Migraine vs Headache: How to Tell the Difference

What makes a migraine different from a regular headache?

Migraine is a disorder of the nervous system, not simply a severe version of the tension headaches that most people experience occasionally. Clinicians use the International Classification of Headache Disorders (ICHD) criteria, which define migraine by a specific cluster of features. A migraine attack typically:

• Lasts between 4 and 72 hours if untreated
• Produces moderate to severe pain that is often throbbing or pulsating
• Is usually (but not always) one-sided — affecting one temple, behind one eye, or on one half of the face
• Worsens with routine physical activity such as walking or climbing stairs
• Causes nausea or vomiting
• Causes marked sensitivity to light (photophobia) and/or sound (phonophobia)

For a diagnosis of migraine without aura, at least five attacks meeting these features are required. For migraine with aura, two attacks with a fully reversible aura are sufficient 1Ref 1National Library of Medicine (2025).Migraine.ICHD diagnostic criteria for migraine and migraine with aura — features and duration thresholds.

What is migraine aura?

Aura is a set of fully reversible neurological symptoms that develop over 5–60 minutes and resolve before or as the headache begins. About one in four people with migraine experience aura. The most common form is visual aura — often described as a flickering arc of light (called a scintillating scotoma) or a blind spot that gradually expands across the visual field. Other aura types include:

• Sensory aura — tingling or numbness spreading up one arm or across the face
• Speech/language aura — difficulty finding words or forming sentences
• Motor aura — weakness on one side (this is less common and is called hemiplegic migraine)

The visual aura of migraine is distinctive enough that many people recognize it immediately, though the first occurrence can be frightening. A new aura always warrants a clinical evaluation to rule out other causes.

What is a tension-type headache, and how is it different?

Tension-type headache is the most common headache disorder. Its features are quite different from migraine:

| Feature | Tension headache | Migraine | |---|---|---| | Location | Both sides of the head | Usually one side | | Quality | Pressing, tightening, band-like | Throbbing, pulsating | | Severity | Mild to moderate | Moderate to severe | | Worsens with activity | Usually not | Yes | | Nausea | Rare | Common | | Light/sound sensitivity | Mild or absent | Often significant | | Duration | 30 minutes to 7 days | 4–72 hours |

Tension headaches can sometimes accompany stress, poor posture, or neck muscle tension, and they respond reasonably well to over-the-counter analgesics. They do not usually disable people the way migraines do.

What about cluster headaches?

Cluster headaches are far less common than migraine or tension headaches but are among the most severe pain conditions known. Key features:

• Excruciating, stabbing or burning pain strictly around or behind one eye
• Attacks last 15–180 minutes but occur in clusters — one to eight times per day for weeks to months, then remit
• Accompanied by autonomic symptoms on the same side as the pain: tearing, eye redness, nasal congestion or runny nose, drooping eyelid, restlessness (people often cannot stay still, unlike migraines where lying still helps)
• More common in men

Cluster headaches require evaluation by a clinician or headache specialist — first-line treatments differ substantially from migraine therapy.

Is it possible to have both migraine and tension headaches?

Yes. Many people experience both types, and they can be difficult to distinguish when a tension headache escalates in severity. Some clinicians use the presence of nausea, photophobia, and activity-worsening as the most reliable distinguishing features of migraine. A headache diary that tracks symptoms, severity, and functional impact over several months helps clarify the pattern.

A primary care clinician can review your headache history, apply diagnostic criteria, and determine whether you need any testing (such as imaging) to rule out secondary causes 2Ref 2Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society (2021).The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice.Headache diary use, diagnosis in primary care, and integrating migraine workup into clinical practice.

When should I see a clinician about my headaches?

See a Gale primary care clinician if: - Headaches are happening four or more times per month - Attacks last more than a day and significantly disrupt your life - Over-the-counter treatments are not working or you are using them more than two days per week - The headache pattern has changed significantly - Headaches started after age 50

Primary care is the right first stop for headache evaluation. Many migraines can be effectively managed at this level, and your clinician will refer you to a neurologist or headache specialist when indicated 3Ref 3Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E (2012).Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.Threshold for specialist referral and when preventive therapy is indicated at primary care level.