Migraine vs Headache: Causes, Differences, and When to Seek Care

Headache and migraine are often used interchangeably, but they represent different conditions with distinct underlying biology, symptom profiles, and treatment approaches. A headache is a symptom that can arise from many causes. Migraine is a specific neurological disorder characterised by recurrent episodes of head pain accompanied by a range of other symptoms. Misidentifying migraine as a simple headache frequently leads to undertreatment and unnecessary disability.

This article explains the types of headaches, how migraine differs from other headache disorders, how both are diagnosed, what treatment involves, and which symptoms require urgent medical attention.
 

When to Seek Urgent Medical Care

Most headaches are benign and do not indicate a serious underlying problem. However, certain features require immediate medical assessment because they may indicate a dangerous secondary cause such as meningitis, subarachnoid haemorrhage, stroke, or a space-occupying lesion.

Seek emergency medical care immediately for:

• A sudden, severe headache that reaches maximum intensity within seconds to a minute, sometimes described as the worst headache of the person's life. This can indicate a subarachnoid haemorrhage and requires emergency investigation.
• Headache with fever, neck stiffness, sensitivity to light, or confusion, which may indicate meningitis or encephalitis
• Headache with sudden weakness, numbness, or paralysis on one side of the body, face drooping, sudden difficulty speaking, or loss of vision, which may indicate stroke
• Headache following a head injury, particularly if accompanied by loss of consciousness, confusion, vomiting, or worsening pain
• New headache in a person over 50 years of age, particularly if progressively worsening
• Headache that is consistently present and worsens progressively over days to weeks
• Headache accompanied by seizures
• Headache in someone with a known cancer, HIV infection, or immunocompromised state

See a doctor within days rather than immediately for headaches that are frequent, disabling, poorly controlled, not responding to usual treatment, or represent a clear change from a previous established pattern.
 

Understanding Headaches: Primary and Secondary

Headaches are classified as primary or secondary. In primary headache disorders, the headache itself is the condition. There is no underlying structural, metabolic, or other pathology causing it. The most common primary headache disorders are tension-type headache, migraine, and cluster headache. In secondary headaches, the pain is a symptom of an underlying condition such as infection, raised intracranial pressure, vascular disease, medication overuse, or systemic illness. Secondary headaches require identification and treatment of the underlying cause.

This distinction matters clinically because the management of primary and secondary headaches is fundamentally different. A persistent headache that is new or changing in character may represent a secondary cause and warrants investigation.
 

Types of Primary Headache

Tension-Type Headache

Tension-type headache is the most common type of primary headache disorder. It typically presents as a dull, pressing, or tightening pain affecting both sides of the head, often described as a band or vice-like sensation around the head. The pain is usually mild to moderate in intensity, does not throb, and is not worsened by routine physical activity. Nausea and vomiting are not features of tension-type headache, and sensitivity to light or sound, if present, is mild. Episodes may last from thirty minutes to several hours.

The cause of tension-type headache is not fully understood. Peripheral mechanisms including muscle tenderness in the head and neck, and central sensitisation of pain pathways, are thought to contribute. Common precipitating factors include stress, fatigue, poor sleep, prolonged screen use, dehydration, and inadequate food intake.
 

Cluster Headache

Cluster headache is less common but produces some of the most severe pain of any primary headache disorder. It causes intense, strictly one-sided pain centred around or behind one eye, often accompanied by autonomic features on the same side as the pain, including redness and watering of the eye, nasal congestion or runny nose, drooping of the eyelid, and facial sweating. Attacks last between fifteen minutes and three hours and occur in clusters, meaning multiple attacks per day for weeks to months, followed by periods of remission. The pain typically causes restlessness, and the person is unable to lie still, in contrast to migraine during which lying in a dark quiet room is preferred. Cluster headache requires specialist treatment and should not be managed as ordinary headache.
 

Migraine

Migraine is a neurological disorder involving recurrent episodes of head pain associated with a variety of other symptoms. It is among the most prevalent neurological conditions worldwide and is significantly underdiagnosed and undertreated. Migraine causes substantial functional impairment and is a leading cause of years lived with disability globally.

