The simplest way to tell a headache from a migraine is by checking for three things: throbbing pain (often on one side), nausea, and sensitivity to light or sound. A standard tension headache produces a dull, pressing sensation on both sides of your head. A migraine brings moderate to severe throbbing pain, usually concentrated around one temple or behind one eye, and it comes packaged with symptoms that have nothing to do with your head at all.
How the Pain Feels Different
A tension headache feels like a band of pressure squeezing evenly around your skull. People often describe it as a vice grip. The pain sits on both sides, stays at a mild to moderate level, and rarely stops you from getting through your day. It’s uncomfortable and distracting, but you can usually push through work, errands, or a conversation without much trouble.
Migraine pain is a different animal. It throbs or pulses, tends to settle on one side of your head (though not always), and ranges from moderate to severe. The pain often centers around your eyes or temples. Physical activity, even something as simple as bending over to pick something up or climbing stairs, can make migraine pain noticeably worse. That’s a useful test: if moving around intensifies your headache, you’re likely dealing with a migraine. Tension headaches generally don’t respond to movement at all.
Symptoms Beyond the Pain
This is where the distinction becomes clearest. A tension headache is essentially just head pain. A migraine recruits your whole body.
Over 80% of people with migraines experience sensitivity to light and sound. During an attack, normal room lighting can feel blinding and ordinary conversation volume can feel unbearable. Many people retreat to dark, quiet rooms not because it’s comfortable, but because any sensory input amplifies the pain. Nausea is also common, sometimes progressing to vomiting. You might notice sensitivity to smells too, where perfume or cooking odors become intolerable.
Tension headaches don’t typically produce any of these accompanying symptoms. If your headache comes with nausea or sends you reaching for sunglasses indoors, that’s a strong signal you’re experiencing a migraine.
The Four Phases of a Migraine
One of the most distinctive features of a migraine is that it doesn’t just start and stop. It unfolds in phases, and the headache itself is only one of them.
The first phase, called the prodrome, can begin hours or even days before the pain arrives. You might feel unusually irritable, fatigued, or unable to concentrate. Some people notice food cravings, excessive yawning, neck stiffness, or frequent urination. These warning signs are easy to miss if you don’t know to look for them, but once you recognize your personal pattern, they can give you a head start on treatment.
About 25 to 30% of migraine sufferers experience an aura, which typically develops over five minutes and lasts up to an hour. Visual auras are the most common: flashing lights, zigzag lines, shimmering spots, or temporary blind spots in your field of vision. Some people get sensory auras instead, feeling tingling or numbness that spreads through an arm or up one side of the face. A smaller number experience speech difficulties, like slurred words or trouble finding the right phrase. If you’ve never had an aura before and suddenly develop one, it’s worth getting evaluated to rule out other causes.
The headache phase itself lasts anywhere from several hours to three days. Beyond the throbbing pain, this phase can include anxiety, insomnia, and the light and sound sensitivity described above.
After the pain resolves, many people enter a postdrome phase sometimes called a “migraine hangover.” You might feel wiped out, achy, dizzy, or mentally foggy for hours afterward. This phase doesn’t happen with tension headaches, and experiencing it is another clue that what you had was a migraine.
The Sinus Headache Problem
Many people who think they get sinus headaches actually have migraines. Research pooling data from multiple studies found that roughly 59% of people who self-diagnosed with sinus headaches were clinically determined to have migraines instead. The confusion makes sense: migraines can cause pain and pressure around the forehead, cheeks, and eyes, and they sometimes trigger nasal congestion or a runny nose. But true sinus headaches are caused by an active infection and come with thick discolored nasal discharge, reduced sense of smell, and often fever. If your “sinus headaches” recur without those infection signs, especially if they bring nausea or light sensitivity, you’re likely dealing with migraines.
Why Migraines Hurt Differently
Migraines aren’t just a more intense version of a headache. They involve a fundamentally different process in your brain. The pain originates from a network connecting blood vessels and membranes surrounding the brain to the trigeminal nerve, which is the largest sensory nerve in your head and face. When this system activates during a migraine, nerve endings release a signaling molecule that dilates blood vessels and triggers inflammation in the protective tissues around the brain. This cascade creates the throbbing, pulsing quality of migraine pain and explains why the experience is so much more intense and complex than the muscle tension behind a standard headache.
Tension headaches, by contrast, are thought to involve tightening of the muscles in the scalp, neck, and shoulders, along with changes in pain sensitivity. The mechanism is simpler, which is why the symptoms are simpler too.
A Quick Self-Check
When you’re in the middle of a headache and trying to figure out what you’re dealing with, run through these questions:
- Where is the pain? Both sides evenly (likely tension) vs. one side or around one eye (likely migraine)
- What does it feel like? Steady pressure or squeezing (tension) vs. throbbing or pulsing (migraine)
- Does moving make it worse? No change (tension) vs. noticeably worse with activity (migraine)
- Do you feel nauseated? Rarely with tension headaches, common with migraines
- Is light or sound bothering you more than usual? A hallmark of migraines, not tension headaches
- Did you notice warning signs beforehand? Prodrome symptoms like unusual fatigue, cravings, or yawning point toward migraine
If you answer “yes” to two or more of the migraine indicators, particularly nausea and light sensitivity combined with one-sided throbbing pain, a migraine is the most likely explanation.
Headache Symptoms That Need Immediate Attention
Most headaches and migraines, while miserable, aren’t dangerous. But certain patterns signal something more serious. A headache that reaches maximum intensity within seconds, often called a thunderclap headache, can indicate a vascular emergency like a brain aneurysm and needs evaluation right away. The same applies to headaches accompanied by new neurological symptoms like sudden weakness on one side of your body, vision changes that don’t fit your usual migraine aura, or numbness you haven’t experienced before.
Other warning signs include headaches that are clearly getting worse over weeks, a new headache pattern starting after age 50, headaches that change with body position (significantly better or worse when you stand up or lie down), and headaches paired with fever, night sweats, or unexplained weight loss. New headaches during or shortly after pregnancy also warrant prompt evaluation. These patterns don’t automatically mean something dangerous is happening, but they fall outside the profile of typical tension headaches and migraines and deserve a closer look.