Headaches and migraines have a lot of similarities, but migraines have some very distinctive symptoms.

By Alyssa Sparacino
Updated May 31, 2019
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The signs and symptoms of migraines and tension headaches might seem similar—both make your head hurt, right? True, but it turns out there are actually some stand-out factors that make it crystal clear whether you’re dealing with one or the other.

First, you should know that migraines are actually just one of the many hundreds of headache disorders out there, says Elizabeth Seng, Ph.D., assistant professor in the Albert Einstein College of Medicine at Yeshiva University. What’s more, 18 percent of women suffer from migraines, while only 6 percent of men do.

Tension-type headaches are the most common type of primary headache disorder, says Seng. Primary, in this case, means that the headache was not caused by another medical condition. So, for example, if you experience a headache the day after a night out drinking or on a morning when you forget to have your usual cup of coffee, that’s a secondary headache. The headache is actually caused by withdrawal from alcohol or caffeine, whereas a primary headache disorder such as a tension headache or migraine is not caused by a condition like a withdrawal. (Related: The Reason You Feel Anxious After a Night of Drinking Could Be "Hangxiety")

Now that you know the headache basics, here’s what you need to know about differentiating between a regular headache and a migraine.

The Location, Type, and Severity of the Pain

“Tension headaches are typically on both sides of the head, and the pain feels like it’s pressing or tightening,” says Seng. Headache pain is usually classified as moderate in severity, she adds.

However, “during a migraine attack, the head pain is typically on one side of the head and is pounding or pulsing,” says Seng. Migraine pain is usually classified as moderate to severe and gets worse with even little physical activity, such as simply climbing up the stairs.

The Symptoms of Headaches vs. Migraines

The biggest difference between symptoms of tension-type headaches and migraines is that head pain is only one of many symptoms people experience during a migraine attack, whereas headaches are a little less complicated.

Other key indicators of a migraine are nausea and vomiting as well as sensitivity to light and sound, but “sensitivity only begins to describe it,” says Seng. “People will often experience bright lights or loud sounds as physically painful.”

Plus, there are other symptoms of migraines that, although not in the formal diagnostic criteria, are very common in people with migraines. These migraine symptoms can include sensitivity to smell, difficulty thinking or concentrating, trouble speaking, and allodynia, which is when you experience pain from non-painful touch, says Seng. Think: When you have the flu and even brushing your hair hurts.

The Stages of a Migraine

There is only one stage to tension-type headaches—the pain. In a migraine, however, there are three to four different stages, which can vary in duration. Here’s the breakdown, according to Seng:

Phase 1: The Premonitory Phase

This is the very beginning of a migraine attack, but you might not even know it, says Seng. “During the premonitory phase, there are a number of neurological symptoms that can crop up before the head pain starts,” she says. These include, but are not limited to, yawning, increased thirst, difficulty thinking, and sensitivity to light and sound. Now is the perfect time to take medication if you have been prescribed migraine medication from your doctor, adds Seng.

Phase 2: The Aura

Only about 20 percent of people with migraines experience this phase, says Seng. The aura phase happens anywhere from 20 minutes to 1 hour before the head pain starts, can last up to 30 minutes, and typically manifests as a strange sensory experience, adds Sara Crystal, M.D., neurologist, headache specialist, and medical advisor for Cove, a service providing FDA-approved headache and migraine pain treatments. “For most people, it’s visual, so that can be like spreading darkness or spreading light in your vision,” in addition to blurriness or blind spots, she says. “For people who have it, it’s very significant.” You may also experience some tingling, weakness, or numbness in your extremities, and have trouble speaking, adds Dr. Crystal.

Phase 3: The Headache

This is where the pain comes in. You’ll experience an onslaught of the various symptoms described above, such as nausea or vomiting and sensitivity to light and sound.

Phase 4: The Postdrome

Also referred to as the “migraine hangover” thanks to the fatigue that sets in, phase four is a deceptively dangerous phase. During this timeframe, which can last as long as 24 hours after the head pain subsides, you are far more likely to have a reoccurrence of the migraine attack, says Seng. It’s now that you should take really good care of yourself, she says. So, take it easy until you know the entire migraine episode has passed.

The Headache vs. Migraine Test

While there's no clinical lab test for diagnosing migraines, your doctor can formally diagnose you based on your reported symptoms, says Dr. Crystal. Genetics also greatly increase your risk, she adds.

If you're still not entirely sure whether your pain is a migraine attack or primary tension headache (remember, if it’s secondary, you’d be able to pinpoint the cause), there's a quick test (below) developed by Richard Lipton, M.D., a professor of neurology also at the Albert Einstein College of Medicine, that might help.

The sooner you can recognize what you’re dealing with, the sooner you can treat it and start feeling better. "Knowing your headaches are migraines is the first step toward managing them," says Dr. Lipton. (Related: How to Use Essential Oils for Migraines)

Ask yourself:

  1. Has a headache limited your activities for a day or more in the last three months?
  2. Are you nauseated or sick to your stomach when you have a headache?
  3. Does light bother you when you have a headache?

If you answer yes to at least two of these three questions, you probably have migraines. Dr. Lipton says you may be able to prevent attacks by avoiding dietary triggers, such as alcohol (especially red wine), chocolate, and cheese. And a number of medications can relieve pain, so see your doctor sooner rather than later to get to the bottom of it.

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