A migraine is a neurological condition with distinct phases, triggers, and symptoms that set it apart from a regular headache. The most common type of headache, a tension headache, produces mild to moderate pain that feels like a tight band around your head. A migraine produces moderate to severe throbbing pain, typically on one side, and comes with additional symptoms like nausea and sensitivity to light or sound. Understanding the differences helps you identify what you’re dealing with and respond appropriately.
How the Pain Feels and Where It Hits
The clearest starting point is the pain itself. A tension headache creates a dull ache or pressure that can affect any part of your head and often radiates to your upper back and neck. People frequently describe it as a tight band squeezing around the skull. The intensity stays in the mild to moderate range, and while it’s uncomfortable, it rarely stops you from going about your day.
Migraine pain is different in almost every way. It throbs or pulses, tends to concentrate on one side of the head (though it can affect both sides or switch between episodes), and ranges from moderate to severe. A hallmark feature: it gets worse with routine physical activity. Something as simple as walking up stairs or bending over can intensify the pain. This is one of the reasons migraines are so disabling compared to tension headaches.
Symptoms Beyond the Pain
What really separates a migraine from a headache is everything that happens alongside the pain. Tension headaches are mostly just pain. Migraines bring a package of neurological symptoms that can be more disruptive than the headache itself.
During a migraine, you’ll typically experience at least one of these: nausea or vomiting, sensitivity to light (photophobia), or sensitivity to sound (phonophobia). About 69% of people with migraines meet clinical thresholds for photosensitivity. Many also develop something called cutaneous allodynia, where normally painless touch, like brushing your hair or resting your head on a pillow, becomes painful.
Tension headaches don’t cause nausea or vomiting, and while mild light or sound sensitivity can occasionally occur, it’s not a defining feature the way it is with migraines.
The Four Phases of a Migraine
A migraine isn’t just a headache that shows up and leaves. It moves through up to four distinct phases, and the headache is only one of them.
Prodrome is the warning phase. It can begin hours or even days before the pain starts. Symptoms include mood changes (irritability, depression), fatigue, difficulty focusing, food cravings, frequent urination, excessive yawning, neck stiffness, and even constipation or diarrhea. Many people learn to recognize their prodrome symptoms as an early alert that a migraine is coming.
Aura affects about 20% of people with migraines. It typically involves visual disturbances like zigzag lines, blind spots, or flashing lights, though some people experience tingling in the face or hands, or difficulty speaking. Aura usually develops over several minutes and lasts less than an hour.
Headache is the main attack phase. An untreated migraine lasts anywhere from 4 to 72 hours. In children and teenagers, attacks can be shorter, starting from about 2 hours. During this phase, the throbbing pain, nausea, and sensory sensitivities peak.
Postdrome is sometimes called a “migraine hangover.” After the pain fades, you may feel fatigued, achy, dizzy, and have trouble concentrating for hours or longer. This phase catches many people off guard because they expect to feel fine once the headache stops.
Tension headaches have none of these phases. They come on gradually, last from 30 minutes to several hours, and end without lingering effects.
What Triggers Each Type
Tension headaches are most commonly triggered by stress, poor posture, eye strain, dehydration, and muscle tension in the neck and shoulders. The triggers are relatively straightforward and tend to be physical or situational.
Migraine triggers overlap with some of those but extend much further. Hormonal fluctuations, particularly drops in estrogen during menstrual periods, pregnancy, and perimenopause, are a major trigger for many women. Specific foods can set off attacks: aged cheeses, salty and processed foods, food additives like MSG, and the artificial sweetener aspartame. Alcohol (especially wine) and excessive caffeine are common culprits. Skipping meals alone can be enough to trigger an episode.
Sensory stimuli play a bigger role in migraines than in tension headaches. Bright or flashing lights, loud sounds, and strong smells like perfume, paint thinner, or secondhand smoke can all initiate an attack. Weather changes and disrupted sleep patterns are also well-documented triggers. Many people with migraines find their attacks are set off by a combination of triggers rather than a single one.
Why Migraines Happen
Tension headaches are generally linked to muscle contraction and stress responses. Migraines involve something far more complex. They are a neurological disorder rooted in the brain’s pain-signaling system.
The leading explanation centers on what researchers call the trigeminovascular system: a network connecting the trigeminal nerve (the major nerve responsible for sensation in the face and head) to the blood vessels surrounding the brain. During a migraine, this system becomes activated, releasing powerful signaling molecules that cause blood vessels in the brain’s protective lining to dilate and become inflamed. This inflammation stimulates pain receptors, producing the characteristic throbbing pain.
One of these signaling molecules, called CGRP, has become a proven therapeutic target. Newer migraine treatments work by blocking its activity, which is why migraine-specific medications exist while tension headaches are typically managed with standard pain relievers.
The Sinus Headache Problem
One of the most common sources of confusion isn’t tension headaches at all. It’s sinus headaches. Studies show that about 90% of self-diagnosed “sinus headaches” are actually migraine attacks.
The confusion makes sense. About 45% of people with migraines experience nasal congestion or watery eyes during an attack. This happens because the same nerves activated during a migraine also supply the sinuses, eyes, and ears. When those nerves fire, they can produce congestion and a runny nose that feels exactly like a sinus problem.
A true sinus headache, called rhinosinusitis, is caused by a viral or bacterial infection and comes with thick, discolored nasal discharge, reduced sense of smell, aching in the upper teeth, and often fever. The pain resolves within about seven days as the infection clears. If your “sinus headaches” keep coming back, are triggered by stress or hormonal changes, come with nausea or light sensitivity, and interfere with your ability to function normally, there’s a 98% chance you’re actually experiencing migraines.
A Quick Comparison
- Pain type: Tension headaches produce a dull, pressing ache. Migraines produce throbbing, pulsating pain.
- Location: Tension headaches affect both sides of the head. Migraines typically affect one side.
- Intensity: Tension headaches are mild to moderate. Migraines are moderate to severe.
- Duration: Tension headaches last 30 minutes to several hours. Migraines last 4 to 72 hours untreated.
- Physical activity: Tension headaches aren’t worsened by movement. Migraines get worse with routine activity.
- Nausea: Absent in tension headaches. Common in migraines.
- Light and sound sensitivity: Rare or mild in tension headaches. A defining feature of migraines.
- Additional phases: Tension headaches have none. Migraines can include prodrome, aura, and postdrome phases.
When a Headache Pattern Changes
If you’ve always had what seemed like ordinary headaches but they’ve started lasting longer, occurring on one side, making you nauseous, or sending you to a dark room, your headaches may have been migraines all along, or they may be evolving. A formal migraine diagnosis requires at least five attacks that meet specific criteria: lasting 4 to 72 hours, with at least two pain characteristics (one-sided, pulsating, moderate to severe, or worsened by activity) and at least one associated symptom (nausea/vomiting or sensitivity to both light and sound).
Tracking your headaches in a diary, including the pain location, intensity, duration, accompanying symptoms, and potential triggers, gives you and your doctor the clearest picture of what’s happening. Many people live with migraines for years thinking they just get “bad headaches,” and the distinction matters because migraines respond to different treatments and management strategies than tension headaches do.