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Differentiating migraine and tension headache

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

 

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

none

Trigger factors

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

overexertion

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

menstruation

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

psychological stress

Therefore:

  • 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

 

Reference:

 


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