Tension-type headache and migraine – signs & symptoms

Woman with a headache

How do patients present?

Tension-type headache

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


Migraines also tend to start around puberty and usually affect those between the ages of 35-45 years old. Like TTH, it seems to affect more women than men due to its association with hormonal influence. Migraines may also present with other symptoms and is more severe than TTH.1

Signs, symptoms and “red flags”

Icon for headache

Distinguishing between tension-type headache and migraines2,3

TTH Migraine
At least 10 episodes lasting around 30 minutes to 7 days per month At least 5 attacks per month that last 4-72 hours if left untreated or is unsuccessfully treated

Associated with at least 2 of the following:

- on both sides of the head

- pressing or tightening quality

- non-throbbing in nature

-mild-to-moderate intensity

- not aggravated by routine activities

Associated with at least 2 of the following:

- on one side of the head

- pulsating or throbbing in nature

- moderate or severe pain

- aggravated by or causes avoidance of routine physical activity such as walking or climbing stairs

It should not be 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

The four phases of migraine

Signs and symptoms associated with phases of migraine4,5

Unlike TTH, there is a recognised pattern for a migraine attack. However, remember that this may not apply to all migraine sufferers. Each phase is usually associated with progressive symptoms as the migraine reaches its peak before subsiding.

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 as a throbbing or pulsating nature and is usually on one side of the head

This phase can last any where 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 also difficult

Woman with a headache

“Red-flag” symptoms2-5

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. These include:

“Red-flag” symptoms
A severe and abrupt onset of headache
Headaches that have suddenly “appeared” in middle-age or older (> 40 years old)
Associated complaints that may indicate problems with the nervous system like a stiff neck, focal signs (drooping face, paralysis on one side of the body and slurred speech) suggestive of a stroke and, reduced consciousness
Other signs such as fever, looking ill and, nausea and/or vomiting that occurs without history of or other symptoms of migraines
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 as, it could be something other than migraines
Onset with strenuous physical activity such as exercise

Understanding headaches and migraine

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Headaches & migraine overview

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


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Learn about the causes and triggers

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


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

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


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Paracetamol chemical structure


Paracetamol or acetaminophen is one of the most used analgesic and antipyretic over-the-counter drugs globally.6

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Panadol Extra

With a dual “active” formulation that fights tough pain such as headaches,7,8 migraines,9 dental pain10 and menstrual pain.11

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Specially tailored for pharmacists, discover in-depth information on how to manage your migraine patients.

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