The underlying biology involves activation of the trigeminovascular system and the release of neuropeptides including calcitonin gene-related peptide (CGRP), which contributes to pain signalling and inflammation around the blood vessels of the brain. Changes in the way the brain processes sensory information lead to heightened sensitivity to light, sound, smell, and movement. In some individuals, a phenomenon called cortical spreading depression, a wave of electrical activity followed by suppression across the brain's outer layer, is associated with the development of aura symptoms before or during the headache phase.
 

Migraine: Symptoms and Phases

Migraine is not simply a severe headache. It is a condition with several phases, and symptoms can occur before, during, and after the headache itself.
 

Prodrome

Many people with migraine experience early warning signs that begin hours to a day before the headache phase. These prodromal symptoms may include fatigue, difficulty concentrating, mood changes, increased yawning, heightened sensitivity to light or sound, neck stiffness, food cravings, or increased thirst and urination. Recognising the prodrome can help some people identify that an attack is beginning and allow earlier treatment.
 

Aura

Approximately a third of people with migraine experience aura, which consists of transient and fully reversible neurological symptoms that typically develop gradually over several minutes and last up to an hour. Aura most commonly consists of visual symptoms such as flickering lights, zigzag lines, or blind spots. Sensory aura, involving tingling or numbness that spreads across part of the face, arm, or hand, is the second most common type. Speech or language difficulties may occur in some individuals. Motor aura, causing weakness on one side of the body, characterises hemiplegic migraine, a rare subtype that requires specialist assessment.

Aura symptoms are temporary and should fully resolve. Aura that does not resolve, particularly a persistent visual deficit or persistent weakness, requires urgent medical assessment to exclude stroke.
 

Headache Phase

The headache phase of migraine is typically characterised by moderate to severe pulsating or throbbing pain, most often affecting one side of the head, though it may be bilateral in some people. The pain worsens with routine physical activity such as climbing stairs or walking briskly. Nausea and sometimes vomiting are common. Sensitivity to light (photophobia), sensitivity to sound (phonophobia), and in some people sensitivity to smells, are prominent features. Many people prefer to lie in a dark, quiet room during an attack. The headache phase typically lasts between four and seventy-two hours without treatment.

Some people experience allodynia during attacks, meaning that normally non-painful stimuli such as touching the scalp, wearing glasses, or combing the hair feels uncomfortable. Allodynia reflects central sensitisation and can affect the response to treatment if medication is delayed.

Postdrome

After the headache resolves, many people experience a postdrome phase lasting several hours to a day, during which they may feel exhausted, mentally foggy, or generally unwell. Some people feel unusually energetic or elated. The postdrome is sometimes described as a headache hangover and contributes to the overall burden of the condition.
 

Migraine Subtypes

Migraine without aura is the most common subtype, characterised by recurring headache attacks with the features described above but without preceding aura. Migraine with aura includes the transient neurological symptoms described. Chronic migraine is defined as headache occurring on fifteen or more days per month for more than three months, with features of migraine on at least eight of those days. Vestibular migraine is characterised by episodes of vertigo or dizziness, sometimes without prominent head pain, and requires specialist diagnosis. Menstrual migraine refers to attacks that occur predictably around the time of menstruation, driven by the decline in oestrogen levels, and may require specific management adjustments.
 

How Migraine Differs from Tension-Type Headache

The distinction between migraine and tension-type headache matters because their management is different. Key differentiating features are summarised below.

The pain quality in tension-type headache is typically dull, pressing, or tightening, while in migraine it is often throbbing or pulsating. Tension-type headache is usually bilateral, while migraine more commonly affects one side, though this is not absolute. Severity is mild to moderate in tension-type headache and moderate to severe in migraine. Physical activity does not worsen tension-type headache but commonly worsens migraine pain. Nausea and vomiting are absent in tension-type headache but present in many migraine attacks. Significant sensitivity to light and sound is absent or mild in tension-type headache and prominent in migraine. Aura does not occur in tension-type headache. Attacks are generally shorter in tension-type headache, while migraine attacks can last hours to days.

