Muscle Tension Headaches and Migraines: Key Differences and Treatment Options

Muscle tension headache and migraine are two different types of presentation that have in common a pain, which can also be debilitating, in the head area. Back in 2019, in Australia, 3 million people were estimated to suffer from migraine (Wijeratne et al., 2023), where, define how many people are suffering from muscular tension head-ache is a bit more tricky, as is not a presentation that can be easily tracked, due to self managed protocols, and other miss data counting. That said, they have different origins, symptoms, and treatment options. In this blog post, we will explore the key differences between muscle tension headaches and migraines, helping you understand how to identify and manage them.

What Are Muscle Tension Headaches?

Muscle tension headaches, or tension-type headaches, are the most common. This type of headache originates from cervical or facial muscle tensions, which recreates a pattern of pain on the head of facial area. As with all muscles, but even joints, the pain that we can experience can be local or in an area around the tense spot. These headaches are often linked to stress, lack of good posture, anxiety, and even sleep disturbances. They can be chronic or occasional, but compared to migraine, they lack neurological symptoms.

Symptoms of Muscle Tension Headaches:

• Dull, aching pain or pressure around the head, especially in the forehead, temples, and back of the head.

• A sensation of tightness or “band-like” pressure around the head.

• Mild to moderate intensity (usually not as severe as a migraine).

• Pain can last from 30 minutes to several hours, sometimes even days.

• Tenderness or tightness in the neck, shoulders, and scalp.

Causes of Muscle Tension Headaches:

• Stress: Emotional and mental stress is one of the primary causes of muscle tension in the neck and scalp muscles.

• Lack of good posture: Sitting or standing with poor posture and lack of strength in the musculoskeletal system, especially for long work, can strain muscles and trigger headaches.

• Sleep issues: Sleep deprivation or poor-quality sleep can exacerbate muscle tension and lead to headaches. The body recovers from the fatigue of the day before during sleep, especially in the early morning hours. Sleep deprivation would increase the chance of a headache.

• Dehydration: Not drinking enough water can lead to tension and headache symptoms. The body withdraws water from the brain to keep the organ functioning, causing physical brain shrinkage, which leads to headaches.

Recent studies have indicated that chronic tension-type headaches (CTTH) are often exacerbated by environmental stressors, and poor posture in daily activities can cause muscle imbalance and contribute to the frequency of these headaches (Bendtsen et al., 2018; Grazzi et al., 2016).

Treatment Options:

• Pain relief: Over-the-counter pain relievers, like ibuprofen or acetaminophen, can help ease the discomfort.

• Heat pack: Applying a warm compress to the neck and shoulders can help relax tense muscles. Keep always in mind that heat application should be limited to 10-15 minutes, once or twice a day.

• Massage: Gentle massage of the neck and shoulder muscles can reduce tightness and alleviate headache symptoms.

• Stress management: Practising relaxation techniques such as deep breathing, thai yoga, and meditation can reduce stress and prevent muscle tension headaches.

• Strengthen muscles: Strengthening the muscles around your cervical and shoulder area can help reduce the chance of suffering a headache by reducing the inflammatory response that the muscle would activate due to a lack of strength.

What Are Migraines?

As I mentioned above, the significant difference between headaches and migraines is due to neurological symptoms, a unique characteristic of migraines. Migraines are neurological events that involve complex brain activity. They are characterised by intense, throbbing pain, usually on one side of the head. They are often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines are more debilitating than muscle tension headaches and can last a few hours to several days. The intensity of the headache doesn’t have to be severe.

Symptoms of Migraines:

Although many people experience nausea, vomiting, and light sensitivity, migraine symptoms can vary, with some individuals experiencing dizziness or visual disturbances without significant head pain.

• Throbbing or pulsing pain, usually on one side of the head.

• Nausea and vomiting.

• Sensitivity to light, sound, and sometimes smells (aura).

• Visual disturbances such as flashing lights or blind spots (this is known as an aura, which can occur before or during the headache).

• Dizziness or feeling lightheaded.

Migraines are understood to be primarily driven by neurovascular changes and neuronal hyperexcitability (Feng et al., 2021). A review by Wagner et al. (2021) found that the pathophysiology of migraines involves alterations in neurotransmitter systems, notably serotonin and CGRP (calcitonin gene-related peptide), which contribute to the vasodilation and pain signaling pathways.

Causes of Migraines:

• Genetics: Migraines tend to run in families, suggesting a genetic component.

• Hormonal changes: For many women, changes in estrogen levels, such as during menstruation, pregnancy, or menopause, can trigger migraines.

