The terms “headache” and “migraine” are often used interchangeably, but medically, they are distinct conditions with different causes, symptoms, and treatment approaches. A typical headache, such as a tension-type headache, is a common occurrence that rarely interrupts daily life. In contrast, a migraine is a complex neurological event that can be severely debilitating. Understanding the specific characteristics of each is necessary for effective self-management and knowing when medical attention is required.
Defining the Common Headache
The most frequently experienced form of head pain is the Tension-Type Headache (TTH), which serves as the baseline for what most people consider a “common headache.” This pain is generally described as a dull, persistent ache or a sensation of pressure, rather than a sharp or throbbing pain. Individuals often feel as if a tight band is squeezing their head, reflecting the non-pulsatile nature of the discomfort.
The pain is typically mild to moderate in intensity and rarely severe enough to halt daily activities. A key diagnostic feature is the location, as TTH almost always affects both sides of the head (bilateral), often originating in the frontal or occipital regions. Unlike migraines, common headaches are not usually accompanied by nausea, vomiting, or intense sensitivity to light or sound.
These headaches can last for a short period, sometimes only 30 minutes, but in episodic forms, they may persist for up to seven days. Routine physical activities, like walking or climbing stairs, do not usually make the pain worse. Common triggers for TTH often include psychological stress, fatigue, or muscle tension in the neck and shoulders.
Defining the Migraine Experience
A migraine is a neurological disorder that manifests with a much more complex set of symptoms than a common headache. The pain quality is described as throbbing or pulsating, and the severity is typically moderate to severe, often rendering the individual disabled. Left untreated, the painful phase of a migraine can last anywhere from four to 72 hours.
The pain is frequently accompanied by debilitating associated symptoms, most notably nausea and sometimes vomiting. An intense aversion to light (photophobia) and sound (phonophobia) is also characteristic, prompting many sufferers to seek refuge in a dark, quiet room. About 25% of sufferers experience an aura, which is a set of transient neurological symptoms that usually precedes the head pain, though it can occur during or without the pain phase.
The most common type of aura is visual, involving temporary disturbances such as shimmering zigzag lines, flashing lights, or blind spots. Other types of aura can include sensory changes, like numbness or tingling in the face or limbs, or temporary speech difficulties. These symptoms typically develop gradually over five minutes and last no longer than one hour.
Key Distinctions in Presentation
The most direct way to distinguish between a common headache and a migraine is by comparing the nature of the pain and accompanying symptoms. While a Tension-Type Headache presents as a pressing, bilateral pain that is mild to moderate, a migraine is defined by a severe, throbbing pain that is usually focused on one side of the head (unilateral). Migraine pain can sometimes affect both sides or switch sides during an attack.
A significant differentiator is the effect of movement on pain intensity. Routine physical activity, such as bending over or walking, does not typically worsen a common headache. In contrast, even slight movement or exertion often markedly aggravates the throbbing pain of a migraine. This aggravation is a core diagnostic criterion for migraine.
The presence of associated symptoms strongly favors a migraine diagnosis. Common headaches generally lack the gastrointestinal distress and intense sensory sensitivities that characterize a migraine attack. A headache is usually not accompanied by both photophobia and phonophobia, whereas a migraine often includes these symptoms.
Triggers also tend to differ, reflecting their distinct underlying mechanisms. Common headaches are frequently set off by situational factors like muscle tension from poor posture or immediate stress. Migraines, being a neurological disorder, are more often linked to internal and environmental factors, including hormonal changes, specific dietary components, weather fluctuations, or changes in sleep patterns.
When Pain Signals a Serious Issue
While most headaches and migraines are primary conditions that are not life-threatening, certain symptoms act as “red flags” indicating a potentially serious underlying issue requiring immediate medical attention. The most important warning sign is the sudden onset of the “thunderclap” headache, which reaches its maximum, excruciating intensity within 60 seconds. This presentation can be a sign of a subarachnoid hemorrhage.
Any new headache accompanied by fever, a stiff neck, or a change in mental status, such as confusion, must be evaluated urgently, as these symptoms can suggest meningitis or encephalitis. Similarly, a new headache following a recent head injury warrants prompt medical assessment to rule out internal bleeding or trauma-related complications.
The appearance of focal neurological symptoms alongside a headache is a serious concern. This includes new weakness or paralysis on one side of the body, difficulty with speech, or double vision. Finally, any new pattern of headache that occurs in an individual over the age of 50, or a headache that is progressively worsening over days or weeks, should prompt consultation with a healthcare professional to investigate potential secondary causes.