Neurology and Neurosurgery

Headache or migraine: How you can tell the difference

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By Dr. Hida Nierenburg, Director of Headache Medicine, Nuvance Health


Mostly everyone has felt a headache at one time or another. It can sometimes be tough to tell if you’re dealing with a headache or a migraine — especially if the pain is severe or occurs often. This might also make it tough to know how to best treat the headache. Figuring out whether you’re experiencing a headache or migraine can help you get the right treatment — so you can feel better faster. Here’s how you can tell the difference between headaches and migraines.

What is headache?

Headaches cause aching and pain, often in a specific area of the head. There are different types of headaches, including:

  • Tension headache is the most common type of headache in the United States. A tension headache causes pain that starts at the back of the head and spreads forward across both sides of the head. Patients usually describe the pain as a “headband across the entire head.” Oftentimes, patients don’t seek care because they don’t have the disabling symptoms common with migraine. Eyestrain, hunger, and stress often trigger a tension headache.
  • Cluster headache is when dilation of the blood vessels in the brain cause pain that often happens around the same time each day, can last up to three hours at a time, and occurs for multiple days in a row. This type of headache is usually on one side of the head and extremely painful. In fact, this type of headache is more severe than migraine. During an attack, pain usually feels like a stabbing sensation behind the eye, with autonomic features on the same side of the head as the pain including eye redness, swelling and tearing, nasal congestion, runny nose, and sweating. Sinus headache is when swelling in your sinus passages causes pain behind your eyes, cheeks, and nose.
  • Sinus headache is commonly confused with migraine because how the pain feels and where it occurs are similar. A sinus headache is diagnosed if imaging, such as a CT scan, shows evidence of sinus disease. Pain should resolve once the sinus disease is treated.
  • Hemicrania continua is a type of primary headache disorder that commonly gets confused with migraine or sinus disease because they all have similar symptoms. Hemicrania continua causes intense pain on one side of the head that feels like stabbing behind the eye. A hemicrania continua attack can last up to three days. Patients have symptoms of migraine during an attack, but also with autonomic features on the same side of the head as the pain including eye redness, swelling and tearing, nasal congestion, runny nose, ear fullness, and sweating. There’s usually a lingering dull constant pain after the initial attack. This headache is chronic and doesn’t respond to typical migraine medications.


What is migraine?

A common misconception about migraine is that it’s just a more severe headache. The truth is that migraine is a neurological disorder caused by changes in brain activity, arteries, chemicals, and nerve cells. Migraine is the second leading cause of disability worldwide among people 15 to 49 years old because it can make you sick and prevent you from doing activities and work.

Although an intense headache is a hallmark symptom, migraine also causes dizziness, fatigue, nausea, visual disturbances, vomiting, and sensitivity to light, sound or smells. Pain is moderate to severe and worsened by regular activities, such as working on the computer.

Migraine occurs in phases that have unique symptoms and warning signs. However, not everyone with migraine will experience all four phases. The four phases and their symptoms include:

  • Prodrome, the initial phase of a migraine attack, typically lasts a few hours or a few days. It causes symptoms such as: depression, difficulty concentrating, difficulty sleeping, fatigue, food cravings, increased need to urinate, irritability, muscle stiffness, nausea, yawning, sensitivity to light and sound, and trouble speaking or reading.
  • Aura is the second phase, which can last five to 60 minutes. During this phase, you may experience visual disturbances, temporary loss of sight, and numbness or tingling in the body.
  • Headache is the third phase, which can last four to 72 hours. Headache pain may feel like throbbing, drilling, burning, or stabbing on one or both sides of the head. Other symptoms during the headache phase may include nausea, vomiting, giddiness, insomnia, anxiety, nasal congestion, mood changes, neck pain or stiffness, and sensitivity to light, smell, and sound.
  • Postdrome is the final phase, which can last 24 to 48 hours. It’s sometimes referred to as a “migraine hangover.” You may experience difficulty concentrating, fatigue, mood changes, or trouble with comprehension.

Untreated acute migraines can progress to chronic migraine. Chronic migraine is when someone has more than 15 headache days per month for three consecutive months, with migraine attacks on eight of those days.

Related article: Woman receives “life-changing” migraine care at Nuvance Health 

Different conditions, different treatments

Although there’s no cure for headaches or migraines, many people can manage their symptoms and prevent future attacks with medication and lifestyle changes. If you experience frequent or severe headaches, visiting a headache specialist can help you get an accurate diagnosis and effective treatment.

How to prepare for your visit with a headache specialist

To help you and your healthcare clinician understand your condition, it may be helpful to keep a diary and track when your headaches start, how long they last, how severe they are, and what helps to relieve your symptoms. It may also be beneficial to track where you were and what you were doing when the attacks starts.

What to expect when you visit with a headache specialist

At Nuvance Health, our headache specialists will ask you many questions to get a detailed history about your symptoms. Depending on your answers, your headache specialist may perform a physical exam and order additional testing. You and your headache specialist will work together to develop a care plan that meets your concerns and needs, and most importantly, helps you feel better!

Headache treatment

Headache treatment depends on the type of headache. Treatment may include different types of medications depending on patient preference and other medical conditions. The goal of treatment is to decrease frequency, severity, and duration of headache attacks.

Migraine treatment

Migraine is treated in two ways: prevention and rescue treatment


Migraine prevention is key to reduce possible progression to chronic migraine, which is more disabling and tougher to treat. Prevention tactics include:

  • Identifying what triggers your migraines and avoiding them may help you to have fewer attacks. There are varying migraine triggers that may be different depending on the person. Common triggers include:
    • Alcoholic or caffeinated beverages
    • Bright lights, loud noises, or strong smells
    • Certain types of foods
    • Dehydration
    • Hormonal changes
    • Irregular sleep patterns
    • Medications
    • Stress
    • Weather changes

  • Taking a daily medication, or combination of medications, may decrease the frequency and duration of migraine attacks. Your headache specialist may recommend daily medication if you have more than four headache days per month; or, you have less headache days total but your migraine attacks are extremely disabling and last more than two days.
  • Other treatments can include injections, nutraceuticals, and electroceuticals.

Related article: Migraine and weather triggers — Tips to manage your symptoms

Rescue treatment

Your headache specialist may prescribe you a rescue medication to take during a migraine attack. Rescue medication is intended to relieve pain and shorten the duration of the attack within two hours of the onset of symptoms. It’s important to speak with your healthcare clinician if you’re taking over-the-counter medications (OTC) to treat migraine. OTC medications are not effective for a majority of patients and lack of relief can lead to medication overuse.

The bottom line: Although it can be tough to tell the difference, headaches and migraines are two distinct conditions with different symptoms and treatments. If you’re having frequent or severe headaches, a headache specialist can diagnose your condition and recommend the appropriate treatment. 

Dr. Hida Nierenburg completed her fellowship in headaches at Mount Sinai Roosevelt Headache Institute in New York City, and her residency in neurology at Georgetown University Hospital in Washington D.C.

Hida Nierenburg

Headache support group

If you get migraines or headaches, you are not alone! Millions of Americans suffer with headache disorders that affect their quality of life. Dr. Nierenburg is leading a support group for people with headache or migraine concerns. The support group meets virtually at 5:30 pm the last Thursday of each month. To register, call (845) 214-1922. There is no cost to register.


Learn more about migraine care at Nuvance Health.