Neurology and Neurosurgery

Headache vs. migraine How to tell the difference

Headache or migraine How to tell the difference


Know headache and migraine symptoms to get the right treatment and feel better faster


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

Mostly everyone has had a headache at one time or another. It can sometimes be tough to tell if you are dealing with a headache or 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 are experiencing a headache or migraine can help you get the right treatment — so you can feel better faster. Here is how you can tell the difference between headache and migraine.


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. People usually describe the pain as a “headband across the entire head.” Oftentimes, they do not seek care because they do not 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 with 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. People have symptoms of migraine during an attack, but also with autonomic features on the same side of the head with pain including eye redness, swelling and tearing, nasal congestion, runny nose, ear fullness and sweating. There is usually a lingering dull constant pain after the initial attack. This headache is chronic and does not respond to typical migraine medications.


Related article: Should you go to the emergency department for a headache or migraine?


What is migraine?

A common misconception about migraine is that it is 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.


Do you suffer from migraines? Request an appointment with a neurologist at Nuvance Health. 


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:

  1. 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.

  2. 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.

  3. 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.

  4. Postdrome is the final phase, which can last 24 to 48 hours. It is 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


Headache and migraine are different conditions with different treatments

Although there is no cure for headache or migraine, many people can manage 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 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!


How is headache treated?

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.


How is migraine treated?

Migraine is treated in two ways: prevention and rescue treatment


Migraine prevention

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 that vary from person to person
    • Dehydration
    • Hormonal changes
    • Irregular sleep patterns
    • Medications
    • Stress
    • Weather changes

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

  • 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.


Migraine rescue treatment

Your headache specialist may prescribe 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 is important to speak with your healthcare clinician if you are 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.


Do you want to learn more about migraines, headaches and facial pain? Go here.


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


Dr. Hida Nierenburg is double-board certified in neurology and headache medicine. She 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. Dr. Nierenburg is at the forefront of migraine treatment and can discuss advances with electroceuticals and infusion therapy. Book an appointment online with Dr. Nierenburg.

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 remotely at 5:30 p.m. the last Monday of each month. To register, call 845-214-1922. There is no cost to register.