• Ravi Gupta and Manjeet Singh Bhatia.
• Department of Psychiatry, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India.
• Indian J Psychiatry. 2011 Apr 1;53(2):134-9.

ContextMigraine 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.Materials And MethodsThis 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.ResultsIn 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).ConclusionA number of symptoms that are presently not included in the ICHD-2 classification may help in differe-ntiating the migraine from the TTH.

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