Tension-type headache and migraine causes

Woman with a headache

What are they?

Tension-type headache

Tension-type headache (TTH) is a head pain that occurs in frequent or infrequent shorter episodes (episodic*) or that is regularly or constantly present (chronic).1 TTH are usually mild or moderate in intensity and may present as a “pressing” or “tightening” quality. It is usually not aggravated by physical activity.


Migraines on the other hand, are severe and disabling attacks that reoccur over time and often felt on one side of the head. It has a “pulsating” quality and is often associated with changes in light, sound and odor sensitivity. It is usually accompanied by nausea and neck stiffness. Patients will experience seeing spots or stars during attacks and, feeling fatigued or dizzy after.2,3

Pathophysiology, causes and triggers of tension-type headaches

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Pathophysiology of tension-type headaches4

Unlike migraines, the mechanism of TTH is not clearly known. It may originate from tensed muscles especially around the neck area and can be stress-related.

  • Woman with a headache

    TTH are caused by either factors related to increased feeling of stress and/or problems with the neck muscles.

  • Man with a headache

    The triggers for TTH are similar to migraines. The main trigger is related to stress or mental tension. Other triggers associated with TTH are sleep problems, fatigue, weather changes, menstruation and the inability to relax after work.

Pathophysiology, causes and triggers of migraines

Firing neurons at the trigeminal area

Pathophysiology of migraines6

Migraines are caused when the nerves and blood vessels around the trigeminal nerve (trigeminovascular system) located in the head are triggered to fire abnormally. When this happens, the trigeminal nerves produce and release substances called vasoactive neuropeptides, prostaglandins and inflammatory cytokines.

On release, these substances cause inflammation of the surrounding blood vessels, which in turn activates the pain receptors nearby (nociceptors). When nociceptors are activated, these sensory nerves send signals to parts of the brain responsible for producing sensation of pain such as the thalamus and cerebral cortex.

  • Woman with migraine

    Migraines are thought to have a genetic basis with environmental factors playing a significant role in how it affects migraine sufferers.

    In fact if 1 parent has migraine, there is a 50% chance of a child having it too whilst if both parents suffer from migraines then the risk of their child developing migraines increases to 75%.

Understanding headaches

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Headaches & migraine overview

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


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How do they present?

Find out the signs and symptoms of tension-type headache and migraine. Learn to differentiate them and learn about “red flag” symptoms that indicate a referral to a doctor.

Signs and symptoms

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


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