Headache vs Migraine: How to Tell the Difference

"Headache" covers a lot of ground, from a dull ache after a long day at a screen to pain severe enough to send you to bed in a dark room. Migraine sits at the severe end for many people, but it isn't simply a worse headache. It is a distinct neurological condition with its own pattern of symptoms.

So when people ask about headache vs migraine, the real question is usually which kind of headache they are having. This guide explains how migraine differs from other common headaches, using the criteria doctors use and guidance from the NHS, Mayo Clinic and the US National Institutes of Health.

Not medical advice. This article explains general differences between headache types. It can't diagnose you. Only a doctor can tell you which type of headache you have. If you have any of the emergency warning signs listed below, seek help immediately.

Is migraine just a bad headache?

No. NINDS describes migraine as "a health condition that is more than having a bad headache" (NINDS). The head pain is one part of an attack that may also include nausea, sensitivity to light and sound, and symptoms before and after the headache.

Headache itself is a symptom, and many different conditions can cause it. Doctors classify headaches using the International Classification of Headache Disorders (ICHD-3), published by the International Headache Society. Broadly, it separates:

• Primary headaches, where the headache disorder is the condition itself. Migraine, tension-type headache and cluster headache are the best known.
• Secondary headaches, caused by something else, such as an infection, an injury, or overuse of headache medication.

Both migraine and tension-type headache are common. A worldwide review of population studies estimated that about 11% of adults have active migraine and about 42% have tension-type headache (Stovner et al., 2007).

How migraine is defined

For migraine without aura, the most common type, ICHD-3 describes attacks that last 4 to 72 hours when untreated or unsuccessfully treated (ICHD-3, 1.1). The headache has at least two of these four features:

• On one side of the head
• Pulsating or throbbing
• Moderate or severe pain
• Made worse by, or causing you to avoid, routine physical activity like walking or climbing stairs

During the headache there is also at least one of:

• Nausea and/or vomiting
• Sensitivity to both light and sound

ICHD-3 requires at least five such attacks before a diagnosis of migraine without aura, because one or two attacks can be hard to tell apart from other causes (ICHD-3, 1.1).

Migraine phases

Many people notice symptoms beyond the headache itself. Mayo Clinic describes four possible stages (Mayo Clinic):

• Prodrome: one or two days before, subtle changes such as mood shifts, food cravings, neck stiffness, frequent yawning or needing to pee more.
• Aura: in some people, reversible nervous system symptoms that build up over several minutes, most often visual.
• Attack: the headache phase, usually 4 to 72 hours if untreated.
• Postdrome: feeling drained, confused or washed out for up to a day afterwards.

Not everyone goes through every stage. NINDS also notes that some people have migraine episodes without headache at all (NINDS).

What aura is

ICHD-3 describes aura as fully reversible visual, sensory, speech or other nervous system symptoms that usually develop gradually (ICHD-3, 1.2). Each symptom typically lasts 5 to 60 minutes. Visual aura is the most common, occurring in over 90% of people with migraine with aura, at least in some attacks. It often appears as a zigzag shape that spreads gradually. Pins and needles moving slowly across one side of the body or face are the next most common.

Aura is not a feature of tension-type headache. Because some aura symptoms can resemble other serious conditions, any new or unusual neurological symptom should be checked by a doctor.

How tension-type headache differs

Tension-type headache is the most common primary headache. ICHD-3 describes it as typically affecting both sides of the head, with a pressing or tightening quality, mild to moderate intensity, and lasting from 30 minutes to 7 days (ICHD-3, 2.1). It has at least two of these features:

• On both sides of the head
• Pressing or tightening, not pulsating
• Mild or moderate pain
• Not made worse by routine physical activity

It also has no nausea or vomiting, and at most one of light or sound sensitivity, not both.

The NHS describes tension headaches as feeling like "something is pressing on your head or being tightened around it". It adds that you should be able to keep doing daily activities without making the headache worse (NHS). The NHS also notes that a throbbing pain on one side of the head, feeling sick, vomiting or finding light or noise painful can be signs of a different type of headache, such as migraine (NHS).

