What Are Migraine and Tension Headaches?

Man in exam room talking to healthcare provider.Although there are several types of headaches, migraine and tension headaches affect the most people. When you have a headache, it isn't your brain that's hurting. Your head aches because nerves in the bones, blood vessels, meninges, and muscles of your head are irritated. These irritated nerves send pain signals to the brain, which identifies where you hurt and how bad the pain is.

Talk with your healthcare provider about a treatment plan that may help relieve pain and prevent future headaches.

What causes your headache?

The actual headache process is not yet understood. Only rarely are headaches a sign of a serious medical problem such as a tumor. Headache pain may be caused by abnormal interaction between the brain and the nerves and blood vessels in the head. A previous head injury or concussion, neck pain, environmental stresses, muscle tension, anxiety, depression, fatigue, skipping meals, or certain foods and drinks may trigger headache pain.

Brain scans are rarely needed and only for certain danger sign symptoms. CT scans are associated with potential radiation effects and potential inaccurate false findings.

What is referred pain?

Headache pain can be referred pain, which is pain that has its source in one place but is felt in another. For example, pain behind the eyes may actually be caused by tense muscles in the neck and shoulders. This means that the place that hurts may not be the part of the body that needs treatment.

Is it a migraine?

Migraine is a vascular headache that causes throbbing pain felt on one (most common) or both sides (less common) of the head. You may feel nauseated or vomit. This headache may also be preceded or associated with changes in sight (like seeing spots or flashes of light), ability to speak, or sensation (aura). There are a wide variety of environmental and food-related triggers for migraines. The pain may last for 4 to 72 hours. Afterward, you may feel shaky for a day or so. If this is the first time you experience these symptoms, you should immediately seek medical attention because you could be having a stroke.

Is it a tension headache?

This type of headache is usually a dull ache or a sensation of pressure on both sides of the head. It may be associated with pain or tension in the neck and shoulders. Depression, anxiety, and stress can cause a tension headache. The pain may not have a definite beginning or end. It may come and go, or seem never to go away.

When to call the healthcare provider

Call your healthcare provider for headaches that happen along with any of these symptoms:

  • Sudden, severe headache that is different from your usual headache pain

  • Headache associated with fever

  • Sudden headache associated with stiff neck

  • Slurred speech

  • Recurring headache in children 

  • Ongoing numbness or muscle weakness

  • Loss of vision

  • Pain following a head injury

  • Convulsions, or a change in mental awareness

  • A headache you would call "the worst headache you've ever had"

  • New headaches in a pregnant woman