Debate: differences and similarities between tension-type headache and migraine

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ONAN D., Younis S., Wellsgatnik W. D., Farham F., Andruškevičius S., Abashidze A., ...More

Journal of Headache and Pain, vol.24, no.1, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Review
  • Volume: 24 Issue: 1
  • Publication Date: 2023
  • Doi Number: 10.1186/s10194-023-01614-0
  • Journal Name: Journal of Headache and Pain
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CINAHL, EMBASE, MEDLINE, Psycinfo, Directory of Open Access Journals
  • Keywords: Central sensitization, CGRP, Headache, International Classification of Headache Disorders, Migraine, Pericranial tenderness, Tension-type headache, Triptan
  • Hacettepe University Affiliated: Yes


Tension-type headache (TTH) and migraine are two common primary headaches distinguished by clinical characteristics according to the 3rd edition of the International Classification of Headache Disorders. Migraine is identified by specific features such as being more prevalent in females, being aggravated by physical activity, certain genetic factors, having photophobia, phonophobia, nausea, vomiting, or aura, and responding to specific drugs. Nonetheless, TTH and migraine share some common characteristics, such as onset occurring in the 20 s, and being triggered by psychological factors like stress, moderate pain severity, and mild nausea in chronic TTH. Both conditions involve the trigeminovascular system in their pathophysiology. However, distinguishing between TTH and migraine in clinical practice, research, and epidemiological studies can be challenging, as there is a lack of specific diagnostic tests and biomarkers. Moreover, both conditions may coexist, further complicating the diagnostic process. This review aims to explore the similarities and differences in the pathophysiology, epidemiology, burden and disability, comorbidities, and responses to pharmacological and non-pharmacological treatments of TTH and migraine. The review also discusses future research directions to address the diagnostic challenges and improve the understanding and management of these conditions. Graphical Abstract: [Figure not available: see fulltext.]