• Environmental triggers: Bright lights, strong smells, certain foods (like chocolate, cheese, or caffeine), weather changes, lack of sleep, and allergies that cause sinus issues are common migraine triggers.

• Neurological factors: Migraines may involve changes in the brain’s nerve pathways, chemicals, and blood vessels, which cause inflammation and pain.

Treatment Options for Migraines:

• Prescription medications: Triptans and anti-nausea medications are commonly prescribed to treat the acute pain of migraines.

• Preventive medications: For frequent migraine sufferers, medications such as beta-blockers, antidepressants, or anti-seizure drugs may be prescribed to reduce the frequency and severity of attacks.

• Lifestyle changes: Regular sleep, a healthy diet, and consistent exercise can help reduce the frequency of migraines.

• Cognitive-behavioural therapy (CBT): Managing stress through therapy can help alleviate migraine triggers.

• Alternative therapies: Acupuncture, biofeedback, and massage therapy are sometimes used as complementary treatments for migraine management.

Recent studies support preventive treatments for chronic migraines, such as CGRP antagonists (Kundera et al., 2020) and neuromodulation techniques like transcranial magnetic stimulation (Lefaucheur et al., 2017).

Key Differences Between Muscle Tension Headaches and Migraines

Although muscle tension headaches and migraines involve head pain, they differ significantly in their nature and how they affect the body.

• Pain intensity: Muscle tension headaches are usually mild to moderate in intensity, while migraines can be severe and debilitating due to the neurological symptoms, but not in terms of head pain.

• Location of pain: Tension headaches have specific patterns. The type of presentation is really specific to the muscle that triggers the headache.

  • Occipital Muscle – Based on the skull pain;
  • Levator Scapulae – Pain starts at the base of the skull, travels behind and all around the ear (same side), till the front of the head;
  • Splinius capitis – The pain location is on the top of the head;
  • Splinius cervis – The pain is present at the middle side of the skull (middle left or right);
  • SCM – Pain is located at the front of the head and behind the ear.

• Associated symptoms: Migraines must be accompanied by neurological symptoms, including nausea, vomiting, and light sensitivity, whereas muscle tension headaches don’t typically involve these symptoms.

• Duration: Tension headaches can last hours to days, while migraines usually last 4 to 72 hours and can follow a specific pattern.

Migraine phases

Below is a simplified description of the migraine phases. That said, not everyone experiences those phases in the same order, and everyone can experience them with different intensities.

Prodrome Phase (Pre-migraine Phase)

• Time: This phase can start 24 to 48 hours before the headache begins.

• Symptoms: Subtle signs that a migraine may be coming, including:

  • Fatigue or tiredness

  • Mood changes (irritability, depression, euphoria)

  • Food cravings

  • Neck stiffness

  • Increased thirst or frequent urination

  • Sensitivity to light or sound

  • Difficulty concentrating

Aura Phase (If Present)

• Time: Usually lasts from 5 to 20 minutes, but can last up to an hour.

• Symptoms: This phase happens in about 25-30% of people with migraines.

  • Visual disturbances (flashes of light, blind spots, zigzag patterns)

  • Numbness or tingling sensations (often in the face or hands)

  • Speech or language problems (e.g., difficulty forming words)

  • Confusion or dizziness

Headache Phase (The Migraine Attack)

• Time: Can last from 4 hours to 72 hours.

• Symptoms: This is the most intense phase.

  • Throbbing or pulsing headache, often on one side of the head

  • Nausea and vomiting

  • Sensitivity to light (photophobia), sound (phonophobia), and smells

  • Blurred vision or sensitivity to touch

  • Dizziness or lightheadedness

  • Difficulty functioning due to the intensity of the pain

Postdrome Phase (Migraine Hangover)

• Time: Can last 1-2 days after the headache subsides.

• Symptoms:

  • Fatigue and general exhaustion

  • Difficulty concentrating

  • Mood disturbances (e.g., feeling “washed out” or irritable)

  • Mild lingering headache or sensitivity to light and sound

Allergies that cause sinus blockage can also trigger headaches or migraine.

Sinusitis occurs when air-filled cavities behind the forehead, cheeks, and eyes become inflamed due to an infection or allergy. Due to the accumulation of excessive liquid, this inflammation causes pressure and pain in the sinus areas, often resulting in a deep, constant headache. The localisation of the pain is typically in the forehead, cheeks, or around the eyes, and it can get worse when bending over or lying down. The unique aspect of this type of headache, whether it is a migraine or tension headache, is the sinus symptoms, including nasal congestion, a runny nose, and facial tenderness.

The way to deal with this type of headache, then, is not only to reduce the symptoms of the head ache but to decongest the synus blockage.

