All of us experience all types of headaches. While some people have migraine headaches, others have a type of headache known as tension headaches. There are many common terms that you must have heard doctors use, including mixed tension headache, chronic tension headache, mixed headache syndrome, chronic daily headache, migraine headache, and many others. There are many different types of headaches that happen frequently, some of them may strike more than 15 days every month.

These can be either migraine or tension headaches. A mixed tension headache or mixed tension migraine is a type of headache that has features of both a migraine headache and a tension headache, and these tend to occur more frequently in women than in men. Read on to find out everything about what is a mixed tension migraine.

What is a Mixed Tension Migraine?

Over the years, medical experts have concluded that there is a continuum of headaches. It is believed that migraine headaches are at one end of this continuum and tension headaches are at the other end. A mixed tension migraine is a kind of headache that has features of both a migraine headache as well as a tension headache. However, the International Headache Society does not recognize mixed tension migraine to be an official type of migraine. Instead, society classifies tension-type headaches and migraine without aura headaches as being two different types of headaches.^{(1, 2, 3, 4, 5)}

Mixed tension migraine is known to affect more women than men. It is believed that a tension headache is caused due to tension in the muscles, and according to the World Health Organization, it is the most common type of headache. Meanwhile, the cause of migraine headaches is believed to be pain-causing inflammatory substances that surround the nerves and blood vessels in the brain. Millions of people experience frequent migraine headaches all over the world.^{(6, 7, 8)}

Mixed tension migraines are known to have symptoms of both tension and migraine headaches. Due to this, this type of headache falls someplace in the middle of the headache continuum, and it is typically believed that the migraine symptoms strike first, which causes tension, thus triggering the tension headache.

Some mixed tension migraines can last for half an hour, while others can even last for over a week. Experts are not exactly sure what causes this type of mixed headache, but it is believed that stress is a common trigger for mixed tension migraines. For the majority of people, this type of mixed tension migraine is managed with medication and by making specific lifestyle changes especially avoiding the common headache triggers.

Symptoms of Mixed Tension Migraines

Mixed tension migraines tend to have symptoms of both migraines and tension headaches. However, every person experiences different symptoms. This means that you may experience more of the symptoms that are associated with a migraine headache than the symptoms of a tension headache, or vice versa.

The pain experienced in mixed tension migraine can range from throbbing to dull and from mild to severe. This type of headache typically lasts for anywhere between 4 to 72 hours. Some of the common symptoms of a mixed tension migraine may include:⁽⁹⁾

Nausea or vomiting
Pain on one or both sides of the head that tends to worsen with any type of physical activity.
Neck pain
Fatigue
Sensitivity to sound, light, smells, or all of these.
Irritability
Depression
Tingling, numbness, or weakness in the limbs

When we talk about the symptoms of mixed tension migraines, it is essential to understand the symptoms of both types of headaches separately as well.

Tension headaches are known to typically cause a dull and aching pain that is spread out over a large part of your face and head. It is usually not severe enough to cause you to stop doing your day-to-day chores. This form of headache can last for a few minutes to several days, and unlike migraine, the pain does not worsen while doing normal activities like climbing stairs, walking or running. There is also no nausea and/or vomiting associated with this type of headache. People also don’t experience any sensitivity to light, sound, or smells. When you experience the symptoms of a migraine headache with these symptoms, doctors will diagnose you with mixed tension migraine.^{(10, 11, 12)}

The symptoms of migraine without aura are slightly different. The headache pain is throbbing and usually limited to just one side of the head. It is also severe enough to prevent you from doing your regular activities. Some of the other common symptoms of migraine include nausea, vomiting, sensitivity to light, sound, and smell, tingling sensation of numbing in the face, etc. Migraine attacks can last for a full day or even a week sometimes.^{(13, 14, 15)}

Diagnosis of Mixed Tension Migraine Headaches

There is no particular test that is used for diagnosing mixed tension migraines. Your doctor will arrive at a diagnosis after listening to your symptoms and by ruling out the other causes of your symptoms. If you are experiencing the symptoms of a mixed tension migraine, your doctor will start the diagnosis process by asking about your health history. Your doctor will ask about your symptoms, what the pain feels like, the frequency of your headaches, where you feel the pain, and other such questions.