The symptom overlap between these conditions, and the fact that some people experience both types, can make self-classification unreliable. A clinical assessment provides more accurate diagnosis.
 

What Is Commonly Misdiagnosed as Sinus Headache?

Many people who present to doctors with headache pain located around the forehead, eyes, and cheeks are diagnosed or self-diagnose as having sinus headache. Research suggests that the majority of people with recurrent headaches of this type actually have migraine. True sinus headache due to acute sinusitis is usually accompanied by a purulent nasal discharge, fever, and evidence of infection. Migraine can produce facial pressure and nasal symptoms through autonomic mechanisms, which explains the frequent confusion between the two. If headaches are recurring and there is no evidence of acute sinus infection, further assessment for migraine is appropriate.
 

Diagnosis

The diagnosis of migraine and other primary headache disorders is clinical, based on the history and symptom pattern. There is no blood test or imaging finding that confirms migraine. Neuroimaging is not required for the diagnosis of migraine or tension-type headache in the absence of red-flag features. An MRI or CT scan may be ordered when features suggest a secondary cause, when the diagnosis is uncertain, or when the headache pattern changes significantly.

Diagnosis uses the criteria of the International Classification of Headache Disorders (ICHD-3), which defines specific requirements for each headache type based on the number of attacks, their duration, pain characteristics, and associated features. A careful history should cover the pattern of headaches over time, the character, location, severity, and duration of pain, associated symptoms including nausea, vomiting, and sensory sensitivity, aura features if present, family history, response to previous treatments, and the frequency of analgesic or triptan use.

A headache diary kept for four to eight weeks before a specialist appointment provides valuable information about attack frequency, potential triggers, the impact on daily function, and medication use patterns. Many smartphone applications and paper diary formats are available for this purpose.

A focused neurological examination is performed to assess for any objective neurological findings. In most people with uncomplicated primary headache, the examination is normal. Any neurological finding on examination warrants further investigation.

Assessment of the impact of headaches on daily life, work, and relationships is an important part of the evaluation. Validated tools such as the Migraine Disability Assessment score (MIDAS) or the Headache Impact Test (HIT-6) help quantify this and guide treatment decisions.
 

Treatment

Acute Treatment of Migraine

Acute treatment aims to relieve pain and associated symptoms during an attack. Treatment is most effective when taken early in the course of an attack, before central sensitisation and allodynia are established. Waiting until pain is severe reduces the likelihood of a complete and rapid response.

Simple analgesics including paracetamol, aspirin, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are effective for mild to moderate migraine attacks. They are most useful in the early part of an attack and in people who have not been diagnosed with a more severe form of migraine. An antiemetic such as metoclopramide taken alongside a simple analgesic can improve drug absorption in people with nausea and gastric stasis during attacks, and also provides additional symptom relief.

Triptans are migraine-specific medications that act on serotonin receptors to reduce pain signalling and inhibit the release of inflammatory neuropeptides. They are the most effective acute treatment for moderate to severe migraine in people for whom they are suitable. Sumatriptan is the most widely available; other options include rizatriptan, zolmitriptan, eletriptan, and naratriptan, which differ in speed of onset and duration of action. Triptans are contraindicated in people with a history of ischaemic heart disease, stroke, uncontrolled hypertension, or Raynaud's phenomenon, and should be used with caution in people with significant cardiovascular risk factors. They should be used on no more than ten days per month to avoid medication overuse headache.

Gepants, a newer class of medications that block CGRP receptors, and lasmiditan, which acts on a different serotonin receptor subtype than triptans, are alternatives for people who do not respond to triptans or for whom triptans are contraindicated. These are available in some settings and may be offered by a neurologist or headache specialist.

During attacks, lying in a quiet, darkened room reduces sensory stimulation and improves comfort. Cool compresses on the head or neck may help. Adequate hydration, particularly if vomiting has occurred, is important.
 

