Migraine and tension-type headache: how to distinguish between them?
Migraine or headache? The most recent classification of headaches (2013) distinguishes between primary and secondary headaches
Of the primary headaches, migraine and tension-type headache are the most common, but what are their characteristics and how are they distinguished?
Primary headaches are migraine, tension-type headache, cluster headache and other primary headaches. Of these, migraine and tension-type headache are the most common.
Migraine, not just a headache: a specific type of headache
Migraine is a type of headache that is characterised by a unilateral (but can also be bilateral) pain that lasts from 4 to 72 hours and is accompanied by neurovegetative signs and symptoms such as nausea, vomiting, photophobia and phonophobia (discomfort from light and noise).
The pain is throbbing, medium to severe and disabling: sufferers are forced to stop their activities and require analgesics to see an improvement.
Seizures can last up to a few days, with significant repercussions on quality of life.
Migraine affects about 14-16% of the population and requires care in specialised centres.
Muscle tension headache: the common headache
Muscle tension headache is much more common than migraine. It is the common headache, which is characterised by pain of medium intensity, bilateral and constrictive, but which is not associated with other symptoms.
It lasts from 30 minutes to 7 days and can be related to incorrect posture, stress or fatigue, and personal predisposition, as in migraine, also plays a role.
It can be managed with over-the-counter medication, but if it becomes chronic, a specialist should be consulted.
Chronic is defined as a migraine or tension headache that occurs for more than 15 days in a month for more than three months.
Headache, how is it diagnosed?
For the diagnosis it is best to go to a specialised headache centre. In addition to receiving a correct diagnosis that includes defining the type of headache the patient is suffering from, it is essential to exclude secondary causes.
It is necessary to understand whether we are dealing with primary headaches, and therefore with a pathology in itself, or with secondary headaches, in which the headache is a symptom of something else, which must be investigated and addressed.
Diagnosis is made during a specialist examination in which the neurologist listens to the patient’s symptoms and pain patterns and, if necessary, performs a neurological examination and possible radiological examinations such as CT and MRI scans.
Primary headaches and secondary headaches: classification
Headaches are divided into primary headaches and secondary headaches.
Primary headaches are: migraine, tension-type headache, cluster headache and other primary headaches (cough headache, exercise headache, sexual activity headache, cold headache, hypnic headache, night headache, new daily persistent headache, a rare form).
Secondary headaches are: headache from head and/or neck trauma, from vascular disorders (such as stroke), from non-vascular head disorders (such as hypertension or CSF hypotension), from substance use (including painkillers), from infections, from disorders of metabolic homeostasis (such as air travel headache, from sleep apnoea, from dialysis, from high blood pressure, from fasting); disorders of the eyes, ears, nose, teeth and mouth; psychiatric disorders and painful cranial neuropathies (such as trigeminal neuralgia and burning mouth syndrome).
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