A regular headache produces mild to moderate pressure or tightness across both sides of your head. A migraine is a neurological condition that causes moderate to severe throbbing pain, typically on one side, along with symptoms like nausea, light sensitivity, and sometimes visual disturbances. The distinction matters because migraines require different treatment, affect daily functioning far more severely, and are one of the top three causes of disability worldwide.
How the Pain Feels
The most common type of everyday headache is a tension-type headache. It feels like a band of pressure squeezing both sides of your head, dull and steady rather than pounding. The pain is mild or moderate, and it doesn’t get worse when you walk up stairs, bend over, or move around. Tension-type headaches last anywhere from 30 minutes to 7 days, and more than 70% of some populations experience them periodically.
Migraine pain is different in almost every way. It’s pulsating or throbbing in about 85% of episodes. It hits one side of the head in roughly 60% of attacks, though it can affect both sides. The intensity is moderate to severe, and physical activity makes it worse. Even routine movement like climbing stairs or walking briskly can amplify the pain. A migraine attack lasts 4 to 72 hours if untreated, and the pain often fluctuates in severity without fully disappearing during that window.
Symptoms Beyond the Pain
This is the biggest distinguishing factor. A tension headache is essentially just head pain. You won’t feel nauseated, and you might have mild sensitivity to light or sound, but not both at the same time. Vomiting doesn’t happen with tension headaches.
Migraine brings a constellation of other symptoms. About 80% of migraine episodes involve nausea. Around 90% involve sensitivity to light. Many people also become sensitive to sound and smell, and some vomit. These symptoms are so prominent that lying in a dark, quiet room often feels like the only tolerable option. A tension headache is annoying; a migraine can make normal functioning impossible.
The Four Phases of a Migraine
Unlike a regular headache, which tends to come and go without much warning, a migraine attack can unfold over several days in distinct phases. Not everyone experiences all four, but recognizing them can help you intervene earlier.
Prodrome
Hours or even days before the headache begins, you may notice mood changes, fatigue, food cravings, frequent urination, neck stiffness, or excessive yawning. These warning signs are easy to miss if you’re not looking for them, but they’re remarkably consistent from one attack to the next for many people.
Aura
About 25 to 30% of people with migraine experience aura, which typically develops over 5 minutes and lasts up to an hour (though in about 20% of cases, it lasts longer). Aura involves visual disturbances: geometric patterns, shimmering or flashing lights, or blind spots in your field of vision. Some people also feel tingling or numbness, or have difficulty speaking.
Headache
The pain phase lasts from several hours to three days. Beyond the throbbing head pain, this phase can include anxiety, insomnia, and heightened sensitivity to light, sound, and smell.
Postdrome
After the pain resolves, many people feel drained for hours or longer. Fatigue, difficulty concentrating, body aches, and lingering light sensitivity are common. Some describe feeling “hungover.” This phase is often overlooked, but it’s a real part of the attack.
What’s Happening in the Brain
Tension headaches involve tightening of the muscles in the scalp, neck, and jaw, often triggered by stress, poor posture, or fatigue. The underlying mechanism is relatively straightforward.
Migraine is a neurological event. The trigeminal nerve, which is the major pain-signaling nerve for the head and face, becomes activated and releases inflammatory signaling molecules into the membranes surrounding the brain. One of these molecules, called CGRP, causes blood vessels in the brain’s lining to dilate and triggers inflammation and pain. This process, known as the trigeminovascular pathway, is now so well understood that newer migraine medications work by blocking CGRP directly. The fact that targeted therapies exist for migraine but not for tension headaches reflects just how different these two conditions are biologically.
Migraine vs. Cluster Headaches
Some people also confuse migraines with cluster headaches, but these are quite different. Cluster headaches produce intense, piercing pain strictly on one side of the head, typically around or behind the eye. They’re shorter (30 to 90 minutes) but can strike up to eight times in a single day, with completely pain-free periods between attacks. The eye on the affected side often turns red and tears up, and the nostril on that side gets congested.
Behaviorally, the two conditions look opposite. People with migraine want to lie still in the dark. People with cluster headaches become restless and agitated, often pacing or rocking during an attack.
Why Migraines Get Misdiagnosed
One of the most common misdiagnoses is “sinus headache.” Migraine can cause nasal congestion, facial pressure, and watery eyes, which leads many people (and some doctors) to assume the problem is in the sinuses. Research pooling data from multiple studies found that among patients who believed they had sinus headaches, 55 to 65% actually met the diagnostic criteria for migraine. In studies looking at confirmed migraine patients, misdiagnosis rates reached as high as 81.5%, with some people going undiagnosed for up to 38 years.
If you get recurring “sinus headaches” that come with throbbing pain, nausea, or sensitivity to light, the cause is more likely migraine than a sinus problem. Getting the right diagnosis changes what treatment you receive and how effective it is.
How Treatment Differs
Tension headaches respond well to standard over-the-counter pain relievers like ibuprofen or acetaminophen. Rest, hydration, and stress management handle most episodes without any medication at all.
Mild to moderate migraines can also be treated with those same pain relievers, but moderate to severe attacks typically require migraine-specific medications called triptans, which work by narrowing blood vessels and blocking pain signals in the trigeminal nerve. For people with frequent migraines, preventive medications taken daily can reduce the number of attacks. Newer treatments that block the CGRP molecule have become available for people who don’t respond to older options. None of these migraine-specific treatments work for tension headaches, which again underscores that the two conditions have different biological roots.
Headache Warning Signs That Need Urgent Attention
Most headaches and migraines, while painful, aren’t dangerous. But certain features suggest a headache may be caused by something more serious, like a blood vessel problem or increased pressure in the brain.
- Sudden, explosive onset: A headache that reaches maximum intensity within seconds (“thunderclap headache”) can signal a vascular emergency and needs immediate evaluation.
- Neurological changes: New weakness in an arm or leg, numbness, vision changes, or confusion alongside a headache are not typical of migraine or tension headaches.
- Fever or systemic illness: Headache with fever, night sweats, or unexplained weight loss can point to infection or another underlying condition.
- New headaches after age 50: A first-time headache pattern appearing later in life is more likely to have a secondary cause.
- Progressive worsening: A headache pattern that steadily becomes more severe or more frequent over weeks deserves investigation.
- Position-dependent pain: Headaches that dramatically change in intensity when you stand up, lie down, or strain (coughing, bearing down) can indicate pressure changes in the brain.