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Migraine (comparison with tension headache)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Comparison of migraine and tension headache


tension headache

often unilateral

generally bilateral

pain often described as 'throbbing'

pain often described as 'tight band'

possible associated features include nausea, vomiting, phonophobia, photophobia, may be neurological features e.g. hemiplegic migraine

generally no associated features

trigger factors include. specific foods such as cheese, hormonal, alchohol, stress

precipitating factors include exposure to environmental factors, psychological stress

responds to specific migraine therapy

non-specific response to migraine therapy

NICE have suggested comparative features of migraine, tension headache and cluster headache in young people and adults (1):


Headache feature

Tension-type headache

Migraine (with or without aura)

Cluster Headache

Location of Pain

  • Headache pain can be felt in the head, face or neck


Bilateral or Unilateral

Unilateral (around the eye, above the eye and along the side of the head/face)

Quality of Pain

Pressing/tightening (nonpulsating)

Pulsating (throbbing or banging in young people aged 12-17 years)

Variable (can be sharp, boring, burning, throbbing or tightening)

Intensity of Pain

Mild or moderate

Moderate or severe

Severe or very severe

How does headache affect activities

Not aggravated by routine activities of daily living

Aggravated by, or causes avoidance of, routine activities of daily living

Restlessness or agitation

Other symptoms


Unusual sensitivity to light and/or sound or nausea and/or vomiting


Symptoms can occur with or without headache and:

  • are fully reversible
  • develop over at least 5 minutes
  • last 5-60 minutes

Typical aura symptoms include visual symptoms such as flickering lights, spots or lines and/or partial loss of vision; sensory symptoms such as numbness and/or pins and needles; and/or speech

On the same side as the headache:

  • red and/or watery eye
  • nasal congestion and/or runny nose
  • swollen eyelid
  • forehead and facial sweating
  • constricted pupil and/or drooping eyelid

Duration of headache

30 minutes-continuous

4-72 hours in adults

1-72 hours in young people aged 12-17 years

15-180 minutes

Frequency of headache

< 15 days per month

  • Episodic tension type headache

>= 15 days per month for more than 3 months

  • Chronic tension-type headache


< 15 days per month

  • Episodic migraine (with or without aura)

>= 15 days per month for more than 3 months

  • Chronic migraine 6 (with or without aura)

1 every other day to 8 per day (the frequency of recurrent headaches during a cluster headache bout), with remission (pain-free period between cluster headache bouts)> 1 month

  • Episodic cluster headache

1 every other day to 8 per day, with a continuous remission <1 month in a 12-month period

  • Chronic cluster headache



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