A mixed tension migraine is a headache that has characteristics of both a tension headache and a migraine headache. According to Harvard Health, scientists believe that there is a continuum of headaches, with tension headache at one end and migraine at the other (Harvard Health).
Medical professionals believe that migraines are caused by changes in the blood flow to the brain. Millions of people worldwide experience regular migraine headaches (Christie Clinic). Tension headaches, which are caused by muscle tension, are even more common. According to the World Health Organization, this headache type affects over 80 percent of adult females and 65 percent of adult males (WHO).
As mixed tension migraines have symptoms of both migraine and tension headaches, they are thought to be somewhere in the middle of the headache continuum. It is believed that the migraine comes first, and it causes tension that triggers a tension headache.
Mixed tension migraines (like regular tension heaches) occur more commonly in women than in men. 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, the symptoms may vary from individual to individual. 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 four 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 and/or vomiting
- sensitivity to light and/or sound
- neck pain
- numbness, tingling, or weakness in the limbs
If you are experiencing symptoms of a mixed tension migraine, your doctor will begin by taking a patient history. He or she will 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 have a genetic link. Most people who experience migraines have a family member who also experiences migraines.
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.
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. He or she will also test your response to different kinds of stimulus, such as light touch, temperature, and vibration. The results of this test will tell your doctor if your nervous system is functioning normally.
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 because underlying conditions can cause headaches.
Finally, if your doctor suspects a more serious problem like bacterial meningitis or hemorrhage, he or she may order a lumbar puncture or spinal tap. This test uses a needle to collect fluid from your spine. The fluid, which is called cerebrospinal fluid (CSF), will then be tested for evidence of certain problems.
Treatment options for mixed tension migraine can include treatments for both tension headaches and migraines. The treatment will depend on your symptoms.
Medications for treating mixed tension migraines include:
- triptans, which work to cause blood vessels to constrict and ease migraine pain
- analgesics, such as acetaminophen, ibuprofen, and aspirin to ease pain of less severe migraines and tension headaches
- combination analgesics, which often contain caffeine to ease migraine and tension headache pain
- ergot derivative drugs, which help decrease pain signals transmitted along the nerves
- non-steroidal anti-inflammatory drugs (NSAIDs), to reduce pain and inflammation
- anti-nausea drugs, to ease nausea and vomiting caused by mixed tension migraine
There are also a number of medications that can be taken to prevent mixed tension migraines. These medications include:
- beta-blockers, which are designed to treat high blood pressure but can also prevent migraines
- calcium channel blockers, which help the blood vessels to remain the same size and promote good blood flow
- antidepressants, which work on neurotransmitters in the brain and can prevent headaches
Nutrition and Complimentary Therapy
Along with medications, there are several other methods that can help relieve mixed tension migraines. According to the Mayo Clinic (Mayo), magnesium and vitamin B2 deficiencies have been noted in people who suffer migraines (Mayo). 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 things that cause you stress and how to control your response to those stressors.
In CBT, a therapist will help you understand the thoughts that cause your feelings of stress. Your therapist will 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 is clear that some things can trigger a migraine. Avoiding your headache triggers can help prevent mixed tension migraines. Try keeping a diary of your headaches, noting what you ate or drank and a description of your surroundings before you felt a mixed tension migraine. Use your diary 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 sleep
- menstruation and other changes in hormone levels
- overuse or withdrawal from certain medications
Written by: Janelle Martel
Medically reviewed by George Krucik, MD