Migraine versus tension headache is one of the most common questions people ask when head pain keeps coming back. The two feel different, behave differently, and respond to different kinds of care, so learning to tell them apart is a useful first step.
This guide explains how each type usually feels, what tends to trigger it, how long it tends to last, and which warning signs mean a headache needs prompt medical care. It is general information, and it cannot diagnose your headache.
If your headaches are new, frequent, or changing in pattern, a clinician can help you work out the type and the best plan. Keeping simple notes about each attack, described later in this guide, makes that conversation much easier.
What migraine feels like
Migraine is more than a bad headache. It is a neurological condition that often causes moderate to severe throbbing or pulsing pain, frequently on one side of the head, although it can affect both sides.
Many people also feel sick to their stomach during an attack. Light, sound, and sometimes smells can feel uncomfortably strong, and ordinary activity such as climbing stairs often makes the pain worse.
Some people get warning signs before or during the head pain, called aura. Aura can involve flashing lights, zigzag lines, blind spots, tingling, or trouble finding words, and it usually builds up gradually and passes within about an hour.
The National Institute of Neurological Disorders and Stroke describes these patterns in its overview of migraine, including the phases an attack can move through. Reading that overview can help you recognise features you may not have thought to mention at an appointment.
What a tension headache feels like
A tension headache is the most common type of headache. It usually causes mild to moderate pressure or tightness that feels like a band being squeezed around the head.
The pain is typically on both sides, and it tends to be steady rather than throbbing. It does not usually cause nausea, and it does not usually get worse with ordinary activity.
Your neck, shoulders, or scalp may feel tender during an episode. Many people notice tension headaches after long hours at a desk, poor sleep, skipped meals, or a stressful stretch of days.
MedlinePlus gives a plain overview of headache types, including tension headache, on its health topics pages. The key contrast is that a tension headache is mostly about pain and tightness, while migraine usually brings a wider set of symptoms.
The main differences, side by side in words
Pain quality is a helpful clue. Migraine pain often throbs or pulses and can be severe enough to stop your day, while tension headache pain is a dull, steady pressure that most people can work through.
Location is another clue. Migraine often starts on one side, although it can spread, while tension headache usually wraps around the whole head or sits across the forehead and the back of the neck.
Extra symptoms separate the two most clearly. Nausea, vomiting, sensitivity to light and sound, and aura point toward migraine. A tension headache usually has none of these, apart from mild tenderness in the neck and shoulders.
Response to activity also differs. With migraine, movement tends to make things worse, so people often seek a dark, quiet room. With a tension headache, a walk or gentle stretching may even help a little.
How long each type tends to last
A tension headache can last from about half an hour to several days, although most episodes ease within a few hours. The pain often builds slowly during the day and fades in the evening.
An untreated migraine attack commonly lasts from several hours to a few days. Many people describe a build up phase, a peak, and then a washed out feeling afterwards that can linger for a day.
That afterwards phase is worth knowing about. Feeling tired, foggy, or unusually hungry after the pain eases is common with migraine, and it can be confusing if you do not expect it.
Frequency matters as much as length. Headaches on many days each month, whatever the type, deserve a proper review, because frequent pain can change how the nervous system responds over time.
Common triggers to watch for
Triggers vary from person to person, but some come up again and again. Poor sleep, skipped meals, dehydration, and bright light are frequent ones for both types.
Stress is a major trigger, and interestingly, migraine often arrives as stress lets up, such as on the first day of a holiday or at the weekend. Our guide to stress and the body explains how long term stress affects health in more depth.
Hormonal changes can trigger migraine in many women, often around periods. Certain foods, alcohol, strong smells, and changes in caffeine habits are also reported, although the evidence differs for each person.
Weather changes and long screen sessions are often blamed as well. A diary is the only reliable way to learn which triggers are real for you, because memory alone can be misleading.
What helps during a tension headache
Start with the basics. Drink some water, eat if you have missed a meal, and take a short break from screens to rest your eyes and move your neck and shoulders gently.
Warmth on the neck or a cool pack on the forehead helps some people. Gentle stretching, a short walk, and fresh air can ease the muscle tightness that often sits behind this type of headache.
Over the counter pain relief can help when used occasionally and as directed on the label. Using pain relief on too many days can, over time, lead to more frequent headaches, so frequent use is a sign to seek advice rather than to keep increasing the dose.
If tension headaches keep returning, look at posture, workstation setup, sleep, and stress load. Small daily habits, repeated, usually matter more than any single quick fix.
