Tension headaches are common. Over 70% of the population will experience a tension headache in their lifetime. (1) Migraines are also common but less so, with approximately 1 in 7 people experiencing migraine at some point. (2) That’s around one billion people. However these two conditions are often confused with each other. Some people think they have a bad headache and they really are having a migraine. Others are having a headache and falsely claim it to be a migraine.
Why is there so much confusion?
A few reasons:
50% of those who experience migraine haven’t been diagnosed by a medical professional. (3)
This is the group most likely to believe they are experiencing bad headaches. The sad reality is that they are most likely suffering excessively because they are undertreating or treating the wrong condition.
Migraine has a wide range of severity.
Like autism, migraine isn’t the same for each person. There is a broad spectrum among those who experience it. On one end, some people experience vertigo or dizziness or visual distortions with no associated head pain. These are called Vestibular Migraines and Aura without Migraine, respectively.
On the other side of the scale are crippling migraine attacks called Hemiplegic migraines where individuals experience stroke like symptoms. They can lose function of entire sections of their body. Some people are not able to move or walk. Debilitating pain is also present. Each migraineur experiences their condition differently.
A painful headache is mistaken for migraine.
Another reason for the confusion is that many of those with tension headaches haven’t been to a doctor, they don’t really know what a migraine is and think because their headache is “bad” it must be a migraine.
Without diagnoses from a health professional to confirm their actual condition, this only spreads more confusion.
Migraines are not well understood.
If you ask someone if they have heard of migraines, almost everyone you speak to you will say yes. Then ask them what a migraine is and very few can give you an accurate answer. The vast majority will say ”A bad headache?”. If you were to ask them what symptoms distinguish their migraine from a tension headache very few offer anything but pain severity.
The World Health Organisation has confirmed this issue on a global scale and reported that migraines are under-diagnosed, undertreated and poorly managed. (1)
You can’t see migraines or headaches.
Very few signs of migraine are visible to the untrained eye. You may notice the blood drain from an individuals face, vomiting or a drooping eye. But often there are no physical signs. So the only way to confirm a migraine is by relying on information from the individual.
Some individuals seek attention or sympathy.
There are people who cry wolf. They may well be experiencing a tension headache with moderate pain but they falsely self-diagnose themselves with migraine when a migraine is not present.
These are just a few reasons for the widespread confusion. You’ve probably heard someone say “I’ve got the worst headache. It’s a migraine.“
How do you know when someone is telling the truth?
If you’re facing this question yourself with a family member, friend or employee, the question to ask is “have you seen a doctor?” If someone has migraine, they should be getting treatment from a medical professional. Migraine is not like tension headaches in that you can easily manage them by yourself or with basic treatments.
Any serious migraineur will have a treatment plan in place with their doctor with the aim of reducing their attacks. If the individual hasn’t seen a doctor then the claims cannot be confirmed until this has occurred.
Very few migraineurs cry wolf
If the individual refuses to see a doctor to be diagnosed then there is a greater chance that they’re exaggerating. Most migraineurs I know will never lie purposely about having a migraine. Many are warriors who fight endlessly against their condition and work twice as hard to appear normal.
Tension headache sufferers on the other hand tend to throw the ‘M-word’ around.
It’s all too easy to label a bad headache a migraine. If they had a cold or flu they wouldn’t say they have pneumonia. Why? Because it’s easy to disprove. Migraine are harder to disprove but without a doctor’s diagnosis they are treated with skepticism.
Sometimes the skepticism may not end even with a doctors diagnosis. Many migraineurs are treated with suspicion, discrimination and stigma. Often it comes from those close friends, family and employers who don’t understand it. They’ve never experienced a migraine and may not even believe in the condition. Click here for a list of some of the most common insults to migraineurs that often come from those closest to us.
The stigma surrounding migraine for diagnosed migraineurs is a real problem. Chronic migraineurs endure more stigma than epilepsy. (4) They are also several times more likely to suffer depression and anxiety as a result of their condition.
Unfortunately those who exaggerate and call their tension headaches a migraine are typically the loudest and most vocal. They drown out the legitimate migraineurs and help perpetuate the stigma against migraineurs. Migraineurs are often the opposite. They know firsthand what’s it’s like to be judged and debilitated by actual migraines. They are quiet, polite, compassionate and considerate of others.
It’s a destructive cycle of ignorance, suspicion and stigma. The only way to solve it is with greater awareness and understanding of migraine. To help increase your understanding below are the differences between migraine and tension headache:
How is a migraine different to the common tension headache?
1) Migraine tends to be one-sided. A tension headache is usually both sides.
2) Migraine tends be throbbing or pulsating quality versus pressure from a tension headache.
3) Migraine gets worse with activity or movement, tension doesn’t.
4) Migraine is always associated with another symptom like nausea, vomiting, sensitivity to light, sound and visual disruptions (aura).
To be diagnosed with migraine, there is at least one of the following symptoms: nausea, vomiting, sensitivity to light or noise.
