Headache and Migraine: How to Tell the Difference and What to Do
Headache is one of the most common complaints in the world. Nearly 96% of people have experienced one at some point, and for one in seven, they are a regular occurrence. Headache is not a single symptom but dozens of different conditions: from ordinary tension to migraine, from high blood pressure to intracranial problems. This article covers the main types of headache, how to tell them apart, and when a headache calls for urgent care.
Types of headache: how to tell them apart
The International Headache Society recognises over 200 types. For most people, three primary types are relevant — conditions where the headache is a disorder in its own right, not a symptom of something else.
Tension-type headache (TTH) — the most common, affecting 30–80% of people. It feels like pressure or tightening around the head ("a band"), usually bilateral, moderate in intensity, and doesn't worsen with physical activity. Nausea is absent or mild. Often linked to stress, poor posture, or prolonged screen time.
Migraine — second most common but first in its impact on quality of life. About 15% of people are affected. Characterised by intense, throbbing, usually one-sided pain that worsens with exertion, light, sound, and smells. Accompanied by nausea or vomiting.
Cluster headache — rare (0.1% of the population) but arguably the most intense of all. Severe pain around one eye, accompanied by tearing, nasal congestion, and eye redness. Attacks last 15 minutes to 3 hours and come in "clusters" — several episodes per day over weeks or months.
Migraine: symptoms, phases, triggers
Migraine is not simply "a bad headache". It is a neurological disorder with a specific mechanism: activation of the trigeminal nerve and changes in cerebral vascular tone.
The four phases of migraine:
- Prodrome (1–2 days before the headache): mood changes, yawning, thirst, food cravings, fatigue. Many people only recognise these signs in retrospect.
- Aura (in 25–30% of patients, 20–60 minutes before the headache): visual disturbances (flickering zigzags, blind spots), numbness or tingling in the face and arm, difficulty speaking. Aura is fully reversible.
- Headache (4–72 hours): throbbing, usually one-sided, moderate to severe. Worsens with activity, bright light, loud sounds, and strong smells. Nausea and vomiting are common.
- Postdrome ("migraine hangover"): after the pain ends — fatigue, brain fog, and scalp tenderness lasting hours to a day.
Common migraine triggers:
- hormonal changes (in women — menstruation, ovulation, combined oral contraceptives, menopause);
- skipping meals or dehydration;
- disrupted sleep — both too little and too much;
- alcohol (especially red wine and beer);
- stress and post-stress relaxation ("weekend migraine");
- bright or flickering light, strong smells;
- weather changes;
- certain foods: aged cheeses, cured meats, caffeine.
Keeping a headache diary helps identify personal triggers and patterns. Several dedicated apps are available for this purpose.
Cluster headache
Cluster headache is one of the most painful conditions in medicine. Patients describe it as "a hot poker through the eye". The pain is so intense that people cannot lie still — they pace, rock, and cannot find a comfortable position.
Distinguishing features:
- strictly one-sided pain around the eye or temple;
- tearing, eye redness, nasal congestion on the side of the pain;
- attacks at the same time of day (often at night);
- "cluster" period: several weeks to 3 months, then remission;
- more common in men (3:1 ratio).
Treatment is specific — ordinary painkillers don't work. Triptans, high-flow oxygen via mask, and preventive medications (verapamil) are used. A neurologist's consultation is necessary.
Tension-type headache — the most common
Most people know it well: the feeling that someone is squeezing the head in a vice. The pain is dull, pressing, and symmetrical. It usually doesn't stop you from working — it's just unpleasant. It lasts from 30 minutes to several hours, sometimes up to a day.
Main causes of TTH:
- tension in the neck and shoulder muscles — especially from screen work;
- stress and anxiety;
- dehydration;
- poor sleep;
- bad posture;
- overuse of painkillers — so-called medication overuse headache.
Medication overuse headache is an important trap: taking painkillers more than 10–15 days per month causes the medications themselves to start triggering headaches. This is particularly common with combination analgesics containing caffeine. The solution is gradual withdrawal under a neurologist's supervision.
When a headache is dangerous
Most headaches are unpleasant but not dangerous. However, certain features demand immediate medical attention:
- "Thunderclap headache" — sudden, maximal-intensity pain you've never experienced before. This may indicate subarachnoid haemorrhage.
- Headache with fever above 38.5°C and neck stiffness (unable to touch chin to chest) — possible meningitis.
- Headache after a head injury — especially if worsening.
- Headache with neurological symptoms: weakness in an arm or leg, visual disturbance, speech or coordination problems.
- Headache in a person with cancer or HIV.
- New severe headache in someone over 50.
- Progressively worsening headache over several days or weeks.
Any of these signals — call emergency services or go to an emergency room immediately.
If you have frequent headaches and want to know which specialist to see, try describing your symptoms to the assistant. For chronic headaches, a neurologist can establish the diagnosis and prescribe preventive treatment. Use the doctor routing tool to find the right specialist.
Frequently asked questions
How do you tell migraine apart from an ordinary headache?
Migraine is typically more intense, throbbing, usually one-sided, and accompanied by nausea or vomiting and marked sensitivity to light and sound. Tension headache is pressing, bilateral, and without nausea. A simple rule: if the pain makes you nauseous and any light or sound is unbearable — it's most likely migraine.
Do triptans work for migraine?
Yes — triptans (sumatriptan, eletriptan, rizatriptan) are migraine-specific medications and are significantly more effective than ordinary painkillers. They treat the acute attack. The key is to take them at the onset of the attack, not when the pain peaks. Prescribed by a neurologist.
Can migraine be prevented?
For frequent migraine (more than 4 days per month), preventive treatment is used: beta-blockers, amitriptyline, topiramate, CGRP antagonists (newer and highly effective options). These significantly reduce attack frequency. A neurologist chooses and manages the regimen.
Is migraine with aura dangerous?
Aura itself is reversible and harmless. However, migraine with aura slightly increases the risk of ischaemic stroke — particularly in young women who smoke and use oestrogen-containing combined oral contraceptives. If these factors are combined, discuss contraceptive alternatives with a neurologist and gynaecologist.
Why do headaches happen in the morning?
Morning headaches occur in several conditions: sleep apnoea (breathing interruptions during sleep), bruxism (teeth grinding), migraine (often attacks in the early hours), and raised intracranial pressure. If morning headaches are a regular pattern, raise this with a neurologist.
Is an MRI scan necessary for headache?
For typical tension headache or migraine, MRI is not needed — the diagnosis is clinical. MRI is ordered when: the headache is worsening, atypical, accompanied by neurological symptoms, or if it's a first severe episode. The neurologist decides this after examination.
Symptomatica is an informational reference service. Not a medical service; does not diagnose or prescribe treatment. For any symptoms, please consult a doctor.