Migraine vs Headache: Key Differences, Symptoms and Red Flags

Medically reviewed by Dr Saira Bano, BMBS, BMedSci, MRCGP, PGCert MedEd, SCOPE-Certified Obesity Specialist

"I have a migraine" is often used to mean "I have a bad headache". The two are not the same thing, and the distinction is more than semantic.

Migraine is a distinct neurological condition with its own pattern, its own phases and its own treatments. A tension headache and a migraine attack respond to quite different approaches, so knowing which you are dealing with changes what actually helps.

This guide sets out how the two compare on pain, duration, associated symptoms and triggers, explains what migraine aura is, and covers the small number of headache symptoms that should never be ignored.

What is a headache?

Headache is a broad term for pain anywhere in the head, and there are many types. The large majority are not dangerous.

The most common by far is tension-type headache. It typically causes a dull, pressing or tightening pain felt on both sides of the head, often described as a band around the head. It is usually mild to moderate, is not made worse by routine activity, and does not normally come with nausea or sensitivity to light. [1]

Plenty of everyday things bring on headaches: dehydration, poor sleep, skipped meals, eye strain, sinus congestion, caffeine withdrawal, stress, and muscle tension in the neck and shoulders.

One cause deserves particular attention because it is common and widely missed. Medication overuse headache develops when painkillers are taken too frequently, and the treatment itself begins driving the headaches. NICE describes this as a possibility where someone has been taking triptans, opioids or combination painkillers on 10 or more days a month, or paracetamol, aspirin or anti-inflammatories on 15 or more days a month, for three months or longer. [1] It is an easy trap to fall into, because the short-term relief masks the longer-term pattern.

Most ordinary headaches respond well to rest, fluids, simple painkillers and dealing with whatever brought them on.

What is a migraine?

Migraine is a neurological condition rather than simply a severe headache. It involves changes in brain activity, nerve signalling and blood vessels, which is why it produces symptoms well beyond pain and why migraine treatment works differently from ordinary painkillers.

The typical attack involves moderate to severe pain that is often, though not always, on one side of the head. NICE notes that migraine pain can be unilateral or bilateral, so pain on both sides does not rule it out. [1] The pain is usually pulsating or throbbing, is made worse by physical activity, and commonly comes with nausea or vomiting and sensitivity to light, sound or smell. [1]

Duration is one of the most useful distinguishing features. An untreated migraine attack typically lasts between 4 and 72 hours in adults, which is considerably longer than most tension headaches. [1]

Migraine also tends to run in phases, which many people recognise once it is pointed out:

• Prodrome. Early warning signs hours or even a day beforehand, such as tiredness, mood changes, food cravings, yawning or neck stiffness.
• Headache phase. The attack itself.
• Postdrome. Feeling drained, foggy or "hungover" for a day or so afterwards.

Migraine is common. Around 1 in 7 people worldwide are affected, which is roughly 10 million people in the UK. It runs in families, can start at any age, and is two to three times more common in women than men. [3]

What is migraine aura?

About a third of people with migraine experience aura: a set of temporary neurological symptoms that usually arrive before the headache and last from a few minutes up to an hour. [4]

Visual aura is the most common form. People describe flashing lights, zigzag lines, shimmering spots, blind spots, or a pattern that spreads gradually across the vision. Other types include tingling or numbness spreading up an arm or across the face, and difficulty finding words or speaking clearly. [4]

One characteristic matters a great deal, and it links directly to the red flags section below: aura symptoms typically develop gradually over several minutes and then resolve completely. Symptoms that appear suddenly and persist are a different matter entirely.

Some people get aura without any headache following it. And an important caveat: a first-ever aura, or aura that differs from your usual pattern, should be assessed by a clinician rather than assumed to be migraine.