What helps during a migraine attack
During migraine, rest in a dark, quiet room is often the most helpful first step. A cool pack on the forehead or neck brings comfort to many people.
If your clinician has given you a specific plan or prescribed medicine for attacks, follow that plan early, because migraine treatments generally work better when taken at the start of an attack. Do not start prescription medicines meant for someone else.
Small sips of water and a light snack, if you can manage them, can help if low food or fluid intake played a part. Strong smells and bright screens usually make symptoms worse, so limit them where you can.
Sleep is a common way for an attack to end, especially for children and younger adults. If attacks are frequent, severe, or changing, ask about preventive options, because daily prevention and attack treatment are two different parts of migraine care.
Better rest also plays a role across the month. Irregular sleep is a well known trigger, and our guide to better sleep habits offers a practical routine you can adapt.
Warning signs that need prompt care
Most headaches are not emergencies, but some patterns need same day or emergency assessment. Seek urgent care for a headache that comes on suddenly and reaches full force within seconds or a minute, often described as the worst headache of your life.
Also seek prompt help for headache with weakness, numbness, confusion, trouble speaking, fainting, a seizure, or vision loss. These can signal problems that need immediate treatment.
A new headache after a head injury, a headache with fever and a stiff neck or rash, and a headache that steadily worsens over days all need timely medical review as well.
New headaches starting after the age of fifty, headaches that change character, and headaches in people with cancer or a weakened immune system should always be checked. When in doubt, get assessed rather than waiting it out.
MedlinePlus maintains a topic page on migraine that also outlines when headache symptoms need medical attention, and it is worth reading once so the warning signs feel familiar before you ever need them.
Keeping a simple headache diary
A diary turns guesswork into patterns. For each headache, note the date, when it started, how long it lasted, where the pain was, and whether it throbbed or felt like pressure.
Add any extra symptoms, such as nausea, light sensitivity, or aura. Note what you ate and drank, how you slept, your stress level, and, where relevant, where you were in your menstrual cycle.
Also record what you took and whether it helped. Over a couple of months, patterns often appear that point to your real triggers and to which treatments actually work for you.
Bring the diary to appointments. It helps your clinician tell migraine from tension headache far more reliably than memory, and it helps you both judge whether a plan is working.
How clinicians usually make the diagnosis
Most headache diagnoses are made from the story, not from a scan. Your clinician will ask where the pain sits, how it feels, how long it lasts, what comes with it, and what you were doing in the hours before it began.
They will also ask how often headaches happen, how much they interfere with work and family life, and what you have already tried. A physical and neurological examination checks strength, reflexes, coordination, vision, and the neck and jaw.
Blood tests or scans are not routine for typical patterns. They enter the picture when warning signs are present, when the examination is abnormal, or when the pattern does not fit either common type.
Be ready to describe your worst attacks as well as your average ones. The worst attacks often carry the clearest diagnostic clues, and people tend to forget them once the pain has passed.
Patterns across the month and the year
Headaches rarely follow a random pattern, even when they feel unpredictable. Many people find clusters around deadlines, travel, poor sleep stretches, or particular points in the menstrual cycle.
Looking at a few months of diary entries often shows that an attack needs a pile up of factors rather than one single trigger. A short night alone may be fine, but a short night plus skipped lunch plus a stressful afternoon crosses the line.
That pile up idea is useful, because it means you do not have to eliminate every trigger. Reducing the total load, by protecting sleep and meals on busy days, can cut attack frequency even when stress itself cannot be removed.
Seasonal changes appear in diaries too. Bright summer light, heat, allergies, and holiday routine changes all show up for different people, and knowing your season lets you prepare rather than react.
Children and teenagers get both types as well, and their attacks can look different, with shorter migraine episodes and more stomach symptoms. Recurring headaches in a child always deserve a proper conversation with their clinician rather than guesswork at home.
Frequently asked questions
Can you have migraine and tension headache at the same time?
Yes, many people have both types, sometimes in the same week. That is one reason a diary helps, because the two types may need different responses on different days.
How do I know if my headache is migraine without aura?
Migraine without aura usually brings throbbing, often one sided pain with nausea or sensitivity to light and sound, and activity makes it worse. A clinician confirms the diagnosis from your history and an examination.
Do I need a scan for headaches?
Many headaches do not need imaging when the history and examination are typical and there are no warning signs. If red flag features are present, or the pattern changes, your clinician may arrange scans or other tests.
Can stress alone cause migraine?
Stress is one of the most commonly reported migraine triggers, and the let down period after stress can be just as important. Managing stress, sleep, meals, and fluids steadily across the week lowers the load that builds toward an attack.
