A headache is not just a headache
Around two in three people in Austria experience headaches several times a year. The term, however, covers a wide range of different conditions. The two most common forms are tension-type headache and migraine. They differ in the nature of the pain, accompanying symptoms and triggers — and therefore also in the appropriate treatment.
A careful headache diagnosis is the basis of any successful treatment. It helps to distinguish harmless complaints from more serious causes and to identify measures that work for the individual.
Tension-type headache: dull, pressing, bilateral
Tension-type headache is the most common form of headache. It is often described as a dull, pressing pain that wraps around the whole head like a tight band.
Typical features
- bilateral, pressing pain of mild to moderate intensity
- duration of 30 minutes to several days
- no pronounced nausea, no aura
- physical activity usually does not worsen the pain
- occasional sensitivity to light or noise, but rarely both
Possible triggers
- muscular tension in the neck and shoulder area
- stress and psychological strain
- lack of sleep or an irregular sleep pattern
- screen work, poor posture
- inadequate fluid intake
If tension-type headache occurs on fewer than 15 days per month, it is referred to as an episodic form. With more frequent occurrence, a chronic course can develop, which requires more thorough assessment.
Migraine: episodic, pulsating, often one-sided
Migraine is a neurological condition in its own right. It occurs in attacks and can significantly affect daily life.
Typical features
- usually one-sided, pulsating or throbbing pain
- moderate to severe intensity
- duration between 4 and 72 hours
- worsening with physical activity
- accompanying nausea, sometimes vomiting
- marked sensitivity to light, noise and smells
In around a third of those affected, the attack is preceded by what is known as an aura: visual disturbances such as flickering or zigzag lines, tingling, and more rarely speech difficulties. These symptoms usually resolve within an hour.
Known trigger factors
- hormonal fluctuations (e.g. menstruation)
- stress or the relaxation phase after stress
- irregular sleep
- certain foods (e.g. red wine, mature cheese, chocolate)
- changes in the weather
- sensory overload from light or noise
A headache diary can help to identify individual triggers and to assess the success of treatment.
How do the two forms differ?
| Feature | Tension-type headache | Migraine |
|---|---|---|
| Nature of pain | pressing, dull | pulsating, throbbing |
| Location | bilateral | usually one-sided |
| Intensity | mild to moderate | moderate to severe |
| Accompanying symptoms | rare | nausea, sensitivity to light/noise |
| Activity | no worsening | clear worsening |
| Duration | 30 min – several days | 4 – 72 hours |
Diagnosis: step by step to clarity
A thorough headache diagnosis begins with a detailed conversation and a physical and neurological examination. Key elements include:
- medical history: nature of pain, frequency, duration, accompanying symptoms, family history
- a headache diary kept over several weeks
- neurological examination to assess reflexes, eye movements and coordination
- where necessary, imaging (MRI, CT), particularly with warning signs such as a sudden severe headache, neurological deficits or changes in the usual pattern of pain
In Austria, diagnosis and treatment follow the criteria of the International Headache Society and the recommendations of the Austrian Headache Society.
Treatment options for tension-type headache
Treatment of tension-type headache has two aims: to relieve acute symptoms and to prevent new episodes.
Acute measures
- over-the-counter painkillers (e.g. containing the active ingredients ibuprofen or paracetamol) – not more than 10 days per month, in order to avoid medication-overuse headache
- peppermint oil applied to the temples and neck may have a supportive effect
- rest, fresh air, adequate fluid intake
Long-term strategies
- regular physical activity, particularly endurance exercise
- relaxation techniques such as progressive muscle relaxation or autogenic training
- physiotherapy for muscular tension
- ergonomic adjustment of the workplace
- stress management, where appropriate with psychological support
Migraine treatment: acute and preventive
Modern migraine treatment combines acute pain relief with targeted prevention.
Acute therapy
- early use of painkillers (e.g. active ingredients such as ibuprofen, naproxen or acetylsalicylic acid)
- for moderate to severe attacks, triptans as migraine-specific medications
- antiemetics for nausea
- withdrawal to a quiet, darkened room
Prevention for frequent attacks
If migraine attacks occur regularly or are particularly severe, preventive treatment may be useful:
- certain active ingredients from the groups of beta-blockers, anticonvulsants or antidepressants
- modern antibody therapies directed against the CGRP messenger, which act specifically on the mechanisms of migraine
- botulinum toxin type A for the treatment of chronic migraine according to a defined injection scheme
- non-drug approaches such as endurance exercise, biofeedback, relaxation training and acupuncture
Multimodal pain therapy for headaches
For chronic courses, multimodal pain therapy for headaches has proven effective: it combines medication with physiotherapy, psychological support and lifestyle measures. The aim is not necessarily complete freedom from pain, but a clear improvement in quality of life and everyday functioning.
When medical advice is particularly important
A medical assessment is especially advisable in the following situations:
- a very severe headache occurring for the first time
- a change in the character or frequency of known headaches
- accompanying neurological symptoms (paralysis, speech disturbances, loss of vision)
- headaches following an accident
- frequent need for painkillers (more than 10 days per month)
Conclusion
Migraine and tension-type headache are widespread, but they can be clearly distinguished from one another and treated individually. An accurate diagnosis, recognising personal triggers and a tailored treatment plan can help to reduce the frequency and severity of attacks. Anyone who suffers regularly from headaches should not dismiss the symptoms as "normal" but seek medical advice early.
This article does not replace medical advice.