Migraine symptoms vs tension headache: how to tell

In short

• Migraine is typically throbbing, often one-sided, worse with movement, and comes with nausea or sensitivity to light and sound.
• A tension-type headache is usually pressure or a tight band around the head, and it does not usually cause nausea or vomiting.
• Migraine attacks usually last 4 to 72 hours. A tension headache can last from 30 minutes to several days.
• Taking pain medicine too often can bring on medication-overuse headache, so keep track of the days you use it.
• A diary of your headaches helps your clinician choose treatment, and see a clinician if migraines happen more than once a week.

How the two types differ

• Location: migraine is often on one side of the head or behind an eye. Tension-type headache is usually felt all over, not just in one spot or on one side.
• Quality: migraine pain is throbbing or pulsing. Tension-type headache is dull and pressing, often like a tight band, and not throbbing.
• Severity: migraine is often moderate to severe. Tension-type headache is typically mild to moderate and responds to home treatment within a few hours.
• Movement: routine physical activity tends to make a migraine worse.
• Other symptoms: migraine commonly brings nausea, vomiting and sensitivity to light and sound. Nausea or vomiting usually does not occur with a tension headache.
• Duration: migraine attacks usually last 4 to 72 hours. A tension headache may last 30 minutes to 7 days.

Some people have both, which is one reason a headache diary matters. The WHO estimates that headache disorders affect about 40% of the population, and that episodic tension-type headache is reported by more than 70% of people in some populations.

Aura: what it is and when to worry

Some people get an aura before or during a migraine. MedlinePlus describes visual signs such as flashing or bright lights or zig-zag lines, and aura can also cause pins-and-needles numbness, dizziness, muscle weakness or difficulty speaking. According to the NHS, aura symptoms should not last longer than 1 hour.

Sudden weakness on one side of the face, an arm or a leg, trouble speaking, or sudden vision loss are emergency signs that can also mean a stroke. Do not assume it is an aura. Call 911.

Triggers and the diary

• Hormonal changes, including periods.
• Stress, anxiety and tiredness.
• Changes in sleep, and skipped meals.
• Too much caffeine, or caffeine withdrawal.
• Bright or flashing lights, loud noises, strong smells and weather changes.
• Alcohol, and for some people certain foods in combination with other triggers.

Triggers vary from person to person. Chasing forbidden foods can mislead you: MedlinePlus lists food cravings as part of the warning phase that can start up to 24 hours before a migraine, so craving chocolate may be an early sign rather than the cause. Track date, time, duration, severity, symptoms, medicine and its effect, sleep and menstrual cycle in a diary, as the NHS suggests, and share the pattern with your clinician.

Treating an attack

• Act early: the NHS says painkillers work best when taken as soon as the headache starts.
• Migraine medicines include over-the-counter pain relievers, triptans, gepants and anti-sickness medicines. A clinician prescribes the prescription ones and checks they are safe for you.
• For tension-type headache, over-the-counter pain relievers can help, along with massage, ice or hot packs, relaxation, biofeedback and cognitive behavioral therapy.
• At home, rest in a quiet, dark room, use a cool cloth or an ice pack and drink fluids.

The painkiller trap: medication-overuse headache

Using headache medicine too often can cause more headaches. The WHO calls medication-overuse headache the most common secondary headache disorder and notes it is often worst on waking. The NHS advises trying not to take painkillers for more than 2 days a week for migraine, and MedlinePlus says taking pain medicine more than 3 days a week for tension headache may cause rebound headaches.

Ask your clinician how often is safe for you. If you suspect overuse, do not simply stop a prescribed medicine on your own; ask for a plan.

Prevention

MedlinePlus lists regular sleep and meals, exercise, relaxation techniques and biofeedback, and keeping a trigger log as ways to reduce how often migraines happen. For frequent or severe attacks, a clinician can discuss medicines to prevent them. The NHS names beta blockers, certain antidepressants and epilepsy medicines among the options, along with acupuncture, CBT and lifestyle changes.

The NHS advises seeing a clinician if attacks are severe or getting worse, happen more than once a week, are hard to control, or regularly occur before or during your period. Prevention is about fewer and milder attacks, not necessarily none.

When to see a doctor, and red flags

See a clinician if your headache pattern changes, treatments stop working, or you need pain medicine regularly. Get urgent care if a migraine lasts longer than 72 hours, if aura lasts longer than 1 hour, or if you are pregnant or recently gave birth. Headache after coughing, sneezing, bending or exercise, headache with vomiting or eye problems, and headache with jaw pain or a tender scalp also need prompt attention.

Red flags: call 911 for a sudden, extremely severe headache, a headache after a head injury, or a headache with a seizure, drowsiness or confusion, trouble speaking or remembering, vision loss, numbness or weakness in the face or body, or a very high temperature with a stiff neck. Do not drive yourself.

Questions and answers

Sources

1. NHS — Migraine
2. MedlinePlus — Migraine
3. MedlinePlus — Tension headache
4. WHO — Headache disorders

Sources checked on 29 October 2026.