Migraineurs also experience a long list of other symptoms including:
- Aura – this is a term used to describe the visual disturbances that can occur during migraines. These can include dots, coloured spots, sparkles, stars, flashing lights, tunnel vision, zig zag lines, blind spots and even temporary blindness.
- Sensitivity to odours and/or touch.
- Difficulty concentrating, poor articulation, cognitive impairment and confusion.
- Stiff neck or shoulders.
- Pins and needles, tingling or numbness.
- Dizziness or vertigo.
5) Migraine Pain is usually moderate to severe pain versus tension headaches which are mild to moderate pain.
During a migraine attack over 90% of migraineurs cannot function normally. (4) Over half of those with migraine experience severe impairment or require bed rest. (5)
6) Migraine doesn’t respond to many over the counter treatments.
Paracetamol/Acetaminophen (Panadol, Tylenol) and Ibuprofen (Nurofen, Advil) are some of the most common treatments for headaches. They can be effective for some migraineurs, but for many they do nothing to ease the pain.
7) The duration for migraine and tension headaches differ.
To classify a migraine, attacks will last between 4 -72 hours without treatment. Tension headaches on the other hand can last a little as 30 mins but extend to 7 days. (7)
Migraines are also known to include several phases including the prodrome, aura, headache and postdrome.
Prodrome is the early warning phase where changes to the body that signal a migraine may be on it’s way. It may occur days or hours before the actual attack.
Aura refers visual disturbances described above in the symptoms section. Headache is the pain from the migraine and postdrome occurs once the headache has passed. Even after the pain has dissipated, migraineurs may feel a wary haze afterwards, like a migraine-hangover with changes to mood and mental cognition before they recover from the attack. (8)
8) Migraines are a neurological disease.
Whilst not contagious from person- to- person, migraines are a neurological disorder for which there is no permanent cure. The World Health Organisation (WHO) ranks migraine in the top 20 diseases world-wide causing disability. (9) WHO states that a severe migraine attack is one of the most disabling conditions, comparable to quadriplegia and dementia. (9)
9) Chronic migraineurs endure more stigma than epilepsy.
Recent findings have shown that chronic migraineurs experience more stigma than epilepsy and those with episodic migraine. (10) The research reports that victims of stigma “experience stereotyping, devaluation and discrimination”. Aside from the disease itself, stigma has a significant impact on quality of life, behaviour and life opportunities. Interestingly, the ability to work was the strongest predictor of stigma for the individual. (10)
It’s time for a change
No one who experiences migraines asked for this disease. Many suffer with this condition and struggle to maintain a normal life despite of it. As shown above, stigma in addition to this condition only makes things worse for the individual.
According to the Centre of Disease Control (CDC) in the US, 1 in 2 adults have at least one chronic health condition. (11) Chronic illness is extremely common. Now that you are aware of how migraines are different to tension headaches, hopefully you’ll have a little more empathy rather than stereotyping or discrimination. After all, with 1 in 2 adults experiencing a chronic condition, one day you might find yourself on the other side of the table.
Let me know if you agree or disagree in the comments below.
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(1) World Health Organisation. Lifting the Burden. ‘Atlas of headache disorders and resources in the world 2011.’ WHO Press. 2011.
(2) Stovner, LJ. Andree, C. ‘Prevalence of Headache in Europe: a Review for the Eurolight project’. The Journal of Headache & Pain. Aug, 2010, Vol 11. Issue 4, pp 289-299.
(3) Steiner et al. ‘The Prevalence And Disability Burden Of Adult Migraine In England And Their Relationships To Age, Gender And Ethnicity’. Cephalalgia, Sept 2003.
(4) Young WB, Park JE, Tian IX, Kempner J (2013) ‘The Stigma of Migraine.’ PLoS ONE 8(1): e54074. doi:10.1371/journal.pone.0054074
(5) Lipton, RB, Stewart, WF, Diamond, S., Diamond, M. L., & Reed, M. ‘Prevalence and burden of migraine in the United States: data from the American Migraine Study II.’ Headache: The Journal of Head and Face Pain, 2001. 41(7), 646-657.
(6) Lipton, RB, & Bigal, ME. ‘Migraine: epidemiology, impact, and risk factors for progression.’ Headache: The Journal of Head and Face Pain, 2005. 45(s1), S3-S13.
(7) Headache Classification Committee of the International Headache Society. ‘The International Classification of Headache Disorders, 3rd edition (beta version).’ Cephalalgia. July 2013 vol. 33 no. 9 629-808.
(8) Blau, J. ‘Migraine postdromes: symptoms after attacks.’ Cephalalgia, 11, 1991: 228–231. doi: 10.1046/j.1468-2982.1991.1105229.x
(9) World Health Organization. The World Health Report 2001, WHO: Geneva, 2001, pp. 19–45.
(10) Young WB, Park JE, Tian IX, Kempner J (2013) ‘The Stigma of Migraine.’ PLoS ONE 8(1): e54074. doi:10.1371/journal.pone.0054074
(11) Ward BW, Schiller JS, Goodman RA. ‘Multiple chronic conditions among US adults: a 2012 update’. Prev Chronic Dis. 2014;11:130389.