Acute Treatment of Tension-Type Headache

Tension-type headache responds well to simple analgesics including paracetamol, aspirin, and NSAIDs taken at the onset of pain. Frequent use of acute medications, regardless of the headache type, carries the risk of developing medication overuse headache, so these should be used judiciously. Non-pharmacological measures including rest, adequate hydration, stress management, and where relevant, stretching and relaxation of the neck and shoulder muscles, are useful adjuncts.
 

Preventive Treatment of Migraine

Preventive treatment is considered when migraine attacks are frequent enough or disabling enough to significantly affect quality of life. General guidance suggests considering prevention when attacks occur on four or more days per month, when acute treatments are inadequate or poorly tolerated, when medication overuse is occurring, or when the migraine subtype carries specific risks, such as hemiplegic migraine.

The goal of preventive treatment is to reduce the frequency, severity, and duration of attacks and to improve the response to acute treatment. A reduction of fifty percent or more in attack frequency is considered a clinically meaningful response. Preventive medications generally need to be taken daily for at least two to three months before the full effect is established.

Beta-blockers such as propranolol and metoprolol are among the most established preventive agents for migraine and are a common first-line choice. Topiramate and valproate, which are anticonvulsant medications, are effective preventives but carry specific considerations regarding side effects and, in women of childbearing potential, regarding teratogenicity. Amitriptyline, a tricyclic antidepressant, is effective for migraine prevention and has the additional benefit of treating coexisting tension-type headache and sleep disruption. Candesartan, an angiotensin receptor blocker, is used in some people as an alternative.

Anti-CGRP monoclonal antibodies, including erenumab, fremanezumab, and galcanezumab, are a newer class of preventive treatment specifically developed for migraine. They are given by monthly or quarterly injection and have demonstrated significant efficacy in clinical trials, including in people who have not responded to traditional preventive agents. They are typically prescribed by neurologists or headache specialists and are reserved for people with frequent or chronic migraine not adequately controlled by other preventive treatments.

OnabotulinumtoxinA (Botox) injections administered by a trained specialist are an established treatment for chronic migraine, defined as fifteen or more headache days per month. It is given every twelve weeks as a series of injections into the head and neck muscles and requires specialist administration.

The choice of preventive medication should take into account comorbidities, other medications, contraindications, side effect profiles, and patient preference. Preventive medications are typically reviewed after three to six months of treatment, and the dose or agent may be adjusted based on response and tolerability.
 

Medication Overuse Headache

Medication overuse headache is a significant and frequently underrecognised complication of headache treatment. It occurs when acute pain-relieving medications are used too frequently, leading to a paradoxical increase in headache frequency. Using simple analgesics such as paracetamol or NSAIDs on fifteen or more days per month, or triptans or combination analgesics on ten or more days per month, carries substantial risk of developing medication overuse headache.

The hallmark of medication overuse headache is a headache present on most days, often present on waking, which improves temporarily with the overused medication but returns as the drug wears off. Management involves withdrawal of the overused medication, which typically causes a temporary worsening of headaches for one to two weeks before improvement occurs. Preventive treatment is usually needed alongside withdrawal. Management of medication overuse headache is best guided by a doctor or headache specialist.
 

Non-Pharmacological Management

Several non-pharmacological approaches have evidence supporting their use in migraine prevention. Cognitive behavioural therapy helps address the psychological and behavioural dimensions of headache, including headache-related anxiety, avoidance behaviours, and the contribution of stress to attack frequency. Biofeedback, in which the person learns to recognise and modify physiological responses associated with migraine, has evidence particularly for tension-type headache and migraine. Relaxation training and mindfulness-based approaches are beneficial adjuncts.

Regular moderate aerobic exercise, performed consistently, has been shown to reduce migraine frequency in clinical studies. Exercise should be built up gradually, as vigorous exertion can occasionally trigger an attack in people with migraine, particularly at the start of an exercise programme.

