The simplest way to tell: if your head pain is throbbing, sticks to one side, and makes you want to lie down in a dark room, it’s likely a migraine. If it feels like a tight band of pressure across your whole head and you can still go about your day, it’s probably a tension headache. But the distinction goes deeper than that, and getting it right matters because the two respond to different treatments.
How the Pain Feels
A tension headache produces mild to moderate steady pressure, often felt across the forehead or in the back of the head. It’s uncomfortable but rarely stops you from functioning. Most tension headaches last anywhere from 30 minutes to 7 days, and a defining feature is that walking, climbing stairs, or other routine physical activity doesn’t make the pain worse.
Migraine pain is different in almost every way. It’s moderate to severe, pulsating or throbbing, and often concentrated on one side of the head, around the temple or behind one eye. An untreated migraine attack typically lasts 4 to 72 hours. One of the clearest distinguishing signs is that routine movement makes it worse. Walking up a flight of stairs or bending over to pick something up can noticeably intensify the pain, which is why most people with a migraine want to stop what they’re doing and lie still.
There’s a catch, though. As headaches intensify, the lines blur. A severe tension headache can start to feel throbbing, resembling a migraine. And when migraines become very frequent, their pain can flatten into something that feels more like a tension headache. So pain quality alone isn’t always enough to tell them apart.
The Symptoms Beyond Pain
What really separates a migraine from a regular headache is everything that comes with it. Tension headaches are essentially just pain. Migraines bring a constellation of other symptoms that affect your whole body.
In a population-based study of people with migraine, about 81% experienced sound sensitivity, 74% had light sensitivity, 71% reported nausea, and 48% dealt with vomiting. These aren’t occasional add-ons. They’re core features of the condition. If bright lights bother you, sounds feel too loud, or you feel queasy during a headache, that strongly points toward migraine.
Tension headaches don’t typically involve nausea or significant sensitivity to light and sound. You might prefer a quieter room, but you’re not retreating from normal lighting or feeling like you might throw up.
What Aura Looks Like
About a quarter to a third of people with migraine experience aura, a set of neurological symptoms that typically appear 10 to 30 minutes before the head pain starts. Aura is never part of a tension headache, so if you’ve experienced it, you can be confident you’re dealing with migraines.
Visual aura is the most common type. It can start as a small hole of light or bright geometric lines in your field of vision, sometimes expanding into a C-shaped or crescent pattern with zigzag edges. Some people see bright spots, flashes, or experience partial vision loss in one eye. Sensory aura is also common: a tingling sensation that starts in one hand and slowly travels up the arm over 10 to 20 minutes, sometimes spreading to one side of the face and tongue. Rarer forms include temporary difficulty finding words or speaking, and in the least common type (hemiplegic migraine), weakness on one side of the body.
Different Triggers, Different Patterns
Stress can trigger both types, but through different mechanisms. With tension headaches, stress tightens the muscles in your shoulders and neck, and the pain radiates upward. With migraines, stress acts as a neurological trigger, setting off a cascade that results in throbbing, one-sided pain with all its accompanying symptoms.
Migraines have a much longer list of specific triggers. Certain foods, including aged cheese, chocolate, processed meats, citrus fruits, and foods containing MSG or nitrates, can set one off. Hormonal shifts are a major factor: menstrual cycles, perimenopause, and estrogen-based therapies are all tied to migraine onset or worsening. Caffeine withdrawal is another classic trigger. If you normally drink coffee and skip it one day, the resulting headache is often a migraine, not a tension headache, because caffeine constriction of blood vessels reverses and vessels dilate. Environmental factors like bright light, strong scents, humidity, and cold weather are also common migraine triggers.
Tension headaches tend to follow simpler patterns. They’re most closely linked to muscle tension from stress, poor posture, or fatigue. They don’t typically respond to food triggers or hormonal changes the way migraines do.
The “Sinus Headache” Trap
Many people who think they have sinus headaches actually have migraines. A meta-analysis of studies looking at patients who self-diagnosed sinus headache found that 59% of them actually met the criteria for migraine when evaluated by a clinician. The confusion makes sense: migraines can cause pain around the eyes and forehead, pressure in the face, and even nasal congestion. But true sinus headaches almost always come with an active sinus infection, including thick discolored nasal discharge and fever. If your “sinus headaches” recur without those infection signs, they’re likely migraines.
A Quick Comparison
- Pain location: Tension headaches affect both sides of the head. Migraines typically hit one side.
- Pain quality: Tension headaches feel like steady pressure or tightness. Migraines throb or pulse.
- Intensity: Tension headaches are mild to moderate. Migraines are moderate to severe.
- Duration: Tension headaches last 30 minutes to 7 days. Migraines last 4 to 72 hours untreated.
- Physical activity: Walking or climbing stairs doesn’t worsen a tension headache. It makes a migraine noticeably worse.
- Nausea: Rare with tension headaches. Present in about 70% of migraine attacks.
- Light and sound sensitivity: Minimal with tension headaches. Reported by 74% and 81% of migraine sufferers, respectively.
- Aura: Never occurs with tension headaches. Occurs in some migraine sufferers.
Warning Signs That Need Urgent Attention
Most headaches and migraines, while miserable, aren’t dangerous. But certain patterns signal something more serious. A sudden, explosive headache that reaches maximum intensity within seconds (sometimes called a thunderclap headache) can indicate a vascular emergency like an aneurysm and needs immediate evaluation.
Other red flags include headaches accompanied by new neurological symptoms like weakness in an arm or leg, numbness you haven’t experienced before, or vision changes outside of your usual aura pattern. A headache paired with fever, night sweats, or other signs of systemic illness also warrants prompt medical attention. New-onset headaches after age 50, headaches that are clearly and steadily getting worse over weeks, and head pain that changes dramatically with position (standing versus lying down) or that’s triggered by coughing or straining are all patterns worth getting checked out quickly.