Manual Lymphatic Drainage (MLD) is a technique that can help with that, also in acute sinus symptoms, as long as no infections are in course, and that you are not taking antibiotics to deal with the presentation.

When to Seek Professional Help

While occasional headaches are common and often manageable at home, it’s essential to seek a health provider helps if you experience:

• Frequent or severe headaches.

• Changes in the pattern or nature of your headaches.

• Symptoms that interfere with daily life.

• New or unusual headache symptoms, such as sudden severe pain or visual disturbances.

How Can Melbourne Massage and Treatment Help?

At Melbourne Massage and Treatment, I get to see a lot of patients who suffer from muscular tension, headaches, and migraine. In order to help them, the first thing I do is go through their clinical history, asking specific questions, to map out their presentation.

Things that I do consider when asking questions are:

• Type of symptoms;
• Timing of symptoms;
• How often does the person suffer from headache;
• Do they wear a mouth guard?
• Any history of brain cancer in the family?
• How much water do they drink?
• Where in the head do they feel the pain?
• And more detailed questions….

What would make me thing that I need to refer the person of the GP is if I see any red flag along the answers, such as heavy dizziness, previous history of brain cancer, neurological symptoms, or combination of other symptoms that mix with headache make it clear that a massage would not be of any help at their stage.

What can massage and myotherapy do for headaches and migraines?

With massage and myotherapy techniques, I can help a fair bit to prevent and change the headache patterns.

Assessment

First, we would assess the presentation, including the clinical history and movement of the neck and upper shoulder area.

Treatment

Based on the severity of the presentation, on the day of the treatment, we would create a treatment plan. We may start with soft tissue massage, dry needling, or joint mobilisation to kickstart a relaxation process and reduce muscle and joint tensions.

Exercises

Based on the type of headache you experience, due to the muscle or joint involved in the pain presentation, I would suggest a series of exercises that can help to strengthen your cervical area to reduce the recurrence of headaches and their severity.

For Migraine presentation, on the other hand, which are more neurological presentations, we will still use massage techniques, like deep tissue, but also MLD, which may help with deep relaxation or could help with sinus congestion that can trigger the headache.

In conclusion, if you are local to Fitzroy North area, and you are seeking help for muscular tension headaches or you need relief from migraine presentation, book your next appointment now, or get in touch to discuss how Melbourne Massage and Treatment services can help your presentation.

Frequently Asked Questions about Muscular Tension Headache and Migraine

What is the difference between a muscle tension headache and a migraine?

• Answer: Muscle tension headaches are usually caused by muscle tightness in the neck, shoulders, and scalp, and they often feel like a dull, aching pressure or a “band-like” tightness around the head. In contrast, migraines are neurological events characterised by intense, throbbing pain, typically on one side of the head, and are often accompanied by symptoms like nausea, vomiting, and sensitivity to light and sound.

Can a muscle tension headache become a migraine?

• Answer: While muscle tension headaches and migraines are distinct conditions, it’s possible for someone who experiences frequent muscle tension headaches to develop migraines over time, especially if there are other triggers like stress, lack of sleep, or environmental factors. However, they remain different types of headaches with different causes and symptoms.

How can I treat a muscle tension headache at home?

• Answer: Treatment for muscle tension headaches often includes over-the-counter pain relievers, applying a warm compress or heat pack to the neck and shoulders, gentle massage, and practising relaxation techniques like deep breathing or meditation. Ensuring good posture and managing stress can also help prevent them.

What are the best treatments for migraines?

• Answer: Treatment for migraines often includes prescription medications like triptans, which help to alleviate acute migraine pain. Preventive medications, such as beta-blockers or antidepressants, may also be prescribed for frequent migraines. Lifestyle changes like maintaining a regular sleep schedule, managing stress, and avoiding known triggers can help reduce the frequency of attacks. For some, alternative therapies like acupuncture or biofeedback can be beneficial.

Can massage therapy help with headaches or migraines?

• Answer: Yes! Massage therapy can be highly effective for both muscle tension headaches and migraines. For muscle tension headaches, massage can help relax tight muscles in the neck and shoulders, easing pain. For migraines, massage can reduce muscle tension and promote relaxation, while techniques like Manual Lymphatic Drainage (MLD) can help alleviate sinus congestion that may trigger a migraine.

When should I seek professional help for my headaches?

• Answer: If you experience frequent or severe headaches, a change in your headache pattern, or new, unusual symptoms like sudden severe pain, visual disturbances, or neurological symptoms, it’s important to consult a healthcare provider. They can help diagnose the cause of your headaches and determine the best course of treatment, ensuring you get the care you need.

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