VHOSPITAL.CLINIC · Differential Diagnosis
Migraine vs Tension-Type Headache
Clinical comparison — shared symptoms, key differences, distinguishing diagnostic tests, treatment pathways, and when to seek urgent evaluation.
Condition Overview
Condition A
Migraine
Migraine is a neurological disorder characterized by recurrent, severe headaches often accompanied by nausea, vomiting, and sensitivity to light and sound. Attacks can last 4–72 hours and significantly impair daily functioning.
Condition B
Tension-Type Headache
Tension-type headache is the most common headache disorder, causing a dull, pressing, bilateral head pain described as a tight band. Stress, poor posture, and sleep deprivation are common triggers; it responds to simple analgesics.
Shared Symptoms — Why They're Confused
Both conditions present with 3 overlapping symptoms, making clinical differentiation essential.
Key Clinical Differences
Migraine
- Moderate-severe unilateral throbbing pain
- Nausea/vomiting
- Photophobia and phonophobia
- Duration 4–72 hours
- Aggravated by routine physical activity
Tension-Type Headache
- Bilateral band-like pressing/tightening pain
- Mild to moderate severity — not disabling
- No nausea or vomiting
- No aggravation with physical activity
- Most common headache type
Distinguishing Diagnostic Tests
| Test | Migraine | Tension-Type Headache |
|---|---|---|
| Clinical criteria (ICHD-3) | ≥2 of: unilateral, pulsating, moderate-severe, activity aggravation + ≥1 of nausea/photo-phonophobia | ≥2 of: bilateral, pressing, mild-moderate, no activity aggravation + no nausea or photo-phonophobia |
| Neurological examination | Normal between attacks; aura in 30% | Normal; pericranial muscle tenderness on palpation |
| Response to triptans | Responds well to triptans (5-HT1B/1D agonists) | Does not respond to triptans; responds to simple analgesics |
Treatment Approaches
Migraine
- •Triptans (sumatriptan, zolmitriptan)
- •NSAIDs + antiemetics
- •Preventive: propranolol, amitriptyline, CGRP antagonists
Tension-Type Headache
- •Simple analgesics (paracetamol, ibuprofen)
- •Stress management and sleep hygiene
- •Physiotherapy for cervicogenic component
- •Amitriptyline for chronic tension headache
When Doctors Consider Each Diagnosis
🔵 Consider Migraine when:
- →Unilateral throbbing headache with nausea and sensitivity to light/sound, lasting 4–72h
🟢 Consider Tension-Type Headache when:
- →Bilateral band-like headache, mild severity, no nausea, occurs with stress or muscle tension
Explore Each Condition in Detail
Related Clinical Pages
Migraine
Medical References
Content on this page is informed by evidence-based clinical sources including:
- World Health Organization (WHO)Global health guidance and disease classification
- National Health Service (NHS)UK clinical guidelines and patient information
- National Institute for Health and Care Excellence (NICE)Evidence-based clinical practice guidelines
- Centers for Disease Control and Prevention (CDC)US public health data and clinical recommendations
- PubMed – NCBIPeer-reviewed biomedical literature and clinical studies
- Cochrane LibrarySystematic reviews and meta-analyses in evidence-based medicine
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