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 migraine headaches.
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.
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 your head that may get worse with activity
- nausea or vomiting
- sensitivity to light, sound, or both
- neck pain
- numbness, tingling, or weakness in your limbs
There is no test for mixed tension migraine. 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 exam, 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 will tell your doctor if your nervous system is functioning normally.
Your doctor may order a CT scan or 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 your 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, also known as a spinal tap. This test uses a needle to collect fluid from your spine. They’ll analyze the fluid, which is called cerebrospinal fluid, for evidence of problems.
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 following:
- triptans: cause blood vessels to constrict and ease migraine pain
- analgesics: ease pain of less severe migraines and tension headaches, and include acetaminophen (Tylenol)
- combination analgesics: often contain caffeine to ease migraine and tension headache pain
- ergot derivative drugs: help decrease pain signals transmitted along the nerves
- nonsteroidal anti-inflammatory drugs: reduce pain and inflammation, and include ibuprofen (Advil), and aspirin (Bufferin), which are also analgesics
- anti-nausea 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:
- beta-blockers: designed to treat high blood pressure, but can also prevent migraines
- calcium channel blockers: help the blood vessels remain the same size and promote good blood flow
- antidepressants: 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 moist heat applied 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.
Biofeedback uses special equipment to teach you to monitor and control responses to stress like muscle tension.
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 enough sleep or too much sleep
- menstruation and other changes in hormone levels
- overuse or withdrawal from certain medications
Written by: Janelle Martel
Medically reviewed on May 11, 2017 by Deborah Weatherspoon, PhD, MSN, RN, CRNA