How can one differentiate between a migraine and a tension headache?

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How can one differentiate between a migraine and a tension headache?

Differentiating between a migraine and a tension headache is important for proper treatment and management. Here’s how to distinguish between the two based on symptoms, triggers, and severity:

1. Pain Location

Tension Headache: The pain is usually generalized or felt on both sides of the head. It often feels like a tight band or pressure around the forehead, back of the head, and neck.
Migraine: Migraine pain is typically one-sided (though it can affect both sides) and is often felt around the temples, behind one eye, or on one side of the head. The pain may shift sides during different migraine attacks.

2. Pain Type

Tension Headache: The pain is often described as a dull, aching sensation. It may feel like tightness or pressure in the head, but it is generally mild to moderate in intensity.
Migraine: Migraine pain is usually throbbing or pulsating and tends to be moderate to severe. It can interfere with daily activities and is often more intense than tension headache pain.

3. Pain Intensity

Tension Headache: The pain is usually mild to moderate. While it may be uncomfortable, it doesn’t typically prevent someone from carrying out daily activities.
Migraine: Migraine pain is moderate to severe and can be disabling. It often requires rest or a quiet, dark environment for relief, as it can interfere significantly with routine tasks.

4. Duration

Tension Headache: Tension headaches can last from 30 minutes to several hours or even a few days, but the intensity typically remains steady.
Migraine: Migraines can last from 4 hours to 72 hours. They often have a distinct start and can worsen as the attack progresses.

5. Associated Symptoms

Tension Headache: Generally, there are no other significant symptoms, though some people may experience mild sensitivity to light or sound.
Migraine: Migraines are often accompanied by additional symptoms such as:
- Nausea and vomiting
- Sensitivity to light (photophobia) and sound (phonophobia)
- Visual disturbances (aura), such as flashing lights, zigzag patterns, or blind spots, which may precede the headache (in some cases).

6. Aura (Specific to Migraine)

Tension Headache: There is no aura associated with tension headaches.
Migraine: Some people experience an aura before or during a migraine attack. An aura can involve visual changes (flashes of light, blind spots), sensory disturbances (numbness or tingling), or speech difficulties.

7. Triggers

Tension Headache: Common triggers include:
- Stress or anxiety
- Poor posture or tension in the neck and shoulders
- Eye strain from long periods of reading or screen use
- Fatigue
Migraine: Migraine triggers are more varied and can include:
- Hormonal changes (e.g., menstruation)
- Certain foods (like aged cheese, alcohol, caffeine, or chocolate)
- Sensory stimuli (bright lights, loud sounds, or strong smells)
- Weather changes
- Lack of sleep or disrupted sleep patterns
- Stress

8. Response to Activity

Tension Headache: Physical activity does not typically worsen a tension headache. In fact, some mild physical movement or relaxation exercises may help alleviate the pain.
Migraine: Physical activity often worsens the pain. Simple movements like walking, climbing stairs, or bending over can intensify the throbbing sensation of a migraine.

9. Response to Medication

Tension Headache: Over-the-counter pain relievers (such as ibuprofen, aspirin, or acetaminophen) usually help relieve tension headaches fairly quickly.
Migraine: Migraines may require specific medications, such as triptans or prescription drugs. Over-the-counter pain relievers might not be as effective for severe migraine attacks.

10. Frequency

Tension Headache: Tension headaches are more common and can occur frequently, sometimes on a daily or weekly basis. They tend to be more episodic but can become chronic if persistent.
Migraine: Migraines are typically less frequent but more intense. Some people experience migraines a few times a month, while others may have them more frequently, especially if they suffer from chronic migraines.