Your doctor will also enquire about whether there is a history of headaches in your family. This is because there is a genetic link present with migraines. Most people who experience migraine headaches usually have a family member who also has frequent migraines.^{(16, 17, 18)}

If needed, your doctor will perform a neurological examination to rule out any neuropathy and neurological disorders that are known to cause similar symptoms. Your reflexes and muscle tone will also be tested, along with your response to various stimuli like temperature, touch, light, and vibration. The results from these exams will tell your doctor if your nervous system is working normally.

You may also have to undergo a CT scan or MRI scan of the head and neck. Your doctor gets to see detailed images of your brain and brain stem from these tests to check if your symptoms are caused by some problem in the brain. Blood work may also be ordered to find out if there are any other underlying conditions causing your headaches.^{(19, 20)}

If a more serious condition is suspected, like hemorrhage or bacterial meningitis, your doctor may prescribe a lumbar puncture or a spinal tap. A spinal tap uses a needle to take out fluid from the spine. This fluid is analyzed to search for evidence of any problems.

Treatment for Mixed Tension Migraines

Treatment for mixed tension migraines includes treatments for both migraines and tension headaches. The exact treatment will depend on your symptoms and their severity. Some of these include:

Medication

There are many medications for the treatment of mixed tension migraines. Some of these include:

Analgesics: These drugs help reduce the pain of less severe migraines and tension headaches. Medication includes acetaminophen (brand name: Tylenol).
Combination Analgesics: These medications tend to contain caffeine that helps reduce the pain associated with tension headaches and migraine.
Triptans: Triptans cause blood vessels to constrict, thus helping ease migraine pain.
Non-Steroidal Anti-inflammatory Drugs (NSAIDs): This class of drugs helps reduce inflammation and pain. They include medicines like aspirin and ibuprofen (brand name: Advil), which are also known for being analgesics.
Ergot Derivative Drugs: These medicines help reduce the pain signals that get transmitted along the nerves making you feel the pain.
Anti-Nausea Drugs: They alleviate nausea and vomiting caused by mixed tension migraine.

There are some medications that can be taken to prevent the onset of mixed tension migraines, including:

Antidepressants: They typically work on neurotransmitters in the brain and help prevent headaches.
Calcium Channel Blockers: These help the blood vessels remain the same size while also promoting good blood flow to prevent headaches.
Beta-blockers: These drugs are designed for the treatment of high blood pressure, but they also help prevent migraines.

Cognitive Behavioral Therapy (CBT) and Biofeedback

Many people find relief with cognitive behavioral therapy (CBT) and biofeedback. Both these therapies help you learn how to be aware of the causes of stress and how to control your response to stress. In CBT, a therapist enables you to determine the thoughts that cause stress, and they teach you techniques to change your thought patterns and reduce your stress levels.

Biofeedback makes use of special equipment to teach you how to monitor and control your response to stress, such as muscle tension.

Nutrition and Complementary Therapy

Apart from medications and therapy, there are many other treatments that can help alleviate mixed tension migraines. Vitamin B2 and magnesium deficiencies are commonly found in people with migraines. Increasing the intake of these vitamins can help prevent migraines.

At the same time, eating your meals regularly throughout the day, getting regular exercise, staying hydrated, and getting a good night’s sleep can also be helpful in preventing migraines. Meditation, massage, physical therapy, applying moist heat to the back of the neck, and relaxation training are all some other methods that may work in case of mixed tension migraines.

Conclusion: Can You Prevent a Mixed Tension Migraine?

Though the exact cause of migraines is not known, it is known that there are some clear triggers for a migraine. Avoiding these headache triggers can help prevent mixed tension migraines. Maintaining a log of your headaches, noting down what you eat and drink, and what you were doing just before getting a mixed tension migraine will help you find out what triggers your headaches.

