differentiating migraine and tension headache

Last reviewed 05/2021

    The main challenges to the primary care physician are:

      • to identify those who have sinister or secondary headache
      • to differentiate migraine from other most common headache types:
        • tension headaches (the most common form of primary headache)
        • cluster headaches (1)


      Migraine Tension-type headache
    Pain features of acute attacks

    throbbing, unilateral head pain

    worsening of pain with movement

    boring or squashing, bilateral head pain

    no effect of head movement

    Associated features

    nausea and vomiting may occur

    phonophobia or photophobia may be associated

    Trigger factors

    altered sleep patterns (too little or too much sleep may precipitate migraine)


    skipping meals

    changes in stress level - may be too much or too little relaxation

    excess of afferent stimuli e.g. bright lights

    changes in the weather may precipitate migraine attacks


    chemical trigger e.g. delayed headache after glyceryl trinitrate or alcohol

    psychological stress


    • migraine is therefore a head pain head pain with associated features (contrasting with tension-type headache which is featureless head pain)
    • migraine is often associated with onset after confrontation to particular triggers