We’ve known for centuries that headaches come from different sources, and they come with different symptoms. A hundred years ago we were calling some forms of migraine "sick headache". Somewhere along the line we started talking about"tension headache" – just a little pain from muscle tension and stress.
Or so we thought.
We started to associate the so-called common headache with tension headache. As we learned more about the anatomy of the head, we theorized that the muscle around your skull was getting tense and causing changed in blood flow.
But as we started to study migraine and other types of headache more closely, the mystery deepened.
Studies of tension headache weren’t always turning out the way we thought. Why were people getting tension headaches when they weren’t even under stress? And – wait – why do so many people with tension headache not have any more muscle tension than anyone else?
So we changed the name from tension headache to tension-type headache (meaning that we had no idea what caused it, but it certainly doesn’t seem to be muscle tension!).
Now comes another debate – how can we diagnose tension headache or migraine headache? If we go by the symptoms, it would seem that tension-type headache is the most common headache. What if we go by how many people actually go to the doctor? Well, migraine is starting to gain on other types of headache.
But research is pointing in a new direction. We now think that the mechanism of tension-type headache and the mechanism of migraine may not be so different. In fact, many of the treatments for migraine seem to work well for those diagnosed with tension headache!
In his book The Keeler Migraine Method, Dr. Robert Cowan suggests that migraine is in fact the most common cause of headache. In fact, he writes:
Studies suggest that 40 percent of migraineurs may be misdiagnosed as suffering from tension-type headaches because, unfortunately, both headache types may include features that we commonly associate with the other. This happens because both headache types involve the trigeminal nerve system. The trigeminal nerve system dips down well into the cervical spinal cord, and in tension-type headaches it can irritate the nerves that travel to the neck muscles and the muscles that tense the forehead and temples. Almost anyone with a headache of any type is likely to tense the shoulder and neck muscles, so muscle tension is not a reliable indicator for headache type.
So if the common headache is actually a result of migraine, how can you be sure to get the right treatment?
Because primary headache is generally diagnosed by symptom, pay close attention to your symptoms. Tell your doctor about anything you notice, such as sensitivity to light, the location of the pain, nausea, and what the pain feels like. That will give you a better chance of getting the right treatment, whether for the tension-type headache, or the headache from migraine – which is probably a lot more common than we used to think.