What's the Difference Between a Headache and a Migraine?

We've all been there: Your head starts throbbing painfully. As the pressure builds, you might have a sense that this headache is particularly nasty; you might even question if you're experiencing a full-blown migraine.

Still, it can be difficult to tell whether you're having a typical headache or a migraine — especially when your head feels like it's going to split in two. Let's explore the differences between migraines and headaches, and why it's important to be able to tell them apart.

Simply put, a migraine is more than just a "bad" headache. This neurological disease is often lifelong, characterized by recurring, throbbing pain — typically on one side of the head — and several other symptoms that can leave an individual bedridden for days.

In general, headaches can be a symptom of other conditions, and can mean a lot of things, says Sara Austin, a neurologist at the University of Texas at Austin's Dell Medical School. But migraines are just one type of primary headache, and have specific diagnostic criteria, adds Timothy Collins, a neurologist at Duke University. 

First things first, to be considered a migraine, the headache must last longer than four hours without any medication. A true migraine must also have two out of the following four characteristics:

• Pain mainly on one side of your head.

• Throbbing or pounding pain.

• Moderate to severe intensity.

• Pain that’s worse with regular activity, like walking around the house.

In addition to those symptoms, to have a migraine, a patient must also experience either nausea or sensitivity to lights or sounds. (Austin notes that you may feel like you can’t think as quickly or as sharply, as well.) Basically, when you think about a migraine, it's really all about the additional symptoms, Collins says. 

Read More: The Science of Migraines

While there are many primary headache disorders — which include migraines, tension, and cluster headaches — Collins explains how a majority of patients he sees in the clinic have migraine headaches. He attributes this to the fact that migraines can be debilitating, can impede on one’s daily activities, and over-the-counter medications don’t always work.

What's more, about 12 percent of adults in the U.S. experience migraines, according to the National Institute of Neurological Disorders and Stroke. Indeed, in a 2020 study published in The Journal of Headache and Pain, researchers highlighted the fact that migraines are second among the causes of disability worldwide — and first among young women.

The good news? Many new migraine-specific medications have been approved in recent years, thanks to some new breakthroughs. For example, researchers have found that neurotransmitters such as calcitonin gene-related peptide (CGRP) and serotonin can be key players during a migraine headache, making them the targets for certain drugs used today.

“It's like if your kidneys hurt or your leg hurts or something, these medicines wouldn't help, but if you have a migraine, they really often help a lot,” Austin says.

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If you’ve ever experienced a migraine, you probably found yourself aching to crawl into bed with a pillow over your head and the curtains closed. Why? Well, experts say migraine sufferers are typically overly sensitive to certain stimuli.

Put simply, when experiencing a migraine, the brain’s ability to process pain signals becomes distorted, and even a light touch can be perceived as pain, Collins explains. While the brain itself doesn’t actually have pain receptors, pain fibers can be found elsewhere, such as the face and the dura (a membrane between the skull and the brain), which relay messages to the brain.

During migraine headache attacks, inflammation around the blood vessels in say, the dura, makes the pain fibers hypersensitive, Collins notes. “You just ruffle your hair and it kind of hurts,” Austin adds. That's why smells, noise, lights, and even tight paints can all be potential triggers.

Read More: Why Does Pain Hurt?

Just like migraines have their own specific characteristics, so do other types of headaches, such as tension and cluster headaches.

While tension headaches are very common, “[they] have none of the features of a migraine,” Collins says.

In general, these headaches usually dull and non-throbbing, and they aren’t typically as severe as migraines. Still, it's a misconception that tension-type headaches are less painful or disabling than migraines.

Plus, if you experience a tension headache, you might also find you can usually go about your daily activities, as lights, noise, or sounds aren’t usually triggering.

If you experience a cluster headache, which are not as common, you may have symptoms such as a sharp pain on one side, typically near the eye, which lasts about an hour. You might also experience nasal congestion, and eye redness.

And while migraines might make you want to shut your eyes in a quiet dark room, cluster headaches, by contrast, can make patients unable to sit still, says Austin.

Beyond that, researchers even found differences in which parts of the brain are activated by those two types of headaches. In a study published in The Lancet in 2001, researchers found that the brain stem — the bottom, stalklike portion of the brain that connects to the spinal cord — was activated during migraine attacks, but not during a cluster headache. 

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Clearly, each headache type is unique. Sometimes, a headache can be a symptom of something more serious that warrants further medical evaluation. (Though Austin notes that it's quite rare for something like a brain tumor to cause a headache as a primary symptom.)

Still, if you have a dramatic change in the types of headaches you experience, start getting headaches for seemingly no reason, or start having headaches after menopause, it's probably a good idea to get evaluated by your physician.

And if you experience red-flag symptoms such as loss of consciousness, weakness or paralysis in one arm or leg, double vision, or difficulty talking in addition to your headache, don't hesitate to call for emergency medical attention. 

Read More: What’s Really Going on When Your Head Aches?

If you do experience migraines, just know you’re not alone. In fact, the authors of a 2012 study published in the Annals of Neuroscience described migraines as "the most debilitating chronic medical illness that hampers normal life."

As Collins says, “nobody really wants to talk about migraines,” yet we’ll talk more freely about other health problems. Still, he's noticed that some patients seem perplexed when discussing migraines with him, since they feel like no one else around them seems to be experiencing what they’re experiencing.

This holiday season, talking with those around you about headaches and migraines can help normalize them. And take comfort knowing that researchers and medical professionals are continuing to investigate migraines to find new treatments.

If all else fails, and you can’t seem to find relief, or your head hurts from simply trying to figure out if you have a migraine or not, remember that medical professionals and neurologists are here to help.

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