Migraine vs. Headache: How to Tell the Difference
Not every bad headache is a migraine, and not every migraine involves severe head pain. Here's how to tell the difference — and why it matters for getting the right treatment.
"It's just a headache." This phrase frustrates anyone who lives with migraine, because the two conditions are fundamentally different — in their biology, their symptoms, their impact, and their treatment. At the same time, the line between them isn't always obvious, which is why many people with migraine go years without a correct diagnosis.
Here's how to actually tell them apart.
What a Tension Headache Actually Is
The most common type of headache — the one most people mean when they say "just a headache" — is a tension-type headache. It produces a dull, steady ache or pressure sensation that typically affects both sides of the head, often described as a tight band or vice around the skull. Tension headaches are not usually worsened by movement. Nausea is uncommon. Sensitivity to light or sound may occur, but rarely both at once and rarely severely.
Tension headaches are unpleasant but generally manageable with over-the-counter pain relievers. They tend to last 30 minutes to a few hours, occasionally longer, and they don't typically interfere with daily function the way a migraine does.
What Migraine Actually Is
Migraine is a neurological disease — a disorder of brain excitability that involves widespread changes in nervous system activity, blood flow, and pain processing. A migraine attack is not simply a severe headache. The headache is one symptom of a complex process that can involve four distinct phases (prodrome, aura, headache, postdrome) and affect multiple body systems at once.
The headache itself, when it occurs, is typically moderate to severe in intensity, often one-sided (though not always), and described as throbbing or pulsating. It characteristically worsens with physical activity — walking up stairs, bending over, moving quickly — which is a key distinguishing feature. Tension headaches typically don't change with movement.
Nausea or vomiting accompany many migraine attacks. Sensitivity to light (photophobia) and sensitivity to sound (phonophobia) are hallmark features, often to a degree where the person needs to lie in a dark, quiet room. These symptoms are rare or mild with tension headaches.
The Clinical Diagnostic Criteria
Neurologists use criteria from the International Classification of Headache Disorders to formally diagnose migraine. For migraine without aura, the criteria require at least five attacks with:
- Duration of 4 to 72 hours (untreated or unsuccessfully treated)
- At least two of: one-sided location, pulsating quality, moderate-to-severe pain, worsened by routine activity
- At least one of: nausea/vomiting, or sensitivity to both light and sound
- Not better accounted for by another diagnosis
You don't need to memorize these criteria, but knowing them can help you recognize why what you're experiencing isn't "just a headache" — and why it warrants specific treatment.
Can You Have Both?
Yes. Many people with migraine also get tension headaches, and the two can be difficult to distinguish, especially at the start of an attack before it fully develops. Some mild migraines never reach severe intensity and may look superficially like a bad tension headache. And some tension headaches become severe enough that they're mistaken for migraine.
The best guide is the pattern over time. If your headaches regularly involve nausea, light sensitivity, sound sensitivity, and worsening with movement — especially if they're one-sided and throbbing — migraine is the more likely diagnosis regardless of pain severity.
Why the Distinction Matters
Treatment is where the difference becomes practically significant. Tension headaches generally respond to common over-the-counter analgesics like ibuprofen or paracetamol. Migraine-specific medications — triptans, gepants (like rimegepant), ditans (like lasmiditan), and the newer CGRP-targeting treatments — work specifically on migraine pathways and are far more effective for migraine than standard pain relievers.
If you're treating what is actually migraine with only ibuprofen or paracetamol, you may be undertreating your attacks — and over time, frequent use of those medications can even worsen the pattern through medication overuse headache.
Getting the right diagnosis from a neurologist or headache specialist opens the door to treatments that are actually targeted to what's happening in your brain. If you suspect your headaches are migraines but haven't been diagnosed, bringing detailed symptom data to your doctor is the most useful thing you can do.
Tracking Helps Clarify the Diagnosis
A migraine diary that captures attack timing, symptoms, severity, associated features, and potential triggers builds exactly the kind of pattern data that's most useful for diagnosis and treatment decisions. Environmental triggers like barometric pressure changes — one of the most reliably researched migraine triggers — can be tracked automatically using MigraineCast, which correlates your logged attacks with real weather data to help identify patterns you wouldn't spot on your own.
Think your headaches might be migraine? Start tracking with MigraineCast on iOS — log attacks in seconds and build the data your doctor needs to give you an accurate picture.
Frequently Asked Questions
What is the key difference between a migraine and a tension headache?
The most reliable distinguishing features: migraines typically worsen with physical activity (walking, bending over), while tension headaches don't. Migraines are commonly one-sided and pulsating; tension headaches produce bilateral pressure or tightening. Nausea, vomiting, and severe light and sound sensitivity together point strongly to migraine. Duration differs too: tension headaches typically last 30 minutes to a few hours; migraines last 4 to 72 hours.
Can a headache be both a migraine and a tension headache?
Yes — many people with migraine also experience tension-type headaches, and a mild migraine can look like a tension headache if it doesn't reach severe intensity. The two can coexist, and distinguishing them in any given episode is sometimes genuinely difficult. The pattern over time — whether attacks regularly involve nausea, light/sound sensitivity, and worsening with movement — is a more reliable guide than any single episode.
What officially makes a headache a migraine?
Neurologists use the International Classification of Headache Disorders (ICHD-3) criteria: at least 5 attacks lasting 4–72 hours, with at least 2 of the following 4 features (one-sided, pulsating, moderate-to-severe pain, worsened by routine activity), and at least 1 of: nausea/vomiting or both light and sound sensitivity. The attacks must not be better explained by another condition.