Migraine vs Tension-Type Headache
Migraine and Tension-Type Headache are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Migraine vs Tension-Type Headache at a glance
- Migraine: Recurrent primary headache disorder with unilateral throbbing pain, photophobia, nausea.
- Tension-Type Headache: Most common primary headache; bilateral pressing/tightening, mild-moderate, no nausea.
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Side-by-side comparison
| Feature | Migraine | Tension-Type Headache |
|---|---|---|
| At a glance | Recurrent primary headache disorder with unilateral throbbing pain, photophobia, nausea. | Most common primary headache; bilateral pressing/tightening, mild-moderate, no nausea. |
| Classic presentation | POUND mnemonic: Pulsatile, One-day duration (4-72 h), Unilateral, Nausea, Disabling — 4 of 5 features highly suggest migraine.; Prodrome (hours-days before): mood changes, food cravings, neck stiffness, yawning, urinary frequency; Aura (~25%): visual (scintillating scotoma, fortification spectra, hemianopia), sensory (paresthesias… | Bilateral, non-throbbing, mild-moderate, without autonomic or migrainous features.; Bilateral 'band-like' pressing or tightening pain; Mild to moderate intensity (does not preclude activities); Duration 30 min to 7 days; NO nausea/vomiting; At most one of photophobia or phonophobia; Not aggravated by routine physical activity (unlike… |
| Workup / key labs | ICHD-3 criteria: ≥5 attacks lasting 4-72 hours, with ≥2 of [unilateral, pulsating, moderate-severe, aggravated by activity] AND ≥1 of [nausea/vomiting, photophobia + phonophobia].; Generally not indicated for typical migraine; ESR/CRP if temporal arteritis suspected (age >50); CBC, BMP if atypical features | ICHD-3: ≥10 episodes lasting 30 min-7 days, with ≥2 of [bilateral, pressing/tightening, mild-moderate, not aggravated by activity] AND no nausea/vomiting AND ≤1 of [photophobia, phonophobia].; Not routinely indicated; ESR/CRP if temporal arteritis suspected (age >50) |
| Imaging | Neuroimaging NOT routinely indicated for typical migraine with normal exam; MRI brain indicated for: red flags (SNOOP: Systemic symptoms/Secondary risk factors, Neurologic signs, Onset sudden/thunderclap, Older age >50 with new headache, Pattern change/Progressive/Positional/Precipitated by Valsalva); Lumbar puncture if SAH or… | Not indicated for typical TTH with normal exam; MRI brain only if red flags (SNOOP — systemic, neurologic, onset, older age, pattern change) |
| First-line treatment | Abortive: NSAIDs (ibuprofen 400-800 mg, naproxen 500 mg) for mild-moderate attacks; Triptan — sumatriptan 50-100 mg PO (also 6 mg SC, 20 mg nasal), rizatriptan 10 mg, eletriptan 40 mg — best taken at headache onset; contraindicated with CAD, uncontrolled HTN, prior stroke, hemiplegic/basilar migraine, ergot use within 24 h; Combination… | NSAIDs — ibuprofen 400-800 mg, naproxen 500 mg — first-line for acute treatment; Acetaminophen 1000 mg — alternative; less effective than NSAIDs; Aspirin 650-1000 mg; Combination analgesics (acetaminophen-aspirin-caffeine) — effective but increase risk of medication overuse headache; Limit acute medications to <2 days/week to prevent… |
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