Tension headache is not aggravated by routine physical activity such as walking or climbing stairs. It is not accompanied by nausea, but occasionally either sound or light sensitivity might be present.
Is it tension headache or migraine?
Sometimes people mistake tension headache for migraine, or vice versa. However, there are a few tell-tale differences that can help you understand which type of headache you have.
| Migraine | Tension headache |
| Moderate to severe pain | Mild to moderate pain |
| Pulsating headache on one side of the head | Dull ache or tightening sensation, usually across the entire head |
| Typically lasts 4-72 hours | Can last between 30 minutes and 7 days |
| Associated with nausea, vomiting, sound & light sensitivity | Unlikely to be accompanied by other symptoms |
| Aura symptoms may be present (may be described as flickering lights, zigzag lines or loss of part of the visual field, usually occurring just before or during the headache) | No aura symptoms |
| Aggravated by physical activity | No aggravation by physical activity |
The misdiagnosis of migraine and tension headache occurs partially because migraine is misrepresented as ‘just a headache’. This stigma affects the diagnosis of both headache disorders. If someone is having a bad tension headache, they might think it is migraine. On the other hand people with migraine tend to downplay their condition, especially if people in their life don’t take it seriously.
It is important to diagnose headache disorders accurately to reduce stigma and help people get the right treatment. If your headache begins to interfere with your day-to-day life, please consult your doctor.
Types of tension headache
Episodic tension headache
Episodic forms of tension headache are the most common causes of headache in the general population (2). It can be infrequent (0-1 headache days per month) or frequent (1-14 days per month).
Most people treat episodic tension headache by themselves using over-the-counter pain medication (e.g. paracetamol, ibuprofen, aspirin). People with higher frequency episodic headache might consult a doctor. If you have headache more than once a week, it can start to affect your personal, professional, and social life.
Chronic tension headache
Chronic tension headache is much less common, affecting about 3% of the general population (2). It evolves from episodic tension headache and is diagnosed when someone has headache on 15 or more days per month.
Chronic tension headache can be highly disabling and people often need to see a doctor to discuss their treatment. Managing this headache type usually involves a combination of lifestyle changes, preventive medication, and non-pharmaceutical treatments.