Acupuncture has evidence of benefit for migraine prevention in randomised trials and may be offered as an alternative or complementary approach, particularly for people who prefer to minimise medication.
 

Lifestyle and Self-Management

Consistency in daily routines is one of the most effective non-medication strategies for reducing migraine frequency. The brain of a person with migraine is particularly sensitive to physiological fluctuations, and irregular schedules in sleep, meals, or activity are common triggers.

Maintaining consistent sleep and wake times, even at weekends, helps regulate the sleep-wake cycle that strongly influences migraine threshold. Sleep deprivation and oversleeping are both recognised migraine triggers. Eating regular meals and not skipping breakfast helps maintain stable blood glucose and avoids the hunger trigger. Adequate and consistent hydration throughout the day is important; dehydration is a frequent precipitant in susceptible individuals.

Identifying and managing personal triggers is a useful but nuanced approach. Common reported triggers include stress, poor sleep, hormonal changes, bright or flickering light, strong smells, certain foods or drinks including alcohol and caffeine, changes in weather, and physical exertion. However, an overly rigid trigger-avoidance approach can itself increase anxiety and disability. The goal is to identify the most consistent and controllable triggers rather than attempting to eliminate all possible precipitants from daily life.

Nutritional supplements including magnesium, riboflavin (vitamin B2), and coenzyme Q10 have some evidence from clinical trials supporting their role in migraine prevention, particularly in people with deficiency or those in whom pharmacological prevention is not desired. They should be used at appropriate doses and in consultation with a doctor, as they are not universally effective and their benefit is modest compared with pharmacological preventive agents.

Limiting or avoiding alcohol, particularly red wine and beer, reduces trigger exposure for many people with migraine. Caffeine has a complex relationship with migraine: it can help abort an attack when taken in the early phase and is an ingredient in some analgesic preparations, but regular high caffeine intake and caffeine withdrawal are both migraine triggers. Gradual rather than abrupt changes in caffeine intake are advisable.

Managing light exposure can help during attacks. Wearing blue-light-filtering glasses or FL-41 tinted lenses during screen use may reduce trigger exposure for photosensitive individuals. Fluorescent lighting and flickering screens are more commonly triggering than steady incandescent or natural light.

Hormonal Migraine and Women

Migraine is approximately three times more common in women than men after puberty, a difference largely attributable to hormonal influences. Fluctuations in oestrogen levels are a potent migraine trigger. Menstrual migraine, which occurs in the days around menstruation corresponding to the oestrogen decline, tends to be more severe, longer, and less responsive to treatment than attacks at other times of the cycle. Specific management strategies including the use of frovatriptan or naproxen as short-term prophylaxis around the expected time of menstruation may help.

Migraine may worsen in the first trimester of pregnancy and typically improves in the second and third trimester in many women. However, the limited medication options during pregnancy make management more challenging. Paracetamol is generally considered safe; NSAIDs should be avoided after twenty weeks of pregnancy; triptans are not formally licensed for use in pregnancy, though available data have not identified a clear signal of harm. Management during pregnancy should be guided by a doctor.

Migraine patterns often change around perimenopause, sometimes worsening due to oestrogen fluctuations. Hormone replacement therapy, when indicated, may help or worsen migraine depending on the formulation and route of administration. Combined oral contraceptives containing oestrogen may increase the frequency of migraine with aura and are generally avoided in women with migraine with aura due to an associated increase in stroke risk. This should be discussed with a gynaecologist or neurologist.
 

Frequently Asked Questions

1. Can a headache turn into a migraine?

Migraine and tension-type headache are distinct conditions, but they can coexist in the same person. Some people experience tension-type headache that, on some occasions, evolves into a migraine attack. Others may have both conditions independently. Keeping a diary helps clarify the pattern.
 

2. Why does migraine cause sensitivity to light and sound?

Migraine affects how the brain processes sensory information. During an attack, the threshold for sensory stimulation is reduced, meaning that normally tolerable levels of light and sound are perceived as painful or overwhelming. This is a central neurological feature of migraine related to sensitisation of pain pathways rather than a problem with the eyes or ears themselves.
 

