Tension-type headache and migraines — signs & symptoms

Woman with a headache

How do patients present?

Tension-type headache

Tension-type headache (TTH) usually begins during the teenage years, and it tends to affect more women than men.1 TTH is usually described as a pressure or tightness, like a band around the head that may feel as if it’s coming from or radiating to the neck.1


Migraines most often tend to start around puberty and usually affects those between the ages of 35–45 years.1 Similar to TTH, it seems to affect more women than men due to its association with hormonal influences.1 Migraines may also present with other symptoms (i.e., nausea).

Signs, symptoms, and “red flags”

Man, with headache

Distinguishing between tension-type headache and migraines2-6

TTH Migraine
  • Infrequent: At least 10 episodes of headache occurring on <1 day/month on average (<12 days/year) lasting from 30 minutes to 7 days
  • Frequent: At least 10 episodes of headache occurring on 1-14 days/month on average for >3 months (≥12 and <180 days/year) lasting from 30 minutes to 7 days
  • At least 5 attacks, lasting 4–72 hours if left untreated or if unsuccessfully treated

Associated with at least 2 of the following:

  • Bilateral location
  • Pressing or tightening (non-throbbing) quality
  • Mild-to-moderate intensity
  • Not aggravated by routine activities

Associated with at least 2 of the following:

  • Unilateral location
  • Pulsating quality
  • moderate or severe pain
  • Aggravated by or causes avoidance of routine physical activity (e.g., walking, climbing stairs)

It is NOT associated with:

  • Nausea or vomiting
  • Sensitivity to light and/or sound

It should include one of the following:

  • Nausea and/or vomiting
  • Sensitivity to light or sound

TTH = tension-type headache.

The four phases of migraine

Signs and symptoms associated with phases of migraine

Unlike TTH, there is a recognized pattern for a migraine attack. However, this may not apply to all migraine sufferers.7

Each phase is usually associated with progressive symptoms, as the migraine reaches its peak before subsiding:4,5,7,8

Phase Characteristics
I – Prodrome or premonitory phase
  • Blurred vision
  • Food cravings
  • Feeling tired, irritable or depressed
  • Can occur hours or days before the pain starts
II – Aura phase
  • Occurs in patients who experience migraines with aura
  • Changes to vision such as zigzag lines, flickering lights, or a blind spot in the field of vision
  • Sensations in the skin, such as tingling and numbness in the hands or face
III – Attack or headache phase
  • Headache starts with throbbing or pulsating, and is usually on one side of the head
  • Can last anywhere from 4–72 hours
IV – Postdrome or resolution phase
  • Once the worst of the pain recedes, patients are left feeling tired, irritable, and depressed
  • Concentrating is difficult

TTH = tension-type headache.

Woman with a headache

“Red-flag” symptoms

Though common, TTH and migraines are not the only causes of headaches. Sometimes, patients could present with symptoms or a history that should be considered for urgent referral to either a doctor or a specialist.4

These “red-flag” symptoms include:4,9

“Red-flag” symptoms
A severe and abrupt onset of headache
Headaches that have suddenly “appeared” in middle-age or older (>50 years old)
Problems associated with the nervous system such as a stiff neck, focal signs (drooping face, paralysis on one side of the body, and slurred speech) suggestive of a stroke, and reduced consciousness
Headache with signs of systemic illness (e.g., fever, rash)
Significant changes in the pattern of headaches experienced (e.g., increased frequency or worsening severity)
Severe headaches at night or when waking up in the morning (could be something other than migraines)
Headache onset with strenuous physical activity (e.g., exercise)

Understanding headaches and migraine

Icon for headache

Headaches & migraine overview

Find out more about how headaches and migraines can impact people’s lives.


Woman with headache

Learn about the causes and triggers

Discover some of the causes and triggers for the more common types of primary headache disorders — tension-type headache and migraines.1


Management icon

What can you recommend to your patients for pain relief from their headaches?

Find out more about pharmacological and non-pharmacological treatments for tension-type headache and migraines.


Learn more

Advil Extra Strength Liqui-Gels pack shot

Advil Extra Strength Liqui-Gels

An over-the-counter analgesic containing 400 mg ibuprofen that relieves mild to moderate migraine headaches including associated symptoms of nausea, and sensitivity to light and sound.10

Find out more

Advil Liqui-Gels 200 mg pack shot

Advil Liqui-Gels

An over-the counter analgesic containing 200 mg ibuprofen that helps your patients manage their headache pain including tension headache.10

Find out more


Condition information

Access information for a variety of acute pain conditions.

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