are pregnant or breastfeeding (the medicines that can be used are limited, and the plan is made separately)
- In patients over 50 with new-onset headache (a detailed assessment is needed)
- In patients with a history of cancer or of a disease that suppresses the immune system (secondary causes are investigated first)
- In patients whose pain started after a head injury (the assessment is made separately)
- In patients whose blood pressure runs high (a blood pressure assessment is carried out at the same time)
- In patients who use painkillers frequently (medication-overuse headache is assessed separately)
- In patients under 18 years of age (assessment lies within the field of paediatrics; this content has been prepared for adults)
Points to be aware of
Frequent use of painkillers may keep the pain going. The World Health Organization describes medication-overuse headache as the most common secondary headache disorder and reports that it may be seen at rates of up to 5% in some populations. For this reason, how often painkillers are used is asked about separately during the examination.
Do not start a medicine or increase its dose on your own initiative. Which medicine is suitable and how often it may be used are determined by the physician.
The type of the pain may change over time. Both types may be present together in the same person.
Imaging is not needed for every headache. Whether it is needed is determined according to the examination findings.
Results vary from person to person. The triggers and the response are not the same in every patient.
When should you see a physician without delay?
If you notice these symptoms, consult a physician without delay:
- Pain that began after a head injury
- A marked change in the character of the pain
- Headache starting for the first time over 50 years of age
In the event of a very severe headache of sudden onset, headache accompanied by fever and neck stiffness, loss of vision, double vision or disturbance of speech, loss of strength or numbness in an arm or leg, altered consciousness or a seizure, go directly to the emergency department.
Frequently asked questions
Can I tell at home which type it is?
The features in the table may point the way, but the distinction is made through examination. The two types may be present together in the same person and the symptoms may overlap. Keeping a pain diary contributes to the assessment.
Is imaging needed for headache?
Imaging is not needed for every headache. Whether it is needed is determined according to the examination findings, the features of the pain and whether or not there are warning symptoms.
How often is too often to use a painkiller?
No definite answer can be given to this; it varies according to the medicine used and the person. However, regular and frequent use of painkillers may lead to medication-overuse headache. Tell your physician how often you use them.
Does neck pain cause headache?
It could. Tension-type headache may be related to musculoskeletal problems in the neck region. For this reason the neck is also examined during the assessment.
Does high blood pressure cause headache?
High blood pressure often gives no symptoms. However, headache may be seen when the readings are very high. Blood pressure is measured routinely in patients who present with a complaint of headache.
What records should I keep for headache?
The date of the pain, the time it began, how long it lasted, its severity, which side it was on, the accompanying symptoms, your sleep and your meals that day, and the medicine you took and its dose. A few weeks of records provide distinguishing information at the consultation.
Sources
- World Health Organization, Headache disorders fact sheet, 24 October 2025. https://www.who.int/news-room/fact-sheets/detail/headache-disorders (opens in a new tab)
- World Health Organization, Musculoskeletal health fact sheet, 14 July 2022. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions (opens in a new tab)