3. Is sinus headache different from migraine?

Many headaches diagnosed as sinus headache are actually migraine. True sinus headache due to acute sinusitis is accompanied by purulent nasal discharge and evidence of infection. Migraine can produce facial pressure and nasal symptoms through autonomic mechanisms. If you have recurrent headaches in the sinus area without evidence of infection, migraine is the more likely diagnosis and should be assessed properly.
 

4. Is migraine hereditary?

Yes, migraine has a significant genetic component and often runs in families. Having a parent or sibling with migraine substantially increases the likelihood of developing it. Familial hemiplegic migraine, a rare subtype, follows a clear autosomal dominant pattern and has identified gene mutations. For common migraine, multiple genes contribute and the inheritance is complex.
 

5. What is medication overuse headache and how is it prevented?

Medication overuse headache develops when acute headache medications are used too frequently, typically more than ten days per month for triptans or combination analgesics, or fifteen or more days per month for simple analgesics. The headache becomes more frequent and is present most days. Prevention involves using acute medications on fewer than ten days per month and addressing the underlying headache condition with preventive treatment when attacks are frequent.
 

6. Can weather changes trigger headaches?

Yes. Changes in barometric pressure, temperature, humidity, and bright sunlight are reported as triggers by many people with migraine. The mechanism is not fully established but likely relates to changes in brain sensitivity to environmental stimuli. Preventive treatment reduces the degree to which environmental triggers precipitate attacks.

7. What is the difference between migraine with aura and a stroke?

Aura symptoms typically develop gradually over five to twenty minutes and resolve completely within an hour. Stroke symptoms develop suddenly, often within seconds, and do not resolve spontaneously. Any neurological symptom that develops suddenly, is severe, does not follow the gradual spread pattern typical of aura, or does not resolve within an hour, should be assessed as a potential stroke rather than attributed to migraine aura without medical evaluation.
 

8. Can children have migraines?

Yes. Migraine occurs in children and adolescents. It may present somewhat differently in younger children, with shorter attack duration, bilateral pain, and more prominent abdominal symptoms. Childhood migraine equivalents such as cyclic vomiting syndrome and abdominal migraine are recognised. Management in children should involve a paediatrician and use age-appropriate treatments.
 

9. What is chronic migraine and how is it treated?

Chronic migraine is defined as headache on fifteen or more days per month for more than three months, with features of migraine on at least eight of those days. It significantly impairs quality of life and is often associated with medication overuse. Treatment involves preventive medication, usually with anti-CGRP monoclonal antibodies or onabotulinumtoxinA, alongside management of any medication overuse and non-pharmacological support. Specialist care from a neurologist or headache clinic is usually required.
 

Key Takeaways

• Headache is a symptom; migraine is a neurological disorder. They have different mechanisms, features, and treatments.
• Migraine typically causes moderate to severe throbbing pain, worsened by physical activity, with nausea and sensitivity to light and sound. Tension-type headache causes dull bilateral pressure without these associated features.
• Aura consists of transient, reversible neurological symptoms, most commonly visual, that precede or accompany the migraine headache. Aura that does not resolve requires urgent medical assessment.
• Seek emergency care immediately for a sudden severe headache reaching peak intensity within seconds, headache with fever and neck stiffness, or headache with neurological symptoms such as weakness, speech difficulty, or vision loss.
• Diagnosis is clinical. Neuroimaging is not routinely required for primary headache but is indicated when red-flag features are present.
• Effective treatment includes acute medications taken early in an attack, preventive treatment for frequent or disabling migraine, and non-pharmacological measures including regular routines, trigger management, and psychological support.
• Medication overuse headache is a common and preventable complication. Acute medications should be used on fewer than ten to fifteen days per month depending on the type.
• Migraine in women is strongly influenced by hormonal changes. Combined oral contraceptives containing oestrogen are generally avoided in women with migraine with aura due to stroke risk.