Mixed tension migraine

Alternative names
Headache - mixed tension migraine

Definition

A headache with features of both tension headache and migraine headache.

See also:

     
  • tension headache  
  • common migraine  
  • classic migraine

Causes, incidence, and risk factors

Migraine headaches affect millions of people. Tension headaches are even more common, affecting about 40% of the population. People with mixed tension migraine have features of both types of headaches and it is difficult to differentiate which symptoms are migrainous and which are tension related. Women are more commonly afflicted than men.

Common triggers for these headaches are hormonal changes, dietary factors, environmental factors, sensory stimuli, and stress. Examples include too much or too little sleep; missed or delayed meals; menstruation; alcohol; food and food additives; chemical and drug ingestion and withdrawal; light glare; and odors.

Symptoms

Symptoms associated with mixed tension-migraine headache may include:

     
  • headache on one or both sides  
  • throbbing  
  • dull, tight or band-like sensation  
  • pain varies in intensity from annoying to incapacitating  
  • may be aggravated by routine physical activity  
  • nausea or vomiting  
  • sensitivity to light or sound  
  • visual scintillations  
  • may last from 4-72 hours, however, may evolve into chronic daily headache  
  • irritability, depression  
  • sluggishness  
  • numbness, tingling, weakness  
  • neck pain

Signs and tests

It is important to have a full medical and neurological evaluation if:

     
  • Headaches have just started to occur regularly  
  • The intensity or symptoms of the headache are different from your previous experience of common headaches

Based on the history of your symptoms and a physical examination, a physician will decide whether you should be treated for migraine-tension headache, or whether further evaluation to rule out other causes of headache is necessary. These tests may include:

     
  • a head and or neck CT or MRI  
  • blood tests  
  • lumbar puncture (spinal tap)

Treatment

Avoid triggers, if possible and reduce stress. It is important to eat a proper diet, exercise regularly and get adequate sleep.

Anti-inflammatory medications and over the counter medications such as ibuprofen and acetominophen may help. Some people benefit from ergot derivative drugs and triptans.

If headaches become frequent and interfere in daily functioning, medication may be given on a daily basis to prevent the headaches. These include beta blockers, calcium channel blockers, anti-convulsants, and anti-depressants, depending on the type of headache and what proves effective for the particular person.

Expectations (prognosis)
The long-term outlook is good if the headache symptoms can be brought under control by avoiding triggers and taking medicine.

Complications
Complications may occur from side-effects of medications. Rebound headaches may occur from overuse of medications. It is important to only use medication as directed.

Calling your health care provider
Call your health care provider if you experience a new headache, a change in quality of a previous headache or difficult to manage symptoms of headaches.

Prevention
Prevention of headaches includes avoidance of triggers and maintaining adequate sleep, nutrition, diet and exercise. In some cases, preventative medication may be required.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.