Migraines vs. tension headaches: Key differences and symptoms

Taffic. Bills. Juggling work and family. It can all lead to stress — and headaches.

For many people, headaches are a minor discomfort. They may even feel like a normal part of modern life. But if your headaches are severe or frequent, or they often overlap with other symptoms, they might be migraines. 

Unlike other headaches, migraines are a neurological condition that can lead to more intense symptoms. They have many possible triggers, including hormonal changes like drops in estrogen. For this reason, they may coincide with certain parts of a menstrual cycle. In fact, women are 3 times more likely than men to get migraines, and migraines are one of the top causes of disability in women between 15 and 49 years old.¹ But with proper medical attention and treatment, it’s possible to avoid long-term health issues.

Whether they happen often or every once in a while, the good news is that migraines are manageable with a doctor’s help. That’s why it’s important to know the difference between tension and migraine headache symptoms — so you know when to talk with a professional. 

What is a tension headache?

Headaches involve pain in any part of your head or face. Tension headaches are the most common, and most people will have them at some point in their lives. While they can cause an uncomfortable throbbing pressure, they don’t usually indicate a serious medical problem. They’ll go away on their own in 20 minutes to a few hours, so you don’t need any special treatments or prescriptions to treat them. But some over-the-counter pain relievers can help with symptoms.

Common tension headache symptoms and causes

Common tension headache symptoms include:

• Mild to moderate pain that feels like an ache or pressure in your head
• Pain that lasts 30 minutes to several hours
• Pain that feels like a tight band around your head
• Pain that may travel to your upper back and neck

Common causes, also know as triggers, include:

• Stress
• Eye strain or too much screen time
• Neck strain or neck injuries
• Illnesses like cold or flu

While tension headaches are the most common, there are other types of headaches you should know about:

• Cluster headaches: Cause extreme pain for about 30 minutes at a time, always on one side of the head. These can happen in a “cluster” of time, from a few days or weeks to (rarely) months. Pain tends to happen at the same time each day, often focused behind the eye and sometimes causing eye redness. Between headaches, you may not feel pain at all. Cluster headaches are 6 times more common in men than women.²  
• Sinus headaches: Usually related to a sinus infection and produce a dull pain around the eyes, forehead, cheekbones, or nose. As with any infection, they can accompany fever and illness, so you should consult a doctor to make sure you don’t need antibiotics. But often, sinus headaches are viral or seasonal.
• Thunderclap headaches: Sudden, extremely painful headaches that may indicate a serious medical condition or emergency. If you haven’t been diagnosed with a condition that can cause thunderclap headaches, you should seek medical care immediately.³   

What is a migraine?

A migraine is a headache that can last 4 to 72 hours. To be considered a migraine, it needs to have specific symptoms beyond just head pain. A doctor can examine you and ask about your symptoms to decide if it’s a migraine. But it’s helpful to know the signs yourself.

People often sense they’re going to have a migraine before it starts. You may feel warning signs hours or even days before the onset of a migraine. For example, you can feel fatigued, emotional, or have food cravings during this time. You might also feel neck pain or stiffness or have changes in your menstrual cycle. It’s helpful to track your symptoms to identify patterns and possible triggers.

Common migraine symptoms

Here are some signs your headache may be a migraine:

• Moderate to severe pain that throbs or gets worse with physical activity or when you move your head.
• Pain that’s on one side of your head. Most migraines are one-sided, but they can also be on both sides of your head or change from one side to the other between episodes.
• Nausea — this is the most common migraine symptom after head pain.
• Sensitivity to light, noise, or both, with a desire to lie down in a dark quiet room and sleep.
• Auras that last 5 to 60 minutes before the headache. These are usually visual distortions like flashing or neon lights or dark spots that expand. Sometimes, auras can happen without a headache.
• Numbness or tingling on one side of your body. If this isn’t a typical symptom of your headaches, you should seek medical advice to make sure it’s not a more serious issue.

After a migraine, you may be irritable or have trouble concentrating. Also, your head or scalp may feel sensitive.

Tension vs. migraine headaches: How to tell the difference

If you have any of the migraine symptoms above, that’s a good sign you’re having a migraine headache and not a tension headache. Here’s an overview of some of the key differences.

Common causes of migraines

Migraine triggers are different for every person, but common ones include:

• Stress
• Hormonal changes, like the start of a menstrual cycle
• Sudden weather changes
• Certain smells or odors
• Certain foods or drinks, like alcohol, artificial sweeteners, or the 5 C’s described below
• Changes in routine, like too much or too little sleep
• Skipping meals

Sometimes, a migraine is only triggered when causes are “stacked.” For example, a day of travel may cause stress, poor sleep, and skipped meals.

