A headache is broad term for any pain in the head, while a migraine is a specific neurological condition that involves much more than head pain. Most headaches, like tension-type headaches, produce a dull, pressing sensation on both sides of the head and resolve with over-the-counter painkillers. Migraines are a distinct disorder with their own biology, phases, and treatment requirements.
How the Pain Feels Different
Tension-type headaches, the most common kind, feel like a tight band squeezing around your head. The pain is mild to moderate, affects both sides, and doesn’t get worse when you move around. You can usually push through daily activities, even if they’re less pleasant.
Migraine pain is typically throbbing or pulsating, often concentrated on one side of the head, and ranges from moderate to severe. Physical activity makes it worse. Walking up stairs, bending over, even turning your head quickly can intensify the pain. A migraine attack also brings symptoms that tension headaches don’t: nausea or vomiting, sensitivity to light, noise, and smells. Many people need to lie down in a dark, quiet room until it passes.
What Happens in the Brain
Tension-type headaches involve tightening of the muscles in the scalp and neck, along with changes in pain signaling. The exact mechanism isn’t fully understood, but it’s considered relatively straightforward compared to migraine.
Migraine is a neurological event. It begins with activation of the trigeminal nerve, a major nerve that supplies sensation to the face, eyes, and the protective lining around the brain. When this nerve fires, it releases a signaling molecule called CGRP, which causes blood vessels in the brain to dilate and triggers inflammation in pain-sensitive structures like the brain’s outer membrane and large blood vessels. This cascade is why migraine pain feels so intense and why it responds to different medications than a standard headache.
The Four Phases of a Migraine
One of the clearest differences is that migraines unfold in stages. Not everyone experiences all four, but recognizing them can help you anticipate and manage an attack.
Prodrome can begin hours or even days before the pain hits. You might notice mood changes, fatigue, neck stiffness, food cravings, frequent urination, or excessive yawning. These early warning signs are easy to dismiss, but they’re part of the migraine itself.
Aura affects roughly 25 to 30 percent of people with migraine. It typically develops over about five minutes and lasts up to an hour. Visual aura is the most common type: you might see zigzag lines, shimmering lights, or temporary blind spots. Some people experience tingling in the face or hands, or difficulty finding words.
Headache phase is the main event, lasting anywhere from several hours to three days. Pain occurs on one or both sides of the head alongside nausea, anxiety, inability to sleep, and heightened sensitivity to light, sound, and smell.
Postdrome is the aftermath. Even after the pain fades, many people feel drained, achy, dizzy, and have difficulty concentrating. Some describe it as a “migraine hangover.” Tension headaches, by contrast, simply stop when they stop.
The Sinus Headache Problem
Many people who think they have sinus headaches actually have migraines. Research shows that 45% of people with migraine report nasal congestion or watery eyes during an attack. This happens because the trigeminal nerve, which drives migraine pain, also supplies the sinuses, eyes, and ears. When it activates, it can cause congestion, a runny nose, and facial pressure that feels exactly like a sinus problem.
A true sinus headache (rhinosinusitis) is actually rare and comes with a bacterial or viral infection. The hallmarks are thick, discolored nasal discharge, fever, reduced sense of smell, and aching in the upper teeth. If those signs are absent and you’re also experiencing throbbing pain, nausea, or light sensitivity, it’s more likely migraine. A genuine sinus headache resolves within seven days after the infection clears. Pain that keeps returning is almost certainly something else.
Treatment Is Not the Same
Tension-type headaches typically respond well to standard over-the-counter pain relievers like ibuprofen, aspirin, or naproxen. For most people, that’s enough.
Migraines often don’t respond to those same painkillers, or they provide only partial relief. Migraine-specific medications called triptans work by targeting the trigeminal nerve pathway and counteracting the CGRP-driven inflammation that causes migraine pain. Triptans are not typically effective for tension-type headaches, which reinforces that the two conditions have fundamentally different biology. Newer medications that directly block CGRP have expanded treatment options for people whose migraines are frequent or don’t respond to triptans.
Timing matters too. Migraine medications work best when taken early in an attack, ideally during the prodrome or aura phase. Waiting until the pain peaks makes them less effective.
When Migraines Become Chronic
Most people with migraine have episodic attacks, meaning they occur on fewer than 15 days per month. When headache days hit 15 or more per month, with at least 8 of those meeting the criteria for migraine, the diagnosis shifts to chronic migraine. This distinction matters because chronic migraine often requires preventive treatment taken daily or monthly, rather than just treating individual attacks as they come.
Tension headaches can also become chronic at the same 15-day threshold, but chronic tension headaches rarely produce the nausea, vomiting, and sensory sensitivities that make chronic migraine so disabling.
Warning Signs That Need Urgent Attention
Both headaches and migraines are “primary” headache disorders, meaning they aren’t caused by another disease. But some headaches signal something dangerous. Headache specialists use a set of red flags to identify these situations:
- Sudden, explosive onset: A headache that reaches maximum intensity within seconds, sometimes called a thunderclap headache, can indicate a ruptured blood vessel and needs emergency evaluation.
- New neurological symptoms: Weakness on one side of the body, new numbness, or visual changes that don’t fit a known aura pattern.
- Fever, night sweats, or weight loss alongside headache suggest an underlying infection or systemic illness.
- New headaches after age 50: A first-time headache disorder starting later in life is more likely to have a secondary cause.
- Headaches that keep getting worse: A clear pattern of increasing severity or frequency over weeks, rather than the typical waxing and waning of migraine.
Primary headaches and migraines, while painful and sometimes debilitating, follow recognizable patterns. Any headache that breaks from your usual pattern or comes with new symptoms it hasn’t had before warrants a closer look.