Headaches: Tension - Managing Tension-Type Headaches

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Migraines and tension headaches have some similar characteristics, but also some important differences:

Migraine pain is usually throbbing, while tension-type headache pain is usually a steady ache
Migraine pain often affects only one side of the head, while tension-type headache pain typically affects both sides of the head
Migraine headaches, but not tension-type headaches, may be accompanied by nausea or vomiting, sensitivity to light and sound, or aura

Some research suggests that migraine and tension headaches may be related. [For more information, see In-Depth Report #97: Migraine headaches.]

For an accurate diagnosis, the patient should describe the following:

Duration and frequency of headaches
Recent changes in their character
Location of the pain
Type of pain (throbbing or steady pressure)
Intensity of the headache
Associated symptoms, such as visual disturbances or nausea and vomiting. (These are seen most often with migraines.)
Behaviors during a headache. Different behaviors may help distinguish between migraine and tension headaches. People with tension headaches tend to relieve pain by massaging the scalp, temples, or the nape of the neck. People with migraines are more likely to compress the forehead and temples (tying a scarf around the head) or to apply cold to the area. They also tend to isolate themselves, lie down, induce vomiting, and use more pillows than usual. (None of these maneuvers do much good in relieving either headache, unfortunately.)

The patient should also report any other conditions that might be associated with headache, such as any:

Chronic or recent illness and their treatments
Injuries, particularly head or back injuries
Dietary changes
Current medications or recent withdrawal from any drugs, including over-the-counter or natural remedies
History of caffeine, alcohol, or drug abuse
Serious stress, depression, and anxiety

The doctor will also need the patient's general medical and family history, particularly concerning headaches or other neurological diseases.