The quickest way to tell: if your headache comes with nausea, sensitivity to light or sound, or gets worse when you move around, it’s likely a migraine. A regular tension-type headache produces a steady, dull pressure on both sides of your head and doesn’t come with those extra symptoms. The distinction matters because migraines and tension headaches respond to different treatments, and many people live with migraines for years without realizing that’s what they have.
What a Tension Headache Feels Like
Tension-type headaches are the most common kind. They feel like a tight band squeezing around your head, with mild to moderate pressure on both sides. The pain is steady rather than throbbing, and it doesn’t get worse when you walk up stairs or bend over. You can generally push through your day, even if it’s unpleasant.
These headaches typically last anywhere from 30 minutes to several hours. They don’t cause nausea, and they don’t make you want to hide in a dark room. If your headache fits this description and responds well to over-the-counter pain relievers, you’re almost certainly dealing with a tension headache.
What Makes a Migraine Different
A migraine is a neurological event, not just a bad headache. Untreated, a migraine attack lasts between 4 and 72 hours. The pain is often moderate to severe, frequently throbbing, and tends to concentrate on one side of the head, though it can shift or affect the entire head. The location varies: behind one eye, at the temple, or across the front or back of the skull.
What really separates migraines from tension headaches are the accompanying symptoms. In a population-based study of people with migraine, about 81% experienced sensitivity to sound, 74% had sensitivity to light, 71% reported nausea, and 48% had vomiting. These aren’t rare side effects. They’re central features of the condition. Physical activity also makes migraine pain worse, because a faster heartbeat increases the throbbing sensation. With a tension headache, exercise is neutral or even helpful.
About 30% of people with migraines also experience an aura, a set of sensory disturbances that typically starts 20 to 60 minutes before the headache itself. Visual auras are most common: flashing lights, zigzag lines, or blind spots that drift across your field of vision. Some people get tingling or numbness in their hands or face, ringing in the ears, dizziness, or difficulty speaking clearly. If you’ve ever had visual disturbances followed by a one-sided throbbing headache, that’s a strong signal you’re dealing with migraine.
The Sinus Headache Problem
Many people who think they have sinus headaches actually have migraines. This is one of the most common misdiagnoses in headache medicine. A meta-analysis of studies on self-diagnosed or clinically diagnosed “sinus headache” found that 55% of those patients actually met the criteria for migraine, rising to 65% when probable migraine and tension-type headaches were factored in. In some studies, misdiagnosis rates reached as high as 81.5%, with delays in correct diagnosis stretching up to 38 years.
The confusion happens because migraines can cause nasal congestion, watery eyes, and facial pressure, symptoms people naturally attribute to their sinuses. The key difference is that a true sinus headache comes with an active infection: thick, discolored nasal discharge, fever, and pain that doesn’t throb or worsen with movement. If your “sinus headaches” keep coming back without signs of infection, and especially if they involve nausea or light sensitivity, they’re likely migraines.
How Cluster Headaches Differ From Both
Cluster headaches are less common but worth knowing about because they’re sometimes confused with migraines. A cluster headache hits one side of the head, usually around the eye or temple, and brings intense, piercing pain that peaks within minutes. Unlike migraines, which make people want to lie still in a dark room, cluster headaches often cause restlessness and pacing.
The hallmark of a cluster headache is a set of symptoms on the same side as the pain: a red, watering eye, a drooping eyelid, and nasal congestion or a runny nose, all strictly on one side. Migraines can occasionally cause tearing and congestion too, but those symptoms tend to affect both sides of the face. Cluster headaches are also shorter, typically lasting 15 minutes to 3 hours, and they arrive in clusters of daily or near-daily attacks over weeks or months.
Why the Type of Headache Affects Treatment
Tension headaches generally respond to common pain relievers like ibuprofen or acetaminophen. Migraines often don’t, or they respond only partially. That’s because migraine pain involves different brain mechanisms, including changes in blood vessel circulation and disrupted pain signaling through serotonin pathways.
Prescription migraine medications called triptans work by targeting serotonin receptors that control blood vessel width in the brain and regulate neurotransmitter release. They’re effective for migraines (with or without aura) and cluster headaches, but they won’t do anything for a tension headache. If over-the-counter pain relievers consistently fail to touch your headache, that itself is a clue that you may be dealing with migraine rather than tension-type pain. People who experience frequent migraines also have preventive medication options that reduce how often attacks occur.
A Quick Comparison
- Pain quality: Tension headaches feel like pressure or tightness. Migraines tend to throb or pulse.
- Location: Tension headaches affect both sides. Migraines often favor one side, though not always.
- Severity: Tension headaches are mild to moderate. Migraines are moderate to severe and can be disabling.
- Duration: Tension headaches last 30 minutes to several hours. Migraines last 4 to 72 hours untreated.
- Nausea: Absent in tension headaches. Present in roughly 70% of migraines.
- Light and sound sensitivity: Rare with tension headaches. Present in 74% and 81% of migraines, respectively.
- Effect of movement: Tension headaches aren’t worsened by physical activity. Migraines typically are.
- Aura: Never occurs with tension headaches. Occurs in about 30% of migraines.
When a Headache Needs Urgent Attention
Most headaches, including migraines, aren’t dangerous. But certain features 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 a brain aneurysm and needs immediate evaluation.
Other red flags include a headache accompanied by fever, night sweats, or other signs of systemic illness. New neurological symptoms that aren’t part of your usual pattern, such as sudden weakness on one side of your body, new numbness, or vision changes, also warrant urgent attention. A new type of headache appearing for the first time after age 50 is more likely to have a secondary cause. And any headache that is clearly getting worse over time, becoming more severe or more frequent in a steady progression, should be evaluated rather than managed at home.
New headaches during or shortly after pregnancy also deserve prompt assessment, since they can occasionally reflect vascular or hormonal complications specific to that period.