"I've got a migraine." We all say it, often for an ordinary headache. Medically, though, a migraine and a tension headache are two distinct things, and they are not eased in the same way.
Knowing which one you have changes, concretely, what you should do in the next hour.
Tension headache: the most common
By far the most frequent type. Its typical features:
- A pressing pain, like a tight band around the skull
- On both sides of the head, not one
- Mild to moderate intensity: annoying, but you keep functioning
- Not worsened by exertion: climbing stairs changes nothing
- Often accompanied by tightness in the neck, shoulders and jaw
- Usually no nausea
It typically appears at the end of the day, after long hours of concentration, poor posture or sustained stress.
Migraine: less common, far more disabling
Migraine follows precise criteria set by the International Headache Society. An untreated attack lasts 4 to 72 hours and generally involves:
- A throbbing pain, beating in time with the pulse
- Often on one side only
- Moderate to severe intensity: it prevents normal activity
- Worsened by physical effort, even minimal
- Accompanied by nausea, sometimes vomiting
- With marked sensitivity to light and sound — a highly indicative sign
Around one migraine sufferer in three experiences an aura: visual disturbances (spots of light, zigzag lines, a blind area), sometimes tingling or difficulty finding words, appearing 20 to 60 minutes before the pain.
Side by side
| Criterion | Tension headache | Migraine |
|---|---|---|
| Type of pain | Pressing, band-like | Throbbing, pulsing |
| Location | Both sides | Often one side |
| Intensity | Mild to moderate | Moderate to severe |
| Physical effort | No effect | Clearly worsens it |
| Nausea | Rare | Frequent |
| Light and sound | Little bother | Poorly tolerated |
| Duration | 30 min to several days | 4 to 72 hours |
| Activity | You carry on | You have to stop |
Why the distinction matters in practice
Because what helps is not the same.
For a tension headache, the origin is often muscular. Heat on the neck and shoulders, gentle stretching, a break away from the screen and a change of posture act on the cause.
For a migraine, the useful reflex is the opposite: withdraw into darkness and quiet, and apply cold rather than heat. Heat is generally poorly tolerated during a migraine attack.
Applying heat to a migraine, or stretching vigorously when exertion worsens the pain, amounts to using the wrong remedy.
Signs that call for urgent medical attention
Some headaches belong to neither category and need urgent medical assessment. Call emergency services or go to the emergency department if the headache:
- Comes on suddenly and peaks in under a minute (known as a thunderclap headache)
- Comes with fever and a stiff neck
- Comes with difficulty speaking, seeing, moving or feeling on one side of the body
- Follows a blow to the head
- Comes with confusion, unusual drowsiness or loss of consciousness
- Is unlike anything you have experienced, or worsens steadily over several days
Also see your doctor, without urgency but without delay, if your headaches become more frequent, if you take painkillers on more than two days a week, or if a first severe headache appears after the age of 50.
What this article is not
A guide, not a diagnosis. Only a healthcare professional can diagnose, and the two types frequently coexist in the same person. If headaches weigh on your daily life, speak to your doctor: effective preventive treatments exist.
ThéraMask™ makes a reusable gel mask, usable warm or cold. It is a comfort and relaxation accessory, not a medical device, and it treats no condition.