A regular headache produces a steady, dull pressure on both sides of your head. A migraine is a neurological event that typically causes intense, throbbing pain on one side of your head, along with symptoms like nausea, light sensitivity, and sound sensitivity that a standard headache doesn’t produce. The distinction matters because they have different causes, feel different in your body, and respond to different treatments.
How the Pain Feels
The most common type of everyday headache is a tension-type headache, and it affects more than 70% of some populations. The pain is dull and non-throbbing, often described as a band of tightness or pressure around the scalp and neck. It tends to show up on both sides of your head at once.
Migraine pain is different in character. It’s moderate to severe, one-sided, and pulsating or throbbing. You can feel it behind one eye, in one temple, or along one side of the head extending to the back of the skull. Moving around, bending over, or climbing stairs often makes it worse, while tension headache pain generally stays at the same level regardless of activity.
Symptoms Beyond the Pain
This is where the two really diverge. A tension-type headache is mostly just the head pain itself, sometimes with mild tenderness in the scalp or neck muscles. A migraine brings a whole collection of additional symptoms that can be more disabling than the pain.
Sensitivity to light and sound affects over 80% of people with migraine. During an attack, normal indoor lighting or a conversation at regular volume can feel unbearable. Many people retreat to a dark, quiet room. These sensitivities can even persist between attacks: people with migraine report more discomfort from bright screens, social gatherings, and everyday sounds compared to people without the condition.
Nausea and vomiting are common during migraines and essentially never occur with a tension headache. Some people also experience sensitivity to smells, where cooking odors, perfume, or smoke become intolerable.
The Four Phases of a Migraine
A migraine isn’t just a headache that shows up and leaves. It can unfold in up to four distinct phases over the course of hours or even days.
The first phase, called the prodrome, can begin a day or two before the pain starts. You might notice subtle changes: food cravings, mood shifts, neck stiffness, increased yawning, or unusual fatigue. Not everyone recognizes these signs, but over time some people learn to use them as early warnings.
About 25 to 30% of people with migraine experience an aura phase, which typically begins within an hour before the headache pain and lasts less than 60 minutes. Aura symptoms are mostly visual: zigzag lines floating across your field of vision, blind spots outlined by shimmering shapes, flashes of light, or temporary vision loss affecting both eyes. Aura can also cause tingling in one hand or on one side of the face that slowly spreads along an arm or leg, numbness of the tongue or mouth, difficulty speaking, or even temporary muscle weakness.
The headache phase itself can last anywhere from 4 to 72 hours if untreated. After the pain subsides, many people enter a postdrome phase sometimes called the “migraine hangover,” where they feel drained, foggy, or mildly confused for another day or so. A tension headache, by contrast, has none of these phases. It comes on gradually, lasts a few hours, and resolves without lingering effects.
What’s Happening in Your Brain
A tension-type headache involves tightening of the muscles in the scalp, neck, and jaw, often in response to stress, poor posture, or fatigue. The pain signals are relatively straightforward.
Migraine is a disorder of the central nervous system. During an attack, a major pain-signaling nerve called the trigeminal nerve becomes activated. This nerve wraps around the blood vessels in your brain and releases a signaling molecule (CGRP) that triggers inflammation and causes those blood vessels to swell. That’s what produces the throbbing, pulsating quality of migraine pain, and it’s why the pain syncs with your heartbeat. The nerve’s anatomy also explains why migraine pain often radiates to the back of the head: pain signals from the face and upper neck converge in the same area of the brainstem.
This biological difference is why treatments designed for migraines target that specific nerve pathway, while standard painkillers that work fine for a tension headache often do little for a migraine.
Triggers That Set Off Migraines
Tension headaches are usually triggered by stress, poor sleep, dehydration, or muscle strain. Migraines share some of those triggers but are also set off by stimuli that wouldn’t bother most people.
Sensory triggers play a major role. Bright sunlight, glare from snow or water, fluorescent lighting, flickering or strobe lights, and camera flashes can all launch an attack. Loud or repetitive noises, strong odors (even pleasant ones like perfume), and sudden temperature changes are common triggers too.
Weather is another category unique to migraine. Barometric pressure drops before a storm, seasonal transitions, changes in humidity, altitude shifts during air travel, and even lightning have all been linked to attacks.
Hormonal fluctuations are a particularly significant trigger. Migraine rates are roughly equal between boys and girls until puberty, at which point females outnumber males by 2 to 1 or even 3 to 1. Estrogen shifts during menstruation, pregnancy, and perimenopause are a major reason for this gap. Skipped meals and caffeine withdrawal can trigger migraines as well, though these can also cause non-migraine headaches with distinct characteristics (caffeine withdrawal headaches, for instance, tend to be pulsating on both sides of the head rather than one).
When a Headache Signals Something Serious
Both tension headaches and migraines are “primary” headache disorders, meaning they aren’t caused by another medical condition. But some headaches are warning signs of something more dangerous, and knowing the red flags helps you distinguish a bad-but-normal headache from one that needs immediate attention.
The most alarming sign is sudden onset. A headache that reaches maximum intensity within seconds, sometimes called a thunderclap headache, can indicate a blood vessel problem like an aneurysm and needs emergency evaluation. Headaches accompanied by new neurological symptoms, such as weakness in an arm or leg, new numbness, vision changes, or difficulty speaking (outside the pattern of a known migraine aura), are also red flags.
Other warning signs include headaches that are clearly getting worse over weeks, headaches that change with position (worse when standing or lying down), headaches triggered by coughing or straining, and new headache onset in anyone over 50. Headaches paired with fever, night sweats, or unexplained weight loss suggest an underlying systemic illness. A new headache during or shortly after pregnancy warrants evaluation for vascular or hormonal complications.
The key principle: a headache that follows a familiar pattern, even a migraine, is generally a known quantity. A headache that is new, different, or escalating is the one that deserves prompt medical attention.