Migraine vs headache: how to tell if it's a migraine

If your head hurts badly right now and you are wondering whether this is a migraine, this guide is for you. The short version: migraine has a pattern. It tends to throb, it gets worse when you move, and it brings other symptoms like feeling sick or finding light and sound hard to bear. Today, note what you feel and when it started. If anything on the red-flag list near the end applies to you, get help now.

Is a migraine just a bad headache?

No. A headache is head pain. Migraine is a condition that causes attacks, and head pain is only one part of an attack. The American Migraine Foundation calls migraine “a debilitating neurological disease that comes in many forms, both with and without headache.”

Headaches are very common. The World Health Organization says headache disorders affect “approximately 40% of the population.” The three main types it names are migraine, tension-type headache and cluster headache. Each one has its own pattern, and that pattern is what doctors use to tell them apart.

The NHS also offers some calm news: “Most headaches go away on their own and are not a sign of something more serious.”

Migraine vs tension-type headache vs cluster headache

This table uses the features listed in the NICE guideline on headaches (CG150), with plain wording from the NHS and the American Migraine Foundation. It is a guide to the usual pattern, not a test.

A few things stand out. Tension-type headache does not come with nausea, and the NHS says “you should be able to continue doing daily activities without making the headache worse.” Migraine often makes you want to avoid moving. Cluster headache is the reverse: the American Migraine Foundation says most people in a cluster attack “cannot find a comfortable position and often feel the need to pace or rock.”

How doctors define migraine without aura

The International Headache Society publishes the International Classification of Headache Disorders, third edition (ICHD-3). Here are its criteria for migraine without aura, the most common kind, with plain words after each one.

1. “At least five attacks” that fit the rest of the list. One or two bad headaches are not enough. ICHD-3 says people with fewer than five such attacks are coded as “probable migraine without aura.”
2. “Headache attacks lasting 4-72 hr (untreated or unsuccessfully treated).” So an attack lasts from 4 hours to 3 days if nothing stops it. In children and teens under 18, ICHD-3 says attacks “may last 2-72 hours.”
3. “At least two of the following four characteristics”:
   • “unilateral location”: the pain is on one side
   • “pulsating quality”: it throbs or pulses
   • “moderate or severe pain intensity”: it is more than mild
   • “aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)”: moving makes it worse, or you avoid moving because of it
4. “During headache at least one of the following”: “nausea and/or vomiting”, or “photophobia and phonophobia”. That last pair means sensitivity to light and to sound, both together.
5. “Not better accounted for by another ICHD-3 diagnosis.” A doctor first checks that nothing else explains the headache.

Notice that you only need two of the four pain features. That is why a migraine can be on both sides of the head and still be a migraine, as long as it throbs and gets worse when you move, for example.

What is a migraine aura?

Some people get warning symptoms before or during the head pain. This is called aura. The American Migraine Foundation says about a quarter of people with migraine get aura, and “70-75% of patients with migraine do not experience aura.”

The NHS lists aura signs such as “seeing zigzag lines or flashing lights”, “numbness or a tingling that feels like pins and needles”, feeling dizzy and difficulty speaking. NICE says aura symptoms are fully reversible, build up over at least 5 minutes and “last 5 to 60 minutes.” Aura can also happen with no headache at all.

The NHS says “aura symptoms should not last for longer than 1 hour.” If they do, it advises an urgent GP appointment or a call to 111. The American Migraine Foundation adds: “If you ever experience weakness with your headache, you should seek medical attention immediately.”

How to tell if it’s a migraine or a headache

You cannot diagnose yourself, but you can notice the things a doctor will ask about. During your next headache, check these five questions.

1. Does it throb, or does it press? Throbbing points toward migraine. Pressure or a tight band points toward tension-type headache.
2. Is it on one side? One side is common in migraine. Both sides is typical of tension-type headache. One side around the eye, with a red or watery eye, fits cluster headache.
3. What happens when you move? If walking or climbing stairs makes it worse, that fits migraine. If you can carry on as normal, that fits tension-type headache.
4. What else is going on? Nausea, vomiting, or light and sound feeling too much fit migraine. The NHS tension headache page says throbbing on one side, feeling sick and finding light or noise painful “can be signs of a different type of headache, such as a migraine or cluster headache.”
5. How long does it last? Note the start and end time. A migraine attack in adults lasts 4 to 72 hours. If you fall asleep and wake up without it, ICHD-3 counts the attack as lasting until you woke.

Also note how often you get headaches and what painkillers you take. The NHS says taking painkillers for headaches too often can itself cause headaches, called overuse or rebound headaches. Our guide to medication overuse headache explains this. If it worries you, talk to your doctor or pharmacist before you change anything.

Why only a doctor can tell for sure

Migraine is diagnosed from the pattern of your symptoms, using criteria like the ones above. A doctor will ask about your story: what the pain is like, where it is, how long it lasts and what comes with it. A doctor also checks that nothing else is causing your headaches, which you cannot do at home.

It is not always clear cut. The International Headache Society says the most common difficulty between headache types is telling tension-type headache apart from mild migraine. It adds that people with frequent headaches “often suffer from both disorders.”

This is where notes help. NICE suggests doctors consider a headache diary to help diagnose headaches, kept for “a minimum of 8 weeks.” It lists what to record: how often, how long and how bad your headaches are, other symptoms, all medicines you took, possible triggers, and any link to your period. Our guide to keeping a migraine diary shows how to set one up so your doctor can tell the types apart.

How Headache Pal can help

Headache Pal lets you log a headache in seconds on your iPhone: pain on a 0 to 10 dial, where it hurts on a head map, how it feels and your symptoms. Its insights show what your headaches are like over time, and the doctor report PDF (a Pro feature) sums up the last 30 days for your appointment. The app does not diagnose anything, and it is iPhone only. A paper notebook works well too, as long as you write down the same details each time.

When to get medical help now

Most headaches are not dangerous. But some signs need help straight away. The NHS says to call 999 or go to A&E if you or a child has a headache and:

• it “started suddenly and is extremely painful”
• you have had “a seizure (fit)”
• you have “numbness or weakness in the body or face”
• you find it “difficult to speak, balance, walk or remember things”
• you are “drowsy or confused”
• you have loss of vision
• you have had “a head injury within the last 3 months”
• you have “a very high temperature, a stiff neck, or bright lights are bothering you”
• you have “a rash that does not fade when a glass is rolled over it”

In the US, call 911. Elsewhere, call your local emergency number. The NHS adds: “Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.”

The NHS says to get an urgent GP appointment or call 111 if a migraine attack has “lasted longer than 72 hours”, if aura lasts longer than 1 hour, or if you are pregnant or have just had a baby. The same applies to a headache with vision or eye problems, a headache “triggered or made worse by coughing, sneezing, bending down or exercising”, or “jaw pain when eating or a sore or tender scalp.”

For headaches that are not urgent, the NHS suggests seeing a GP if “you regularly get headaches” or if treating them yourself is not helping. Bring your notes. Whatever kind of headache you have, a doctor can help you find out what it is and what to do next.