Migraine vs Headache: How to Tell the Difference and Why It Matters for Treatment
Written by Naurah Gaspard, DNP, FNP-C, FNP-BC · Medically reviewed by Cherlie Joseph, MSN, FNP-BC · Updated November 2026
Migraine is usually a throbbing, moderate to severe headache, often on one side, that gets worse with activity and comes with nausea or sensitivity to light and sound. A tension-type headache is a steady, band-like pressure on both sides that is mild to moderate and rarely comes with nausea. Knowing which one you have matters because migraine often needs different medicines.
In this guide
Migraine and tension headache at a glance
Most recurring headaches in adults are either tension-type headache or migraine. NINDS describes tension-type headache as the most common kind, while migraine is a neurological condition with symptoms that go well beyond head pain.
| Feature | Migraine | Tension-type headache |
|---|---|---|
| Where it hurts | Often one side, can switch sides or be both | Both sides; a band or tight pressure around the head, forehead or neck |
| How it feels | Throbbing or pulsing | Steady, pressing, squeezing |
| Strength | Moderate to severe | Mild to moderate |
| Activity | Worse with walking, stairs or bending | Usually not worse with routine activity |
| Other symptoms | Nausea or vomiting; sensitivity to light, sound or smells | Usually none (maybe mild light or sound sensitivity, not both) |
| Aura | About 1 in 4 people with migraine have it (vision changes, tingling) | No aura |
| How long | Usually 4 to 72 hours untreated | 30 minutes to several days |
Signs it is probably migraine
A quick screening question set many clinicians use asks three things about your headaches over the last few months:
- Has a headache limited your activities for a day or more?
- Do you feel sick to your stomach with your headaches?
- Does light bother you during a headache?
Answering yes to two or three makes migraine likely. Other clues include a family history of migraine, attacks tied to your menstrual cycle, a need to lie down in a dark, quiet room, and phases before and after the pain. The prodrome can bring yawning, cravings or neck stiffness, and the postdrome can leave you drained or foggy for up to a day or two.
Many people who think they have “sinus headaches” actually have migraine, especially if there is no thick colored nasal discharge or fever. See our guide to sinus headache vs migraine.
Already treated for migraines and running low?
$79 refill review by a nurse practitioner licensed in your state. Adults 18+ in FL, NM, OR and WA.
Request a medication refill →Why the difference matters for treatment
The right label leads to the right medicine. Over-the-counter pain relievers and rest are often enough for tension-type headache. Migraine attacks frequently need migraine-specific treatment:
| Goal | Tension-type headache | Migraine |
|---|---|---|
| Stop an attack | Acetaminophen, ibuprofen or naproxen; heat, stretching, rest | NSAIDs or acetaminophen for mild attacks; triptans such as sumatriptan; gepants such as ubrogepant or rimegepant; anti-nausea medicine |
| Prevent attacks | Stress management, posture, sleep, exercise; sometimes a daily medicine such as amitriptyline | Lifestyle steps plus preventive medicine if attacks are frequent: blood pressure medicines, some antidepressants or anti-seizure medicines, or CGRP medicines |
Treating migraine early in the attack usually works better. Whichever headache you have, limit acute pain medicine to the days your provider recommends, because overuse can cause rebound (medication overuse) headaches. OurTopClinic does not prescribe controlled substances, such as butalbital combinations or opioids, which are not recommended for routine headache care.
Other headaches to know about
- Cluster headache: severe, one-sided pain around one eye, often with a red, teary eye and runny nostril on that side, coming in daily bouts for weeks. It needs specific treatment, so see a provider.
- Medication overuse headache: near-daily headaches in someone taking pain relievers or triptans many days a month.
- Headaches from another cause: such as very high blood pressure, infection, or head injury. These are the reason red-flag symptoms below matter. Read more in headache red flags.
Getting help
Bring a short headache diary to any visit: how often, how long, what it feels like, what you tried and what helped. If you already have a migraine diagnosis and a medicine that works, a refill review can keep you covered. New, changing or more frequent headaches deserve a visit, where a provider can review whether preventive treatment is appropriate.
Get in-person care or call 911 if you have:
- The sudden, worst headache of your life, reaching full strength within about a minute
- Headache with fever and stiff neck, confusion, fainting or a seizure
- New weakness, numbness, trouble speaking, facial droop or vision loss
- Headache after a head injury, or a new headache during pregnancy or soon after giving birth
- A new headache that keeps getting worse over days to weeks, especially after age 50
Frequently asked questions
Can a tension headache turn into a migraine?
They are different conditions, but some people with migraine also get tension-type headaches, and a milder headache can build into a migraine attack. If your headaches regularly ramp up with nausea or light sensitivity, they are likely migraine and worth treating as such.
Is a migraine just a bad headache?
No. Migraine is a neurological condition. Headache is the main symptom, but attacks can include nausea, vomiting, light and sound sensitivity, aura, and fatigue before and after the pain.
Do I need a brain scan for migraine?
Usually not. Most people with a typical migraine pattern and a normal exam do not need imaging. A provider may recommend a scan if you have red-flag symptoms or a headache pattern that changes.
Sources
Keep reading
- Migraine triggers and how to find yours
- Sinus headache vs migraine
- Sumatriptan (Imitrex) for migraine
- Migraine prevention: habits and medicines
- Browse all conditions and treatments A to Z
Already treated for migraines and running low?
$79 refill review by a nurse practitioner licensed in your state. Adults 18+ in FL, NM, OR and WA.
Request a medication refill →
Naurah Gaspard, DNP, FNP-C, FNP-BC
Board-certified family nurse practitioner licensed in Florida, New Mexico, Oregon and Washington, caring for adults online at OurTopClinic. Meet our providers.
This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.