References:

Team, E., What is mixed tension migraine? Migraine.com. Available at: https://migraine.com/migraine-types/tension-migraine#:~:text=Differences%20between%20headache%20and%20migraine,aura%20as%202%20separate%20types. [Accessed August 24, 2022].
Anon, 2022. Guidelines. International Headache Society. Available at: https://ihs-headache.org/en/resources/guidelines/ [Accessed August 24, 2022].
Philips, C., 1978. Tension headache: Theoretical problems. Behaviour Research and Therapy, 16(4), pp.249-261.
Blanchard, E.B., Andrasik, F., Ahles, T.A., Teders, S.J. and O’Keefe, D., 1980. Migraine and tension headache: A meta-analytic review. Behavior Therapy, 11(5), pp.613-631.
Kaniecki, R.G., 2002. Migraine and tension-type headache: an assessment of challenges in diagnosis. Neurology, 58(9 suppl 6), pp.S15-S20.
Anon, Headache disorders. World Health Organization. Available at: https://www.who.int/en/news-room/fact-sheets/detail/headache-disorders [Accessed August 24, 2022].
Friedman, A.P., Von Storch, T.J. and Merritt, H.H., 1954. Migraine and tension headaches: clinical study of two thousand cases. Neurology.
Burch, R., 2019. Migraine and tension-type headache: diagnosis and treatment. Medical Clinics, 103(2), pp.215-233.
Anderson, C.D. and Franks, R.D., 1981. Migraine and tension headache: is there a physiological difference?. Headache: The Journal of Head and Face Pain, 21(2), pp.63-71.
Millea, P.J. and Brodie, J.J., 2002. Tension-type headache. American Family Physician, 66(5), p.797.
Langemark, M., Olesen, J., Poulsen, D.L. and Bech, P., 1988. Clinical characterization of patients with chronic tension headache. Headache: The Journal of Head and Face Pain, 28(9), pp.590-596.
Drummond, P.D. and Lance, J.W., 1984. Clinical diagnosis and computer analysis of headache symptoms. Journal of Neurology, Neurosurgery & Psychiatry, 47(2), pp.128-133.
Anon, 2020. What type of headache do you have? Harvard Health. Available at: https://www.health.harvard.edu/healthbeat/what-type-of-headache-do-you-have [Accessed August 24, 2022].
Lipton, R.B. and Stewart, W.F., 1998. Migraine headaches: epidemiology and comorbidity. Clinical Neuroscience (New York, NY), 5(1), pp.2-9.
Baloh, R.W., 1997. Neurotology of migraine. Headache: The Journal of Head and Face Pain, 37(10), pp.615-621.
Montagna, P., 2000. Molecular genetics of migraine headaches: a review. Cephalalgia, 20(1), pp.3-14.
De Vries, B., Frants, R.R., Ferrari, M.D. and van den Maagdenberg, A.M., 2009. Molecular genetics of migraine. Human genetics, 126(1), pp.115-132.
Russell, M.B. and Olesen, J., 1993. The genetics of migraine without aura and migraine with aura. Cephalalgia, 13(4), pp.245-248.
Pryse-Phillips, W.E., Dodick, D.W., Edmeads, J.G., Gawel, M.J., Nelson, R.F., Purdy, R.A., Robinson, G., Stirling, D. and Worthington, I., 1997. Guidelines for the diagnosis and management of migraine in clinical practice. Cmaj, 156(9), pp.1273-1287.
Pryse-Phillips, W.E., Dodick, D.W., Edmeads, J.G., Gawel, M.J., Nelson, R.F., Purdy, R.A., Robinson, G., Stirling, D. and Worthington, I., 1997. Guidelines for the diagnosis and management of migraine in clinical practice. Cmaj, 156(9), pp.1273-1287.

Also Read:

What is a Mixed Tension Migraine?