Tension Headache or Migraine? Why Location Is Only One Clue

Tension headache vs migraine, side by side

These are typical patterns, rather than a list of symptoms everyone must have. The tension-type column describes episodic headaches, which come in separate episodes, rather than chronic or near-daily headache.

The comparison comes from NICE's headache guidance and the International Headache Society's descriptions of migraine without aura and episodic tension-type headache.

The important difference is what surrounds the pain. Two-sided pressure that stays steady as you go about the day tells a different story from two-sided pain that worsens with movement and comes with nausea. A head-location diagram can't show that difference.

Same place, different afternoons

Imagine two past afternoons with pain across both temples. In the first hypothetical example, the ache felt like steady pressure. Walking around the house didn't make it worse, and you finished making lunch.

In the second, moving around made the pain worse. You felt queasy, the kitchen light and an ordinary conversation both felt too much, and you stopped cooking.

The first account resembles the typical episodic tension-type pattern; the second has more migraine features. “Both temples” describes them equally well. What happened during lunch separates them much more clearly.

Movement means what happened during ordinary tasks

Migraine pain can worsen with routine movement, while the typical tension-type pattern allows daily activity without worsening the pain. Think back to activities you were already doing: walking to the kitchen, getting dressed or moving around at work.

Separate how much it hurt from what movement did. “The pressure was uncomfortable, but walking didn't change it” is different from “Moving around made the pain worse, so I stayed still.” The comparison concerns the effect of movement, not how much work you managed to finish.

Use observations from past episodes. Don't climb stairs, exercise or push through pain to test a theory. A new headache starting with exertion is a different situation from movement worsening an existing headache; follow the care guidance above.

Nausea and a harsh-feeling room add useful information

Feeling sick and becoming unusually sensitive to light and sound are common migraine symptoms described by the NHS. You might remember the room feeling too bright, voices becoming hard to tolerate, or queasiness changing what you could do. Mention those details even if you never vomited.

For episodic tension-type headache, the distinction is specific: nausea and vomiting are absent, while sensitivity to light or sound alone can occur. So “I wanted quiet” gives less information than “Both light and sound bothered me, and I felt sick.” The combination is worth keeping in your description.

Nor do you need flashing lights for migraine to be considered. Only some people have aura, the term for certain temporary neurological symptoms associated with migraine. This isn't a guide to deciding whether a new neurological symptom is aura. New trouble speaking, weakness, confusion or loss of vision needs emergency care, even in someone who has had migraine before.

A pressure feeling doesn't explain its cause

“Tension-type” names a headache pattern; it doesn't establish that stress or tight muscles caused it. The International Headache Society says the exact mechanisms aren't known.

If the pain feels like pressure, say pressure. If a stressful week belongs in the history, mention it too. You can give both observations without having to supply a theory connecting them. The same applies to throbbing: it is a useful description, rather than a requirement for every migraine episode.

Bring back three details, then add the timing

The three details worth bringing back are what ordinary movement did, whether you felt sick, and whether light and sound bothered you together. Start with a past episode you remember. Add where it hurt, roughly how long it lasted and how often episodes happen. Mark uncertain details as uncertain.

For example: “The pain was on both sides. Moving around made it worse, I felt sick, and light and sound bothered me. This happened twice last month, and I had to leave what I was doing.” That gives the appointment a clear starting point.

NICE recommends recording frequency, duration, impact, associated symptoms and headache medicines. Tell your clinician what you already use, including occasional medicines, without changing treatment yourself. Ask what further notes would help; you don't need a perfect diary before the visit.

Wondering how to fit your story, medicine list and questions into one appointment? Our doctor visit checklist helps arrange them. If ongoing exhaustion is a separate concern and reassuring tests haven't explained it, our article on fatigue with normal blood tests explores that next question.

For help putting past episodes into words, try the free SageWiz health chat: “My recurring headaches have hurt on both sides, but movement made some worse and I felt sick. Which details should I bring to my clinician?” or “How can I describe the way light and sound bothered me?”

Caveats

This comparison is for adults with recurring headaches. Chronic or near-daily headache needs its own assessment. Episodic tension-type headache and migraine can coexist, so describe different episodes separately. A clinician uses the full history to make a diagnosis and consider other causes; new or changed symptoms still need the care outlined above.

Curious how we research and check our articles? Read How SageWiz Researches and Checks Its Health Articles.

Evidence

The sources here are professional headache classifications, NICE's clinical guideline and patient guidance from the NHS and MedlinePlus. They explain established clinical patterns, rather than reporting a new discovery or treatment trial. NICE covers people aged 12 and over; this article uses its adult guidance.