A headache is a broad term for any pain in the head, while a migraine is a specific neurological condition that involves much more than head pain. The easiest way to tell them apart: a typical tension headache feels like steady pressure on both sides of your head, while a migraine usually throbs on one side and comes with nausea, sensitivity to light, or visual disturbances. But the differences go deeper than that.
How the Pain Feels
Tension-type headaches, the most common kind, produce a dull, squeezing pressure that wraps around the head like a tight band. The pain is usually mild to moderate, affects both sides, and doesn’t get worse when you move around. Most tension headaches last anywhere from 30 minutes to several hours, and while they’re uncomfortable, they rarely stop you from going about your day.
Migraine pain is different in character. It tends to be moderate to severe, pulsating or throbbing, and concentrated on one side of the head. Physical activity, even walking up stairs, can make it worse. A migraine attack can last anywhere from 4 to 72 hours if untreated, and people in the middle of one often retreat to a dark, quiet room because light and sound become genuinely painful. In clinical pain studies, migraine consistently scores higher in intensity than tension-type headache.
Symptoms Beyond the Pain
This is where the two really diverge. A tension headache is mostly just pain. You might feel some tightness in your neck or scalp muscles, but it doesn’t come with a package of other symptoms.
Migraine, on the other hand, is a full neurological event. During the headache phase, nausea, vomiting, extreme sensitivity to light, sensitivity to sound, and even sensitivity to smells are all common features. Some people experience skin sensitivity so heightened that wearing a necklace or resting their head on a pillow becomes uncomfortable.
About 25% of people with migraines also experience aura, a set of sensory disturbances that typically appear before the headache starts. The most common type is visual: a small blind spot or a cluster of bright, shimmering lines appears in your field of vision, then expands outward over 5 to 60 minutes. Some people get tingling in their hands or face, and a smaller number have temporary difficulty with speech. Aura is a hallmark of migraine. It does not occur with tension headaches.
The Four Phases of a Migraine
One of the clearest signs that migraine is more than “just a bad headache” is that it unfolds in distinct phases, sometimes over the course of days.
The first phase, called the prodrome, can start one to two days before the headache arrives. You might notice neck stiffness, unusual fatigue, difficulty thinking clearly, irritability, excessive yawning, or increased sensitivity to light. These early warning signs are subtle enough that many people don’t recognize them at first, but over time, they can become reliable predictors that an attack is coming.
Next comes the aura phase (for those who get it), followed by the headache phase itself, which is the most debilitating part of the attack. After the pain subsides, many people enter a postdrome phase sometimes called a “migraine hangover.” This can include lingering fatigue, mental fogginess, body aches, and continued sensitivity to light or sound. It can last a day or more. Tension headaches don’t follow this kind of multi-phase pattern.
What’s Happening in the Brain
Tension-type headaches involve tightening of the muscles in the head, neck, and shoulders, combined with changes in pain signaling. The underlying biology is relatively straightforward.
Migraine involves a more complex chain reaction in the nervous system. The trigeminal nerve, the major pain-signaling pathway in the head and face, becomes activated and releases a signaling molecule called CGRP. This triggers a cascade: blood vessels in the brain’s protective lining dilate, surrounding nerves become sensitized, and the pain signals amplify. CGRP also drives a feedback loop where sensitized nerves release even more CGRP, which is one reason migraines can be so difficult to stop once they start. Over time, repeated episodes of this sensitization may help explain why some people’s migraines become more frequent, eventually progressing from occasional episodes to a chronic pattern.
Understanding this mechanism has led to an entirely different class of treatments. Newer migraine medications work by blocking CGRP activity, directly targeting the biology that drives the attack rather than simply dulling the pain.
Triggers and Risk Factors
Tension headaches and migraines share some common triggers: stress, poor sleep, fatigue, skipping meals, and alcohol. But migraines tend to have a wider and more individual set of triggers, and many people with migraine are more sensitive to environmental stimuli in general.
Hormonal changes play a particularly prominent role in migraine. Menstruation is a well-established trigger, which helps explain why migraines are significantly more common in women. Shifts in estrogen levels around puberty, menstrual cycles, and perimenopause all influence migraine frequency. Weather changes, strong odors, bright or flickering lights, and loud noise can also set off attacks. Caffeine withdrawal and dehydration are triggers for both conditions, though they tend to provoke more severe episodes in people with migraine.
There’s a strong genetic component to migraine as well. If one of your parents has migraines, your chances of developing them are substantially higher. Tension headaches, while also more common in some families, don’t carry the same degree of inherited risk.
Who Gets Each Type
Headache disorders affect roughly 40% of the global population, about 3.1 billion people. Tension-type headache is by far the most common, reported by over 70% of some populations. It often begins in the teenage years and is about 50% more common in women than men.
Migraine most often starts around puberty and primarily affects people between the ages of 35 and 45. It’s also more common in women, likely due to hormonal influences. Globally, migraine is less prevalent than tension headache but far more disabling. It consistently ranks among the top causes of years lived with disability worldwide.
How Treatment Differs
Most tension headaches respond well to over-the-counter pain relievers like ibuprofen or acetaminophen. Rest, hydration, and stress management often help. For people with frequent tension headaches, addressing posture, sleep habits, or muscle tension through physical therapy can reduce how often they occur.
Migraine treatment works on two tracks. The first is stopping an attack once it starts. Over-the-counter anti-inflammatory medications are often the initial approach, and they work for many people with mild to moderate attacks. But when those aren’t enough, a class of prescription medications called triptans is the standard next step. Research shows that about 60% of people who don’t respond to anti-inflammatories can successfully treat their attacks with triptans. Newer options that block CGRP are also available for people who can’t take triptans or don’t respond to them.
The second track is prevention. People who have frequent migraines (typically four or more attacks per month) may benefit from daily or monthly preventive medications that reduce how often attacks occur. This category includes several types of medications originally developed for other conditions, like blood pressure drugs and certain antidepressants, as well as the newer CGRP-blocking treatments designed specifically for migraine prevention. Tension headaches rarely require this level of ongoing treatment.
Warning Signs That Need Attention
Most headaches and migraines, while painful, aren’t dangerous. But certain patterns can signal something more serious. Clinicians use a checklist to identify red flags: a headache that comes on suddenly and severely (often described as “the worst headache of my life”), headaches accompanied by neurological symptoms like confusion, weakness, or vision changes that don’t fit your usual migraine pattern, a new headache type starting after age 40, headaches that progressively worsen over weeks, or headaches accompanied by fever, stiff neck, or unexplained weight loss. Any of these patterns warrant prompt medical evaluation to rule out secondary causes like bleeding, infection, or other structural problems in the brain.