The simplest way to tell a headache from a migraine is to check three things: where it hurts, how it hurts, and what else is happening in your body. A typical tension headache produces mild to moderate pressure on both sides of your head, while a migraine delivers moderate to severe pulsating pain, usually on one side, and comes with symptoms that have nothing to do with your head at all, like nausea, vomiting, or intense sensitivity to light and sound.
Where and How the Pain Feels
Tension headaches are often described as a band tightening around the head. The pain is pressing or squeezing, sits on both sides, and stays in the mild to moderate range. You can usually keep going about your day, even if it’s unpleasant. Walking, climbing stairs, or other routine physical activity won’t make the pain worse.
Migraine pain is different in almost every way. It tends to pulse or throb, concentrating around one eye or one side of the head. The intensity is moderate to severe, and routine physical activity makes it noticeably worse. That last detail is actually part of the formal diagnostic criteria: if bending over, walking up stairs, or light exercise ramps up your pain, that points toward migraine rather than a tension headache.
Symptoms Beyond the Pain
This is where the two conditions really diverge. A tension headache is essentially just head pain. You might feel some scalp tenderness or neck tightness, but your stomach is fine and you can tolerate normal light and noise. By definition, tension headaches don’t cause nausea or vomiting, and they allow for at most one of light sensitivity or sound sensitivity, not both.
Migraine, on the other hand, is a whole-body event. Nausea is common, and vomiting isn’t unusual. Light and sound can become genuinely unbearable. Some people also develop skin sensitivity called allodynia, where things that shouldn’t hurt (a ponytail, a shirt collar, resting your head on a pillow) suddenly do. One study found that about 25% of migraine patients experience this kind of skin sensitivity even between attacks, and nearly 70% show heightened light sensitivity.
The Four Phases of a Migraine
One of the clearest differences is that migraines don’t just start and stop. They unfold in phases, sometimes over the course of days. A tension headache, by contrast, is generally a single episode of pain that fades.
Prodrome
Hours or even days before the headache arrives, you might notice subtle warning signs: unusual fatigue, neck stiffness, mood changes, food cravings, excessive yawning, or frequent urination. These prodrome symptoms are unique to migraine and can serve as early signals that an attack is building.
Aura
About 20% of people with migraines experience aura, a phase of neurological symptoms that typically develops over at least five minutes and lasts up to an hour. Visual aura is the most recognizable type: you might see zigzag lines, shimmering lights, bright geometric shapes, or a growing blind spot in your vision. The classic pattern, sometimes called a fortification spectrum, looks like the jagged walls of a medieval fort expanding across your field of view. Some people also get tingling that travels up an arm over 10 to 20 minutes, spreading to one side of the face and tongue. Rarely, aura can cause temporary speech difficulties or weakness on one side of the body.
Headache
The pain phase itself lasts anywhere from several hours to three days. Along with the throbbing head pain, this phase often brings nausea, anxiety, insomnia, and sensitivity to sound, light, and smell.
Postdrome
Even after the pain ends, many people feel a “migraine hangover” marked by fatigue, body aches, dizziness, difficulty concentrating, and lingering light sensitivity. This recovery phase has no real equivalent in a tension headache, where you typically feel fine once the pain subsides.
Duration Differences
Tension headaches can last from 30 minutes to seven days, which is a wide range. Migraines, if untreated, last 4 to 72 hours. In practice, many people can’t tell the difference based on duration alone, since the ranges overlap. Duration becomes more useful when combined with the other features: a six-hour headache that’s throbbing, one-sided, and sends you to a dark room is almost certainly a migraine, while a six-hour headache that’s dull, all over, and lets you work at your desk is more likely tension-type.
How Activity Affects the Pain
This is one of the most practical tests you can do in the moment. During a tension headache, walking or light exercise won’t change your pain level much, and it may even help. During a migraine, standing up, bending over, or climbing stairs will often crank the pain up noticeably. If you find yourself instinctively avoiding any physical movement because it makes your head worse, that’s a strong signal you’re dealing with a migraine.
How Common Each Type Is
Headache disorders affect roughly 40% of the global population, about 3.1 billion people. Tension-type headaches are by far the most common variety, reported by more than 70% of the population in some surveys. Migraine is less common but far more disabling. Many people experience both types at different times, which can make it confusing to sort out which one you’re having on any given day. Tracking your symptoms over several episodes (location, quality, severity, associated symptoms, response to activity) makes the pattern much easier to see.
Why Migraines Respond to Different Treatments
Tension headaches usually respond well to standard over-the-counter pain relievers. Migraines often don’t, or they need something more targeted. Triptans, a class of prescription medication designed specifically for migraines, work by counteracting the biological cascade that drives a migraine attack. In clinical trials, about 32% of people treating a migraine without aura were pain-free two hours after taking a triptan, compared to 24% of those treating a migraine with aura. If over-the-counter pain relievers consistently fail to touch your headaches, that’s another clue you may be dealing with migraines rather than tension headaches.
The underlying biology is different too. Migraines involve a wave of abnormal electrical activity that sweeps across the brain’s surface, triggering the release of a signaling molecule that dilates blood vessels and amplifies pain signals through the nerve network around the head. Tension headaches, by contrast, are thought to involve muscle contraction and sensitization of pain pathways, without this same neurological cascade. That’s why medications targeting the migraine-specific pathway work for migraines but won’t help a tension headache.
Red Flags That Mean Something More Serious
Most headaches and migraines, while painful, aren’t dangerous. But certain features suggest something other than a primary headache disorder. Be alert for these patterns:
- Sudden, explosive onset: A headache that hits maximum intensity within seconds, sometimes called a thunderclap headache, can signal a vascular emergency like a brain aneurysm and needs immediate evaluation.
- New neurological symptoms: Weakness in an arm or leg, new numbness, or vision changes that don’t fit your usual pattern.
- Fever, night sweats, or weight loss accompanying the headache, which may indicate an underlying systemic illness.
- New headaches after age 50: A first-time headache pattern starting later in life is more likely to have a secondary cause.
- Clear progression: Headaches that are steadily getting worse or more frequent over weeks or months.
- Positional changes: Pain that shifts significantly when you stand up, lie down, or strain (coughing, bearing down).
- New headache during or after pregnancy: This warrants evaluation for vascular or hormonal complications.
Any of these patterns calls for prompt medical attention, regardless of whether the headache otherwise looks like a migraine or a tension headache.