Migraine vs headache: the key differences at a glance

Set side by side, the patterns are reasonably distinct [1][2][4]:

	Tension-type headache	Migraine
Pain type	Dull, pressing or tightening (non-pulsating)	Pulsating or throbbing
Location	Both sides of the head	Often one side, but can be both
Severity	Mild to moderate	Moderate to severe
Effect of activity	Not usually worsened by routine activity	Worsened by movement and routine activity
Duration	30 minutes to continuous	4 to 72 hours in adults
Nausea or vomiting	Uncommon	Common
Light and sound sensitivity	Uncommon	Common
Aura	Never	In around a third of people
Warning signs before onset	None	Prodrome common

No single feature confirms migraine on its own. It is the overall pattern that matters, which is why clinicians ask about duration, associated symptoms and what makes it worse rather than focusing on the pain alone.

It is also entirely possible to have both. Tension headaches and migraines frequently coexist, and NICE notes that chronic migraine and chronic tension-type headache commonly overlap, with any migraine features pointing towards a migraine diagnosis. [1]

Six common triggers for migraine and headache

Triggers vary considerably between individuals, and they often act in combination rather than alone. A poor night of sleep on its own may cause no problem; a poor night plus a skipped lunch plus a stressful afternoon may well do.

Common migraine triggers include:

• Hormonal changes, particularly around periods
• Disrupted sleep, whether too little or too much
• Skipped meals and dehydration
• Stress, and the "let-down" period after stress passes
• Alcohol (especially red wine), excess caffeine or caffeine withdrawal, aged cheese and processed meats
• Bright or flickering light, strong smells, and weather changes

Tension headaches share several of these, particularly stress, poor sleep and dehydration, but they are more closely tied to muscle tension and everyday physical strain, including posture at a desk.

The single most useful thing you can do is keep a headache diary for a few weeks, noting timing, symptoms, sleep, meals, stress levels and, for women, where you are in your menstrual cycle. Patterns that are invisible day to day often become obvious across a month, and it is the most valuable thing you can bring to a consultation.

How are migraines and headaches treated differently?

Tension headaches usually respond to simple painkillers such as paracetamol or an anti-inflammatory, alongside rest, fluids and addressing the underlying cause. [1]

Migraine often needs a combination approach. That may include simple painkillers or anti-inflammatories taken early in an attack, anti-sickness medicines where nausea is a significant problem, and for many people a class of migraine-specific medicines called triptans. [1]

Triptans are prescription-only medicines that act on the migraine process itself rather than simply dulling pain, which is why they can work when ordinary painkillers do not. Sumatriptan is one example of this class. Whether a triptan is appropriate, and which one, is a decision for a clinician following an assessment rather than something to determine yourself.

Timing matters more than most people realise. Migraine treatment works considerably better taken early, at the first sign of an attack, than it does once the attack is well established. Waiting to see how bad it gets is usually counterproductive.

People experiencing frequent migraines, typically several a month, may be offered preventive treatment taken regularly rather than only during attacks. That is a conversation to have with a clinician, as it involves weighing benefits against side effects.

The medication overuse point applies here too, and with particular force. Taking painkillers or triptans too frequently can make headaches more frequent rather than less. [1] If you are treating attacks regularly, that is itself a reason to involve a clinician rather than continuing to manage alone.

Red flags: when a headache needs urgent medical attention

The vast majority of headaches and migraines are not dangerous. A small number of features, though, can indicate a serious underlying cause and need immediate assessment.

Call 999 (and do not drive yourself to A&E) if you have a headache and any of the following: [2]

• A headache that came on suddenly and is extremely painful, particularly one reaching maximum intensity within seconds to a minute (sometimes called a thunderclap headache)
• Problems speaking or remembering things
• Loss of vision, or blurred or double vision
• Drowsiness or confusion
• A seizure or fit
• A very high temperature with symptoms of meningitis, such as a stiff neck or a rash
• Weakness or inability to move an arm or leg on one side of the body, or one side of the face
• A recent head injury

Also seek urgent assessment for a headache following a head injury, a headache that is worse on lying down, coughing or straining, or one that wakes you from sleep. A new or different headache in someone over 50, someone with a weakened immune system, or someone with a history of cancer warrants prompt review, as does a headache with a painful red eye or loss of vision.

