Headache is the most common reason for visits to neurology clinics. The two most common types of headaches in our country are tension headaches and migraines. Tension headache is also known as myoconstriction headache. Tension headache is often caused by persistent contraction of the muscles in the head, neck or back due to prolonged mental overstrain, exertion, anxiety, or prolonged poor posture, or due to factors such as trauma or cervical spondylosis. Clinically, there is often a feeling of pressure and heaviness in the temporal region, the top of the head or the cervical occipital region bilaterally, and some patients complain of a feeling of “tightness” in the head. Headaches tend to occur after the age of 30, and are more common in women than men. In the current modern city, people are living and working at a significantly faster pace in order to adapt to the competitive environment, and the work pressure is also increasing, so the tension headache is also more prominent and common. A survey conducted in Hong Kong in March this year showed that 60% of Hong Kong women have tension headaches. In China, tension headaches have increased by 20% over the past 10 years due to the intense work and competitive pressure of white-collar workers. Migraine is a disorder characterized by episodic unilateral or bilateral headache caused by abnormal diastolic and contractile functions of intracranial and extracranial blood vessels due to multiple causes. It can occur at any age, is more common in 20-40 years old, and is three times more common in women than in men. It is the second cause of headache and is one of the main causes of loss of social work ability in patients. I. How to identify tension headache and migraine 1. Different causes: tension headache is pain caused by continuous contraction of head and neck muscles due to mental tension, anxiety, depression or local diseases of cervical spine (cervical spondylosis, etc.); while migraine is mostly caused by menstrual flow, sunlight exposure, food and food additives, etc. 2. Clinical manifestations are different: about 90% or more of patients with tension headache have headache on both sides, mostly on the two temporal sides, forehead, back of the occipital area and top of the head or the whole head. The nature of headache is dull pain, distension, pressure, numbness and band-like tightness, but not ergogenous, mostly not accompanied by nausea and vomiting. The intensity of the headache is mild to moderate, relieved by activity, and aggravated by stress or sleep at night. Some patients may have persistent headaches for years and years, and some patients may have symptoms that go back 10-20 years. Patients can have headaches all day long, but there can be fluctuating sensations of gradual intensification and gradual reduction throughout the day. The headache often worsens because of factors such as excitement, anger, insomnia, anxiety or depression. In contrast, the migraine mostly starts from one side of the head and can spread to the whole head. The headache is episodic, ergogenic in nature, lasts for 4-72 hours, worsens after activity and decreases after sleep or rest, and is mostly accompanied by nausea and vomiting. However, there are some patients who have not only the characteristics of myotonic headache but also the clinical manifestations of migraine, complaining of bilateral temporal throbbing headache, sometimes nausea, vomiting, anxiety, tension, and sleep. This kind of clinical manifestation of both tension headache and migraine is called mixed headache. In addition, if migraine is not effectively treated, it can become mixed headache after a long time attack. How to prevent and control tension headache and migraine Preventing and improving tension headache requires a change in your lifestyle. For example, make sure you can do 45 minutes of aerobic exercise at least 4 days in a week, even when you are most tired. Get enough sleep, but make sure you go to bed and get up at the same time every day. Set aside at least 15 minutes a day to have at your disposal to read, think or enjoy some relaxing music …… Stick with it and you will be a new you in maybe 5 or 6 weeks. If the above relaxation therapy has little effect, you should go to the hospital to find the cause under the guidance of a doctor, such as first neck radiograph (X-ray, CT or MRI) examination, if cervical spine lesions are found, treat cervical spondylosis first, together with muscle relaxation drugs, anti-inflammatory and painkilling drugs and local massage, generally speaking, the effect is very good; if the neck radiograph (X-ray, CT or MRI) examination is not abnormal, and the patient has anxiety, depression, or chest tightness, panic, or with sleep disorder, then, in addition to the above-mentioned drugs to relieve the symptoms, timely anti-anxiety, anti-depression and insomnia treatment should be carried out. Physiotherapy such as local muscle massage, acupuncture, hot water baths, etc. can also play a role in the relief of symptoms. In addition, some patients clinically have both cervical spine lesions (such as cervical spondylosis or trauma) and anxiety or depression, in which case, both cervical spondylosis and anti-anxiety and depression should be treated. Prevention and treatment of migraine should pay attention to menstrual hygiene, be well rested, avoid fatigue, and do not eat cold, cool or foods containing caffeine, 5-hydroxytryptamine or tyrosine, such as coffee, cheese, cola, etc. Treatment is divided into treatment for acute attacks and treatment to prevent recurrence: non-steroidal analgesics such as anti-inflammatory pain are used during acute attacks; if necessary, treprostans, such as Eucerin or ergot, such as ergotamine caffeine. If there are more than 2 attacks per month, they are treated with seizure prevention drugs, such as antiepileptics, calcium antagonists, beta-receptor antagonists, antidepressants and anxiolytics. In conclusion, tension headache and migraine are currently the two most common types of headache in China, and we should identify them early and prevent them. Severe cases should be promptly treated in hospital.