A headache is pain in any part of your head. A migraine is a specific neurological condition where the pain is just one piece of a much larger event happening in your brain. The distinction matters because they feel different, last different amounts of time, and respond to different treatments. Most people who have migraines don’t realize it: misdiagnosis rates run as high as 81.5%, with many migraine sufferers told for years they simply have sinus headaches or tension headaches.
How the Pain Feels
The most common everyday headache is a tension-type headache. It produces mild to moderate steady pressure throughout the head, often felt like a band across the forehead or tightness in the back of the skull. It affects both sides equally, and while it’s uncomfortable, most people can push through their day.
Migraine pain is different in character. It’s moderate to severe, often throbbing or pulsating rather than steady, and it tends to concentrate on one side of the head, around the temple, behind one eye, or at the back of the skull. Routine physical activity like walking up stairs or bending over makes it noticeably worse. A tension headache doesn’t typically flare when you move around.
Symptoms Beyond the Pain
This is where the gap between a headache and a migraine really widens. A tension headache is essentially just pain. A migraine comes with a package of additional symptoms that can be more disruptive than the headache itself. During the pain phase, you’ll typically experience nausea (sometimes vomiting), sensitivity to light, and sensitivity to sound. Many people retreat to a dark, quiet room because normal environments become intolerable. A tension headache rarely causes nausea and doesn’t usually make you sensitive to light or noise.
The formal diagnostic criteria require that a migraine includes at least nausea/vomiting or both light and sound sensitivity. If your “bad headaches” consistently send you to a dark room or make you feel sick to your stomach, that’s a strong signal they’re migraines.
Migraine Has Four Phases
A tension headache starts, hurts for a while, and stops. A migraine unfolds in stages that can stretch across days.
The first stage is the prodrome, which can begin hours or even days before the pain arrives. Symptoms are subtle and easy to miss: unusual fatigue, irritability, difficulty concentrating, neck stiffness, food cravings, frequent urination, or excessive yawning. Many people learn to recognize their prodrome as an early warning system.
Next, about a quarter of migraine sufferers experience an aura. Visual auras are the most common: bright zigzag lines, expanding arcs of light, shimmering spots, or partial blind spots in your vision. These visual disturbances typically last 10 to 30 minutes. Some people get sensory auras instead, feeling tingling that starts in one hand and creeps up the arm over 10 to 20 minutes, sometimes spreading to one side of the face and tongue. Rarer auras can cause temporary difficulty speaking or weakness on one side of the body.
The headache phase itself lasts 4 to 72 hours in adults (and can be as short as 2 hours in children). That’s far longer than most tension headaches, which typically resolve in a few hours.
Finally, the postdrome, often called the “migraine hangover,” lingers after the pain stops. You may feel wiped out, achy, dizzy, and unable to concentrate. This phase varies in length, but many people describe feeling “off” for a full day afterward.
What’s Happening in Your Brain
Tension headaches involve muscle tightening around the head and neck, and researchers believe changes in pain sensitivity play a role. The underlying mechanism is relatively straightforward.
Migraine is a different process entirely. It involves the trigeminovascular system, a network connecting the trigeminal nerve (the major nerve of your face and head) to blood vessels in the brain’s protective membranes. When this system activates, nerve fibers release a signaling molecule called CGRP, which dilates blood vessels, triggers inflammation around the brain, and amplifies pain signals. This cascade is why migraine pain throbs, why it escalates, and why it brings along nausea and sensory sensitivity. Newer migraine treatments work by blocking CGRP specifically, which is why they help migraines but wouldn’t do anything for a tension headache.
Duration and Frequency
A tension headache can last anywhere from 30 minutes to several hours. It might happen a few times a month or, for some people, almost daily. Even when frequent, the pain stays mild to moderate.
A single migraine attack, counting from prodrome through postdrome, can occupy two to four days of your life. The pain phase alone runs 4 to 72 hours. Most people with migraine experience attacks a few times per month, but some develop chronic migraine, defined as 15 or more headache days per month with at least 8 of those meeting migraine criteria. The total burden of a migraine is substantially higher than a tension headache of similar frequency.
How to Tell Which You Have
There’s no blood test or scan that diagnoses migraine. It’s identified by pattern recognition. The formal criteria require at least five attacks that each last 4 to 72 hours, with at least two of these pain features: one-sided location, throbbing quality, moderate to severe intensity, or worsening with physical activity. On top of that, you need either nausea/vomiting or sensitivity to both light and sound.
A few questions can help you sort it out:
- Does moving make it worse? If walking, bending, or climbing stairs intensifies your headache, that points toward migraine.
- Do you feel nauseated? Nausea during a headache is a hallmark of migraine and is uncommon with tension headaches.
- Do you avoid light or noise? Seeking out a dark, quiet room is classic migraine behavior.
- Is the pain on one side? One-sided pain favors migraine, though not every migraine is one-sided.
- How long does it last? Pain persisting beyond several hours, especially past a full day, suggests migraine.
Headache Red Flags Worth Knowing
Most headaches and migraines, while painful, aren’t dangerous. But certain features suggest something more serious is going on. A sudden, explosive headache that hits maximum intensity within seconds (sometimes called a thunderclap headache) can indicate a vascular emergency like an aneurysm and needs immediate evaluation. New headaches starting after age 50, headaches that are clearly getting worse over weeks or months, or headaches accompanied by neurological symptoms like new weakness, numbness, or vision changes that don’t fit your usual migraine pattern are all reasons to get checked promptly.
Headaches that change with position (worse when standing versus lying down, or triggered by coughing and straining) can point to pressure problems in the brain. And if a headache comes with fever, night sweats, or unexplained weight loss, that raises concern about an underlying illness rather than a primary headache disorder.