What Is a Mixed Tension Migraine?
Scientists believe that there is a continuum of headaches, with
tension headache at one end and migraine at the other. A mixed tension migraine
is a headache that has characteristics of both a tension headache and a
migraine headache. They occur more commonly in women than in men.
Pain-producing inflammatory substances surrounding blood vessels
and nerves in the brain are thought to
cause migraines. Millions of people worldwide experience regular
Tension headaches are caused by muscle tension, and are even more
common than migraine headaches. According to the World Health
Organization, this headache type affects over 80 percent of adult females
and 65 percent of adult males.
Because mixed tension migraines have symptoms of both migraine
and tension headaches, they fall somewhere in the middle of the headache continuum.
It’s believed that the migraine comes first, and it causes tension that
triggers a tension headache.
For most people, this type of headache can be managed with
medication and by avoiding headache triggers.
What Are the Symptoms of Mixed Tension Migraines?
Mixed tension migraines have symptoms of both tension headaches
and migraines. However, symptoms may vary from person to person. In other
words, you may have more symptoms associated with a migraine than a tension headache
or vice versa.
The pain of a mixed tension migraine can vary from dull to
throbbing and from mild to severe. Mixed tension migraines typically last 4 to
72 hours. Symptoms of a mixed tension migraine include:
- pain on one or both sides of the head that may
get worse with activity
- nausea or vomiting
- sensitivity to light and/or sound
- neck pain
- numbness, tingling, or weakness in the limbs
How Is a Mixed Tension Migraine Diagnosed?
There is no test for mixed tension migraine, but your doctor can
form a diagnosis based on your symptoms and by ruling out other causes of your
symptoms. If you’re experiencing symptoms of a mixed tension migraine, your
doctor will begin by taking your health
history. They’ll ask you about your symptoms, including where you feel
the pain, what the pain feels like, and how often the headaches occur.
Your doctor will also ask you about your family’s history with
headaches. This is because migraines may have a genetic link. Most people who
experience migraines have a family member who also experiences migraines.
Your doctor may perform a neurological exam to rule out neuropathy and neurological
disorders that can cause similar symptoms. During this test, your doctor will
test your reflexes and muscle tone. They’ll also test your response to
different kinds of stimuli like light touch, temperature, and vibration. The
results of this test will tell your doctor if your nervous system is
Your doctor may order a computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan of your head and neck. These
tests will provide your doctor with an image of your brain and brain stem to
see if your symptoms are being caused by a problem in the brain.
Your doctor may also order blood work to determine if underlying
conditions are causing your headaches.
If your doctor suspects a more serious problem like bacterial
meningitis or hemorrhage, they may order a lumbar puncture or spinal tap. This test uses a needle to
collect fluid from your spine. They’ll test the fluid, which is called cerebrospinal fluid, for evidence
Mixed Tension Migraine Treatment Options
Treatment options for mixed tension migraine can include
treatments for both tension headaches and migraines. The treatment will depend
on your symptoms.
Drugs and Medication
Medications for treating mixed tension migraines include the
work to cause blood vessels to constrict and ease migraine pain
work to ease pain of less severe migraines and tension headaches, and include
acetaminophen, ibuprofen, and aspirin
analgesics: often contain caffeine to ease migraine and tension headache
- ergot derivative
drugs: help decrease pain signals transmitted along the nerves
anti-inflammatory drugs (NSAIDs): reduce pain and inflammation
drugs: ease nausea and vomiting caused by mixed tension migraine
A number of medications can be taken to prevent mixed tension
migraines. These medications include:
designed to treat high blood pressure, but can also prevent migraines
channel blockers: help the blood vessels remain the same size and
promote good blood flow
work on neurotransmitters in the brain and can prevent headaches
Nutrition and Complementary Therapy
Along with medications, there are several other methods that can
help relieve mixed tension migraines. Magnesium and
vitamin B2 deficiencies have
been noted in people with migraines. Increasing your intake of those vitamins
may help prevent your migraines.
Eating regularly throughout the day, staying hydrated, and
getting regular exercise and enough sleep might also be helpful. Relaxation
training, meditation, massage or physical therapy, and applying moist heat to
the back of your neck may provide relief.
CBT and Biofeedback
Some people find cognitive-behavioral therapy (CBT) and
biofeedback helpful. Both therapies will teach you to be aware of what causes stress
and how to control your response to those stressors.
In CBT, a
therapist will help you understand the thoughts that cause you stress. They’ll teach
you ways to change those thoughts and lower your stress.
special equipment to teach you to monitor and control responses to stress like
Mixed Tension Migraine Prevention
Although the exact cause of migraines isn’t understood, it’s
clear that some things can trigger a migraine. Avoiding your headache triggers
can help prevent mixed tension migraines.
Try keeping a log of your headaches, what you ate or drank, and
your surroundings before you felt a mixed tension migraine. Use this record to
figure out what triggers your headaches.
Common headache triggers include:
- alcohol, especially beer and red wine
- bright or flashing lights
- skipping meals
- certain odors
- particular foods or food additives like nitrates
- not getting enough sleep or getting too much
- menstruation and other changes in hormone levels
- overuse or withdrawal from certain medications