Migraine vs tension headache

Based on the ICHD-3 criteria above:

Feature	Migraine (without aura)	Tension-type headache
Location	Often one side	Usually both sides
Quality	Pulsating or throbbing	Pressing or tightening
Intensity	Moderate to severe	Mild to moderate
Physical activity	Makes it worse	Doesn't make it worse
Nausea or vomiting	Common	No
Light and sound sensitivity	Often both	At most one
Typical duration	4 to 72 hours	30 minutes to 7 days
Aura	In some people	No

Real life is messier than a table. Not every attack ticks every box, and you can have more than one headache type. ICHD-3 notes that telling tension-type headache apart from mild migraine without aura is the most common diagnostic difficulty among primary headaches, partly because people with frequent headaches often have both (ICHD-3, 2).

Migraine vs cluster headache

Cluster headache is much rarer, but it is sometimes confused with migraine. The NHS describes (NHS):

• Sharp, burning or piercing pain, usually on one side of the head, around the eye
• Attacks lasting between 15 minutes and 3 hours, which can happen several times a day for weeks or months
• Attacks that often come at the same time of day or year
• Feeling restless or agitated during an attack, rather than wanting to lie still
• A red, watering eye, drooping eyelid, or blocked or runny nose on the same side as the pain

That restlessness is a useful contrast with migraine, where pain is typically made worse by moving around.

Other common causes of headache

The NHS lists everyday causes of headache that aren't migraine, including colds and flu, stress, alcohol, bad posture, eyesight problems, irregular meals, dehydration, hormonal changes around periods or menopause, and taking too many painkillers (NHS). Most headaches go away on their own and aren't a sign of something serious.

Why a headache diary helps tell them apart

Many of the features that separate migraine from other headaches are hard to remember accurately afterwards: which side the pain was on, whether it throbbed, how long it lasted, whether light bothered you. Recording them as they happen gives your doctor much better information. The NHS suggests keeping a diary of how often headaches happen, how long they last, how painful they are, other symptoms and any medicines taken (NHS).

If you want a structured way to do it on iPhone or iPad, Mira is a free tracker that lets you record headache type, pain location on a visual pain map, severity, duration, symptoms and medication for each episode. You can export your history to share with your doctor. It doesn't tell you what type of headache you have; it helps you give your doctor the details they need to work that out. Our free headache diary covers the fields that matter most, and you can print it or fill it in online.

When a headache needs urgent help

Most headaches are not dangerous, but some need immediate care. The NHS advises calling 999 (or your local emergency number) or going to A&E if a headache (NHS):

• Started suddenly and is extremely painful
• Comes with a seizure, or numbness or weakness in the body or face
• Follows a head injury within the last 3 months
• Comes with difficulty speaking, balancing, walking or remembering
• Comes with drowsiness, confusion or loss of vision
• Comes with a rash that doesn't fade when a glass is rolled over it
• Comes with a very high temperature, a stiff neck, or bright lights bothering you

Mayo Clinic adds new headache pain after age 50, and a chronic headache that gets worse after coughing, exertion, straining or sudden movement, as reasons to see a healthcare professional right away (Mayo Clinic).

FAQ

What is the main difference between a migraine and a headache?

Migraine is a specific neurological condition. Its attacks usually involve moderate to severe, often one-sided, throbbing pain that worsens with activity, plus nausea or sensitivity to light and sound. A tension-type headache is usually a milder, pressing pain on both sides without nausea.

How do I know if my headache is a migraine?

You can't be sure on your own. Doctors diagnose migraine from your history, using criteria such as ICHD-3. Keeping a record of your symptoms makes that assessment more accurate.

Can you have a migraine without a headache?

Yes. NINDS notes that some people have migraine episodes without a headache, and ICHD-3 recognises aura without headache.

Can I have both migraine and tension-type headaches?

Yes. ICHD-3 notes that people with frequent headaches often have both, which is one reason telling them apart can be tricky.

How long does a migraine last compared with a tension headache?

Under ICHD-3, an untreated migraine attack in adults lasts 4 to 72 hours. A tension-type headache lasts from 30 minutes to 7 days.

---

This article is for general information only and is not medical advice. It does not replace a consultation with a qualified health professional.