What Are Migraine and Tension Headaches?

Although there are several types of headaches, migraine and tension headaches affect the most people. When you have a headache, it isn't your brain that's hurting. Your head aches because nerves in the bones, blood vessels, meninges, and muscles of your head are irritated. These irritated nerves send pain signals to the brain, which identifies where you hurt and how bad the pain is.

What causes your headache?

The cause of your headaches may not be well understood. Only rarely are headaches a sign of a serious medical problem, such as a tumor. Headache pain may be caused by abnormal interaction between the brain, nerves, and blood vessels in the head. A previous head injury or concussion, neck pain, environmental stresses, muscle tension, anxiety, depression, fatigue, skipping meals, or certain foods and drinks that may trigger headache pain.

To diagnose the cause of headaches and rule out other more serious problems, your healthcare provider will talk to you about your history of headaches and do a neurological exam. Your provider may also recommend an imaging test, such as a CT or MRI scan.

What is referred pain?

Headache pain can be referred pain, which is pain that has its source in one place but is felt in another. For example, pain behind the eyes may actually be caused by tense muscles in the neck and shoulders. This means that the place that hurts may not be the part of the body that needs treatment.

Is it a migraine?

Migraine is a vascular headache that causes throbbing pain felt on one (most common) or both sides (less common) of the head. You may have nausea or vomiting. This type of headache may also be preceded or associated with changes in vision (like seeing spots or flashes of light), ability to speak, or sensation (aura). The pain may last for 4 to 72 hours. Afterward, you may feel fatigue, sensitivity to light, or mental fog for a day or so. If this is the first time you have numbness, weakness, or trouble speaking, get medical attention right away, because you could be having a stroke.

Is it a tension headache?

This type of headache is usually a dull ache or a sensation of pressure on both sides of the head. It may be associated with pain or tension in the neck and shoulders. Depression, anxiety, and stress can cause a tension headache. The pain may not have a definite beginning or end. It may come and go, or seem never to go away completely.

When to call the healthcare provider

Call your healthcare provider or get medical care right away for headaches that happen along with any of these symptoms:

• Sudden, severe headache that is different from your usual headache pain

• Headache with fever

• Sudden headache with stiff neck

• Slurred speech

• Recurring headache in children 

• Ongoing numbness or muscle weakness

• Loss of vision

• Pain following a head injury

• Convulsions, or a change in mental awareness

• A headache you would call "the worst headache you've ever had"

• New headaches in a pregnant woman or someone with a history of cancer