The core difference: pain pattern and what comes with it

A headache is pain in the head or neck. A migraine is a neurological condition where that pain is one symptom among several others—and those other symptoms often matter more than the pain itself.

The clearest distinction: a typical headache hurts, but you can usually still function. You might take over-the-counter pain relief, rest for an hour, and move on with your day. A migraine typically forces you to stop what you're doing. The pain is often severe enough that you need to lie down in a dark, quiet room, and it may come with nausea, vomiting, sensitivity to light, or sensitivity to sound.

Not every migraine includes all of those symptoms, and not every severe headache is a migraine. The pattern matters more than any single feature.

Key Takeaways

  • A migraine is a neurological condition with multiple symptoms; a headache is pain alone, usually manageable without stopping your activities.
  • Migraines often include nausea, vomiting, light sensitivity, or sound sensitivity alongside the pain.
  • Some migraines begin with warning signs called aura—visual disturbances, tingling, or difficulty speaking—15 minutes to an hour before pain starts.
  • A migraine typically lasts 4 to 72 hours; a tension headache usually resolves in 30 minutes to a few hours.
  • Keeping a headache diary for a few weeks helps you and your doctor identify patterns and determine whether you're experiencing migraines or another type of headache.

How pain location and intensity differ

Headaches come in several types, and location varies. A tension headache—the most common kind—usually feels like a band of pressure around the head or tightness in the neck and shoulders. It's typically mild to moderate and affects both sides of the head equally.

Migraine pain is often one-sided, concentrated on one side of the head, though it can shift or spread. The pain is usually throbbing or pulsing rather than constant pressure. It's often described as moderate to severe, and it tends to get worse with physical activity—even walking or climbing stairs can intensify it.

A sinus headache centers around the sinuses (forehead, cheeks, or bridge of nose) and is usually tied to congestion or infection. These are less common than people think; many headaches blamed on sinuses are actually migraines.

The symptoms that appear alongside the pain

This is where migraines stand apart. A migraine frequently includes nausea or vomiting, sometimes severe enough that you can't keep food or water down. You may also feel unusually sensitive to light (photophobia) or sound (phonophobia)—normal room brightness or conversation volume becomes unbearable.

Some people experience aura before a migraine begins. Aura is a set of neurological symptoms that typically start 15 minutes to an hour before the headache pain arrives. Common auras include seeing flashing lights, zigzag lines, or blind spots; tingling in the face, lips, or hands; difficulty finding words; or temporary weakness on one side of the body. Not everyone with migraines has aura, and not every migraine with aura follows the same pattern.

A typical tension headache or sinus headache does not include these symptoms. If you're experiencing nausea, light sensitivity, or visual disturbances alongside head pain, that points toward migraine rather than a simple headache.

Duration: how long each type lasts

A tension headache usually lasts 30 minutes to a few hours. Once it resolves, it's gone.

A migraine is a longer event. The pain phase typically lasts 4 to 72 hours, though some people experience migraines that stretch longer. Even after the pain fades, you may feel exhausted or mentally foggy for hours or even a day afterward—a phase sometimes called the postdrome.

If head pain is recurring multiple times per week and lasting hours each time, that pattern itself is worth documenting and discussing with a doctor, regardless of whether you think it's a migraine or not.

What triggers each type

Tension headaches are usually tied to muscle tension, stress, poor posture, or lack of sleep. They tend to be predictable: you know roughly when they'll happen based on what's happening in your life.

Migraine triggers vary widely from person to person and can include hormonal changes (especially around menstruation), certain foods (chocolate, aged cheeses, processed meats, caffeine withdrawal), skipped meals, dehydration, sleep disruption, bright lights, strong smells, weather changes, or stress. Some people have clear triggers; others find their migraines seem random. Keeping a diary of when migraines occur and what happened in the hours before can help you spot patterns.

When to see a doctor about head pain

See a doctor if you experience a sudden severe headache unlike any you've had before, especially if it comes with fever, stiff neck, confusion, vision changes, difficulty speaking, or weakness. These can signal a serious condition.

Also see a doctor if headaches are new, increasing in frequency, changing in character, or significantly affecting your daily life. This includes migraines that are becoming more common or more severe, or any headache pattern that's different from your usual.

A doctor can help you identify what type of headache you're experiencing, rule out other causes, and discuss treatment options. Bring a headache diary if you have one—notes on when pain occurred, how long it lasted, what symptoms came with it, and what you were doing when it started are far more useful than trying to remember details from memory.

How doctors distinguish between them

Your doctor will ask about the pattern of your headaches: when they start, how long they last, where the pain is, what it feels like, and what symptoms come alongside it. They'll ask about triggers, family history (migraines often run in families), and how the headaches affect your daily life.

For migraines, doctors use criteria from the International Headache Society. Broadly, a migraine diagnosis requires at least five headache episodes with specific features: pain lasting 4 to 72 hours, pain on one or both sides, throbbing quality, moderate to severe intensity, and worsening with physical activity. Additionally, at least one of these must be present: nausea or vomiting, or sensitivity to both light and sound.

Most of the time, a doctor can diagnose a migraine or tension headache based on your description alone. Imaging (like an MRI or CT scan) is not routinely needed unless your headache pattern is new, sudden, or accompanied by other neurological symptoms.

Frequently Asked Questions

Can a migraine happen without a headache?

Yes. Some people experience aura—the visual disturbances, tingling, or other neurological symptoms—without the pain that usually follows. This is called silent migraine or acephalgic migraine. It's less common than migraine with pain, but it does occur.

Does a migraine always involve vomiting?

No. Nausea is common with migraines, but vomiting is not required for a migraine diagnosis. Many people experience migraines with nausea alone, and some have migraines with neither. The presence or absence of vomiting doesn't determine whether you have a migraine.

If over-the-counter pain relief works, is it still a migraine?

Yes. Some migraines respond well to ibuprofen or acetaminophen, especially if you take it early. Others don't. The fact that pain relief works doesn't rule out migraine; it just means that particular migraine was responsive to that medication. Severity and response to treatment aren't reliable ways to distinguish migraine from other headaches.

Can stress cause a migraine?

Stress is a common migraine trigger for many people, though the migraine often comes after the stressful event ends—sometimes called a "letdown migraine." Stress can also trigger tension headaches. If you notice migraines clustering around stressful periods, that's worth noting in a headache diary.

How often do migraines need to happen before I should see a doctor?

There's no minimum frequency. If you're experiencing headaches that are new, worsening, or affecting your ability to work, study, or enjoy daily life, that's reason enough to see a doctor—whether it's one migraine per month or four per week.