What are the 5 C’s for migraines?

The 5 C’s refer to these common foods that are sometimes linked to migraines: 

• Cheese
• Citrus
• Chocolate
• Coffee 
• Cola

Not all these foods are triggers for everyone who has migraines. And research is still needed to prove they cause migraines. But it’s good to be aware of the 5 C’s so you can decide if any of them tend to be triggers for you. If you tend to get migraines often, consider tracking your habits in a log or diary. Just keep in mind that your triggers may be different from anything on this list. 

The link between caffeine and migraines

Regular use of caffeine can make headaches and migraines worse. Caffeine also seems to be a migraine trigger for some people. If you drink a lot of coffee or other caffeinated beverages every day, you may want to cut back. These can cause what are called rebound headaches or migraines.

Try to reduce the amount of caffeine you drink gradually. People react to caffeine differently, so just try drinking one less cup a day until you find an amount that works for you. If you cut back too quickly, or stop completely right away, you could get rebound or withdrawal headaches.

How to prevent headaches and migraines

To prevent a headache or migraine, avoid or reduce your triggers. You can try: 

• Stress reduction techniques like meditation
• Limiting screen time to avoid eye strain
• Exercising
• Improving sleep hygiene
• Cutting back on alcohol

Migraine triggers are different for everyone. If you’re not sure what yours are, keep a log or diary to track your migraines. Include what you did or ate before they started, and look for patterns.

Can children have migraine headaches?

Children usually have normal headaches that don’t pose serious problems. But they may also have migraines that can interfere with their mood, their daily schedule, and school. In fact, about 1 in 10 children and teens have migraines.⁴

There are differences between migraines in children and adults. When a child has a migraine, they usually feel pain on both sides of their head. This is especially true when they’re younger. As they get into their teens, they may be more likely to feel pain on one side of their head, like adults.

Children’s migraines also tend to be shorter than adult migraines. And children are less likely to see the flashing lights or other auras many adults notice at the start of a migraine. Instead, they may become irritable or pale before a migraine starts. In addition to throbbing head pain, they may feel nausea or stomach pain.

If your child is having migraines, talk to their pediatrician. Be ready to provide information about your child’s symptoms and anything that seems to trigger their migraines. If it helps, you and your child can keep a log or diary to track symptoms and triggers.

What are the treatments for headaches and migraines? 

To treat a tension headache, you can take over-the-counter pain relievers like ibuprofen (Advil) or acetaminophen (Tylenol).⁵ You can also apply a cold or warm compress to your head, depending on your preference.

Over-the-counter options may also work for migraines. But there are other very specific treatments and medications available. Be sure to talk to your doctor if you think you’re having migraines to review your treatment options. 

Pain-relieving treatments are best used at the start of a migraine. They can include over-the-counter medications like ibuprofen (Advil) or acetaminophen (Tylenol).⁵ Prescription pain relievers are also available, including medications specifically for migraine pain. If you get migraines often, there are prescription medications you can take daily to reduce the number of migraines you have.

When to get help

You don’t have to figure out how to treat your headaches on your own. Talk to your doctor if you’re concerned — especially if your headaches interfere with work, school, or your daily life. It’s also important to talk to your doctor if you’re having to take more over-the-counter medications than you usually do to relieve your pain. 

Start by avoiding triggers and trying appropriate treatments. Then you and your doctor can make a plan to help you manage your headaches better and stay in control of your life.

When to go to the ER for a migraine 

If you’ve never had migraines — or you have one that’s unusually severe or has serious symptoms that are unusual for you — you may need immediate medical attention. Go to the nearest emergency room if:³ 

• You feel like you’re having the worst migraine you’ve ever had
• The migraine starts suddenly and immediately involves severe pain
• The migraine lasts longer than usual or gets worse, even after you take steps that usually help
• You have a headache that started after head trauma
• You have a headache accompanied by paralysis, trouble speaking, or loss of consciousness
• Your blood pressure is high, or you have swelling in different parts of your body
• Your vision is blurred or lost, or you feel dizzy, particularly if you’ve never had an aura before

If you’re pregnant: If you tend to have migraines and you have the same type of migraine when you’re pregnant, you can probably follow your usual steps for dealing with it. Acetaminophen (the main ingredient in Tylenol) is a safe and effective option for dealing with pain during pregnancy.⁵ But if you have any of the more serious symptoms above, you should go to the ER. Severe headaches may also be a sign of preeclampsia, a serious type of high blood pressure that sometimes happens during pregnancy.

Visit our maternity site for more information about staying healthy during pregnancy.