The distinction between aura and stroke is worth being clear about, because it causes real confusion. Migraine aura develops gradually over minutes, follows a pattern familiar to that person, and resolves fully. Stroke symptoms come on suddenly and persist. Anyone who is unsure which they are experiencing should treat it as an emergency and seek help immediately. [5] The NHS FAST test is a useful reminder of the main signs of stroke: Face drooping on one side, Arms that cannot be lifted and held up because of weakness or numbness, Speech that is slurred or confused, and Time to call 999. [6]

Two further principles are worth holding onto. A "worst headache of my life", or a headache completely unlike anything you have experienced before, should always be assessed. And NHS guidance advises seeking urgent advice if a migraine attack lasts longer than 72 hours, if aura symptoms last longer than an hour at a time, or if you are pregnant or have recently given birth. [2]

This article is general information and does not replace clinical assessment. If something feels wrong, act on it.

When to see a doctor about headaches or migraines

Outside the red flags above, it is worth seeing a clinician if headaches are becoming more frequent or more severe, are affecting your work, sleep or daily life, are not responding to over-the-counter treatment, are occurring on several days a month, or if you are using painkillers regularly.

Migraine is a diagnosable and treatable condition, yet many people go years without a proper diagnosis or effective treatment, often having concluded that bad headaches are simply something to put up with. That is worth challenging.

A clinician can confirm the diagnosis, review your triggers and diary, discuss both acute and preventive options, and check for any underlying cause. A private online GP appointment is one way to get that conversation without a long wait.

How SwiftDoctor can help with migraines

SwiftDoctor offers online consultations for migraine, with a qualified clinician assessing your symptoms and suitability for treatment before anything is prescribed. Where treatment is appropriate, our migraine treatments are delivered discreetly, and the clinical team remains available if your pattern changes or your current treatment is not working well enough.

Frequently asked questions

Can you have a migraine without a headache?

Yes. Some people experience aura, nausea, light sensitivity or the fatigue and fogginess of the prodrome and postdrome phases without significant head pain. This is sometimes called silent migraine. Because aura without headache can resemble other conditions, a first episode should be assessed by a clinician. [4]

Why do I get a headache after a migraine?

What most people describe as a headache afterwards is usually the postdrome phase, sometimes called a migraine hangover. It can leave you feeling drained, foggy, achy or low in mood for up to a day after the pain has gone, and it is a recognised part of the attack rather than a separate problem.

Can a tension headache turn into a migraine?

One does not literally convert into the other, but they frequently coexist, and an attack can begin with tension-type features before developing clear migraine characteristics. NICE notes that where frequent headaches have any features of migraine, chronic migraine should be diagnosed. [1]

Are migraines linked to periods or the menopause?

Yes, for many women. Hormonal fluctuations are a well-recognised migraine trigger, and menstrual-related migraine typically occurs in the days around a period. Migraine patterns often change during perimenopause and may settle after menopause. A headache diary recording your cycle alongside attacks is particularly useful here. [1]

Do children get migraines?

Yes. Migraine can begin in childhood, and in girls it often starts around puberty. [3] Attacks in children and young people can be shorter than in adults, and abdominal symptoms are sometimes more prominent than head pain. Any child with recurrent headaches should be assessed by a clinician.

Can you get a migraine from your neck?

Neck pain and stiffness are commonly reported during migraine attacks, often during the prodrome, so the neck can feel like the cause when it is actually part of the attack. Genuine neck problems can also cause headaches, known as cervicogenic headache. Distinguishing between them needs a clinical assessment rather than guesswork.

Sources

1. National Institute for Health and Care Excellence (NICE), "Headaches in over 12s: diagnosis and management (CG150)", nice.org.uk
2. NHS, "Migraine", nhs.uk
3. The Migraine Trust, "What is migraine?", migrainetrust.org
4. The Migraine Trust, "Understanding migraine aura", migrainetrust.org
5. The Migraine Trust, "Migraine and A&E", migrainetrust.org
6. NHS, "Symptoms of a stroke", nhs.uk