A headache is pain or pressure in your head, while a migraine is a neurological condition that involves head pain along with a constellation of other symptoms like nausea, light sensitivity, and sometimes visual disturbances. The distinction matters because they have different causes, feel different in your body, and respond to different treatments. About 40% of the global population deals with headache disorders, and understanding which type you’re experiencing helps you manage it effectively.
How the Pain Feels Different
The most common type of everyday headache is a tension-type headache. It typically feels like a band of pressure or tightness wrapping around your head, affecting both sides equally. The pain is usually mild to moderate, steady rather than pulsing, and doesn’t get worse when you move around. Most tension headaches last anywhere from 30 minutes to a few hours and don’t stop you from going about your day.
Migraine pain is a different experience. It usually starts on one side of the head, throbs or pounds, and ranges from moderate to severe. Physical activity or even bending over tends to make it worse. A migraine headache phase typically lasts several hours to up to three days. But the pain is only one piece of the picture. About 90% of people with migraines experience sensitivity to light during an attack, roughly 80% become sensitive to sound, and around 80% have nausea. Vomiting occurs in about 30% of episodes. These accompanying symptoms are a hallmark that separates migraines from ordinary headaches.
Migraines Have Four Distinct Phases
One of the biggest differences is that a migraine isn’t just a headache that shows up and leaves. It can unfold in up to four phases over the course of days.
The first phase, called the prodrome, can begin hours or even days before any head pain starts. You might notice mood changes, irritability, difficulty focusing, fatigue, muscle stiffness in your neck and shoulders, or food cravings. Some people yawn frequently or urinate more often. These early warning signs are unique to migraines and can help you recognize an attack before it hits.
The second phase is aura, which not everyone gets. It typically develops gradually over about five minutes and lasts up to 60 minutes, though in roughly 20% of people it can stretch longer. Visual aura is the most common type, accounting for 90% of all auras. It can look like geometric patterns, shimmering or flashing lights, zigzag lines, or temporary blind spots. Some people experience sensory aura instead: tingling that starts in the fingers or around the mouth and spreads outward. A rare form involves temporary difficulty speaking.
The headache phase follows, bringing the throbbing one-sided pain along with nausea, light and sound sensitivity, and sometimes anxiety or difficulty sleeping. After the pain subsides, many people enter a postdrome phase, sometimes called a “migraine hangover.” This can involve fatigue, body aches, trouble concentrating, dizziness, and lingering light sensitivity. Tension headaches, by contrast, simply start and stop without these surrounding phases.
What’s Happening in the Brain
Tension-type headaches are generally driven by muscle tension in the head, neck, and shoulders, often from stress, poor posture, or fatigue. The underlying mechanism is relatively straightforward.
Migraines involve something far more complex. A key process is a wave of electrical and chemical activity that sweeps across the surface of the brain. During this wave, neurons rapidly fire and then go quiet, flooding the surrounding tissue with potassium and excitatory chemicals like glutamate. This electrical disruption is what produces the visual and sensory disturbances of an aura. It also triggers the release of a signaling molecule called CGRP, which is a major driver of migraine pain. CGRP activates pain-sensing nerves around the brain and blood vessels, creating the intense, throbbing pain that follows. This is why migraines respond to treatments that target CGRP or the specific nerve pathways involved, while tension headaches typically respond to standard pain relievers.
Different Triggers
Tension headaches are most commonly triggered by stress, poor sleep, dehydration, hunger, or spending too long in one position (like hunching over a computer). They tend to have fairly predictable, straightforward causes.
Migraine triggers overlap somewhat but also include a wider and sometimes more surprising range. Stress is the most common shared trigger. Beyond that, specific foods can set off a migraine: cheese, chocolate, citrus fruits, bananas, nuts, and processed foods containing nitrites or monosodium glutamate are well-known culprits. Environmental factors like bright or flickering light, strong scents, smoke, humidity, and cold weather are associated with migraines specifically. Even small amounts of alcohol, particularly red wine, can provoke an attack in some people.
Hormonal changes play a significant role, particularly for women. Shifts in estrogen levels during menstrual cycles, perimenopause, or estrogen therapy are linked to migraines. This partly explains why migraines are more common in women than in men. Tension headaches also affect women slightly more, at about 50% higher rates than men, but the gender gap for migraines is considerably wider.
Treatment Differs Significantly
Tension headaches generally respond well to over-the-counter pain relievers like ibuprofen or acetaminophen, rest, and stress management. For most people, that’s enough.
Migraines often require a different approach. A class of medications called triptans is considered first-line treatment for moderate to severe migraine attacks. These work by targeting specific receptors in the brain that are involved in the migraine process, making them pharmacologically specific to migraines in a way that standard pain relievers are not. For people who don’t respond to triptans, other options are available, including medications that target nausea (a major component of many attacks) and newer treatments designed to block CGRP, the pain-signaling molecule central to migraine biology.
People with frequent migraines may also benefit from preventive treatment, which aims to reduce how often attacks happen rather than treating them once they start. Tracking your triggers, whether dietary, hormonal, or environmental, becomes a practical tool for reducing the frequency and severity of attacks over time.
Red Flags That Need Immediate Attention
Most headaches and migraines, while painful, are not dangerous. But certain warning signs suggest something more serious is going on. A sudden-onset headache that reaches maximum intensity within seconds, sometimes called a thunderclap headache, can point to a vascular emergency like an aneurysm and needs immediate evaluation.
Other red flags include: a headache accompanied by fever, night sweats, or signs of systemic illness; neurological symptoms like new weakness in an arm or leg, unusual numbness, or vision changes that don’t fit a typical aura pattern; a headache that clearly worsens when you change position (standing to lying down) or when coughing or straining; and any new-onset headache after age 50 or during pregnancy. A headache pattern that is progressively worsening over weeks, becoming more severe or more frequent, also warrants medical evaluation. Primary headaches and migraines don’t typically come with neurological symptoms outside of a recognized aura, so anything outside that pattern is worth taking seriously.