Migraine vs Tension Type Headache: How They Differ

If you are weighing migraine vs tension type headache, the honest short version is that they are separated by the character of the pain and by what travels with it, not by how much it hurts on a given day. A tension type headache tends to press on both sides like a band, sits at mild to moderate intensity, and does not get worse when you climb the stairs. A migraine more often pulses, sits at moderate to severe, worsens with ordinary activity, and arrives with nausea or with a strong dislike of both light and sound. The two also blur together far more than most articles admit, and sorting them out is a clinician's job rather than a quiz you take at the kitchen table.

Both are extremely common. The World Health Organization notes that episodic tension type headache has been reported by more than 70 percent of some populations (WHO, 2025), which is part of why so many people assume every headache they get is the tension kind.

The features clinicians actually use

Headache specialists work from the International Headache Society criteria, and the useful thing about them is that no single feature decides anything. A tension type headache is described as bilateral, pressing or tightening rather than pulsating, mild to moderate in intensity, and not aggravated by routine physical activity such as walking or going upstairs. At least two of those four need to fit. Alongside that, there is no nausea or vomiting, and either light sensitivity or sound sensitivity may be there, but not both.

Migraine is described the other way round on nearly every point: often one sided though certainly not always, pulsating, moderate to severe, and aggravated by routine physical activity or making you avoid it. Again at least two of the four need to fit, and the attack also brings nausea or vomiting, or else both light and sound sensitivity together. Untreated attacks typically run somewhere between four hours and three days. A minority of people also get aura, visual or sensory symptoms that build over minutes and pass within about an hour, usually just before the head pain.

Where migraine and tension type headache overlap

This is the part worth sitting with. A great many people have both, and get different headaches in different weeks. A mild migraine can feel very like a tension headache, particularly early in an attack. Neck pain and neck tension are very commonly reported during migraine too, so a sore, gripping neck does not rule migraine out and is not evidence for a tension type headache. That single misreading keeps a lot of migraines unnamed for years. Nor is the response to a painkiller a reliable clue. If your headaches recur, a simple diary of timing, quality, duration, and what else happens with them will tell your doctor more than any self assessment can.

One more pattern gets missed often: medication overuse headache, where regular pain relief quietly turns into a driver of more frequent headaches. It can develop with about ten or more treatment days a month for triptans, combination painkillers, or opioids, or fifteen or more for simple painkillers, sustained over more than three months. A headache pattern that is slowly getting worse deserves that question asked out loud.

Where gentle movement honestly fits, and where it does not

Here I want to be careful about my own lane. For tension type headache, habitual neck, jaw, and shoulder tension, long sustained desk postures, and shallow high breathing are genuine contributors, and they are exactly the sort of thing that slow, awareness-based movement can work with. The Feldenkrais Method® does not stretch or press on anything; it invites you to notice how you are holding your head, jaw, and shoulders through an ordinary day, and to find easier options. Our Feldypedia entry on tension headaches covers that pattern, and our entry on neck and shoulder tension follows it further down the body. If that is your picture, our guide to relieving a tension headache and our gentle neck stretches for tension headaches are practical places to start.

For migraine, I will say it plainly: this work is not a treatment. Migraine is a neurological condition with real medical care behind it, and that care sits alongside anything you do with movement. Some people find that quiet, unhurried attention to the neck and shoulders is a comfort between attacks, and less tension in a body is rarely unwelcome, but that is a supportive measure and nothing more. If migraine is part of your life, the person to talk to is your doctor or a headache specialist.

When a headache needs urgent attention

Nothing on this page is a diagnosis, and some headaches need assessment rather than any form of self care. Get help straight away for a headache that comes on suddenly and severely or is the worst you have ever had; one that follows a blow to the head; one alongside fever and a stiff neck; one arriving with new weakness, numbness, confusion, loss of vision, or trouble speaking; one that wakes you from sleep or worsens when you lie down, cough, or strain; a new headache pattern beginning after the age of 50; and, in pregnancy, a headache with swelling or changes in your sight. For the ordinary, familiar sort of head tension, the gentler daily work is what Feldy is built around.

Common Questions about migraine vs tension type headache (FAQ)

How do clinicians tell migraine from tension type headache?

They weigh the character of the pain and what comes with it, using the International Headache Society criteria. Tension type headache is described as pressing or tightening rather than pulsating, usually on both sides, mild to moderate, and not made worse by routine physical activity, with no nausea or vomiting. Migraine is described as often one sided, pulsating, moderate to severe, and aggravated by routine activity, with nausea or with both light and sound sensitivity. These are the features a clinician weighs alongside your history, not a checklist to score at home.

Can you have both migraine and tension type headaches?

Yes, and it is common. Many people live with both patterns and get different headaches at different times, which is one reason self sorting goes wrong so often. Keeping a simple diary of when each headache comes, how it feels, how long it lasts, and what else happens with it gives your doctor far more to work with than trying to label each one yourself.

Does neck pain mean it is a tension headache rather than a migraine?

No. Neck pain and neck tension are very commonly reported during migraine attacks, so a stiff, sore neck does not rule migraine out and is not proof of a tension type headache. The neck is often involved in both. This is one of the most frequent reasons a migraine goes unrecognised for years, so it is worth mentioning your neck symptoms to your doctor rather than treating them as the whole answer.

Can painkillers make headaches worse?

They can, and medication overuse headache is a common cause of a headache pattern that is quietly getting worse. It can develop when pain medication is taken regularly on about ten or more days a month for triptans, combination painkillers, or opioids, or on fifteen or more days a month for simple painkillers, over more than three months. If your headaches are becoming more frequent and you are reaching for something most weeks, that is a conversation to have with your doctor or pharmacist.

Does gentle movement help, and how long until it makes a difference?

For tension type headache, easing habitual neck, jaw, and shoulder tension is working on a genuine contributor, and many people feel some ease within a single unhurried session. A steadier change in how much tension you carry through an ordinary day usually builds over a few weeks of short, regular practice, five or ten minutes most days rather than one long effort. For migraine, gentle movement is at best a supportive comfort measure alongside proper medical care, never a treatment for the migraine itself.

When should I see a doctor about a headache?

See your doctor about any headache that is new for you, changing, becoming more frequent, or not responding as it used to. Seek urgent care for a sudden severe headache or the worst you have ever had, a headache after a head injury, a headache with fever and a stiff neck, one with new weakness, numbness, confusion, vision loss, or trouble speaking, one that wakes you or worsens when you lie down or strain, a new pattern starting after the age of 50, or a headache in pregnancy with swelling or visual changes.