Comparison of clinical characteristics of migraine and tension type headache

Migraine and tension type headache (TTH) are two most common types of primary headaches. Though the International Classification of Headache Disorders-2 (ICHD-2) describes the diagnostic criteria, even then in clinical practice, patients may not respect these boundaries resulting in the difficulty in diagnosis of these pains.

This cross-sectional study involved 50 subjects in each of the two groups - migraine and TTH - after screening for the inclusion and exclusion criteria. Diagnosis was made according to the ICHD-2 criteria. Their clinical history was taken in detail and noted in a semi-structured performa. They were examined for the presence of a number of factors like pericranial tenderness and muscle parafunction. Statistical analysis was done with the help of SPSS v 11.0. To compare the non-parametric issues, chi-square test was run and continuous variables were analyzed using independent sample t test.

In general, migraineurs had progressive illness (χ(2)=9.45; P=0.002) with increasing severity (χ(2)=21.86; P<0.001), frequency (χ(2)=8.5; P=0.04) and duration of each headache episode (χ(2)=4.45; P=0.03) as compared to TTH subjects. Along with the headache, they more commonly suffered orthostatic pre-syncope (χ(2)=19.94; P<0.001), palpitations (42%vs.18% among TTH patients; χ(2)=6.87; P=0.009), nausea and vomiting (68% vs. 6% in TTH; χ(2)=41.22; P<0.001, and 38% vs. none in TTH; χ(2)=23.45, P<0.001, respectively), phonophobia (χ(2)=44.98; P<0.001), photophobia (χ(2)=46.53; P<0.001), and osmophobia (χ(2)=15.94; P<0.001). Their pain tended to be aggravated by head bending (χ(2)=50.17; P<0.001) and exercise (χ(2)=11.41; P<0.001). Analgesics were more likely to relieve pain in migraineurs (χ(2)=21.16; P<0.001). In addition, post-headache lethargy was more frequent among the migraineurs (χ(2)=22.01; P<0.001). On the other hand, stressful situations used to trigger TTH (χ(2)=9.33; P=0.002) and muscle parafunction was more common in TTH patients (46% vs. 20%; χ(2)=7.64; P=0.006). All the cranial autonomic symptoms were more common in migraineurs as compared to TTH subjects (conjunctival injection: χ(2)=10.74, P=0.001; lacrimation: χ(2)=17.82, P<0.001; periorbital swelling: χ(2)=23.45, P<0.001; and nasal symptoms: χ(2)=6.38, P=0.01).

A number of symptoms that are presently not included in the ICHD-2 classification may help in differe-ntiating the migraine from the TTH.