Migraine vs. Headache, Properly Differentiated
By Dr. Brenna Erickson, DC ┃ The Migraine Whisperer 📖 Reading Time: 9 minutes
Language Matters
Someone stubs their toe and says it's "excruciating." Someone's a little tired and says they're "exhausted." Language has a tendency to drift toward the dramatic, and "migraine" has drifted in much the same way — "I have a migraine" has become shorthand for "I have a bad headache," used by people who've never had either of these.
That drift costs something. When a legitimate diagnosis becomes a synonym for intensity, the actual disease underneath it gets harder to explain, harder to take seriously, and — for a lot of people — harder to get properly diagnosed in the first place.
What Headache Is
Headache is a symptom, not a diagnosis. It's pain in the head or neck region, and it can come from dozens of unrelated causes: dehydration, a tight jaw, a sinus infection, a hangover, staring at a screen too long, or even, yes, migraine. Saying "I have a headache" is closer to saying "I have a fever" than to naming a specific condition — it tells you something is happening, not what or why.
Most headaches are what's called tension-type headache: a dull, band-like pressure across the forehead or scalp, usually mild to moderate, usually gone within a few hours. It's the most common headache type by far, and for most people, it doesn't come with nausea, doesn't get worse with movement, and doesn't stop them from going about their day.
What Migraine Is
Migraine is a neurological disease — a chronic condition of the nervous system, not an occasional bad headache. It's marked by recurring attacks that typically involve head pain along with other symptoms: nausea, sensitivity to light, sensitivity to sound. Between attacks, the underlying condition is still there, even when there's no pain — which is part of why a single trigger rarely explains an attack on its own.
The mechanism behind an attack, in short: a wave of electrical activity moves across the surface of the brain, activates the trigeminal nerve, and floods the blood vessels around the brain with inflammatory signals. That inflammation is where the pain comes from. Headache is often part of a migraine attack — but migraine is the disease, and headache, when it shows up, is one symptom of it, not the whole picture.
The Differentiators
These criteria come from the ICHD-3 — the International Classification of Headache Disorders, third edition — the diagnostic standard neurologists and headache specialists actually use. It's not proprietary or invented for this post; it's the real reference clinicians work from, and you can look it up yourself at ichd-3.org.
Clinically, a handful of features separate a migraine attack from an ordinary headache. None of these alone is definitive, but together they paint a clear picture:
Location: migraine pain is usually one-sided; tension-type headache is usually on both sides
Quality: migraine pain tends to throb or pulse; tension-type headache tends to feel like pressure or a tight band
Movement: migraine pain typically worsens with physical activity; tension-type headache generally doesn't
Associated symptoms: migraine commonly comes with nausea, light sensitivity, or sound sensitivity; tension-type headache usually doesn't
Duration: an untreated migraine attack typically lasts 4 to 72 hours; tension-type headache is often shorter and less disabling
A useful shorthand: if a headache is disrupting your ability to function — you need a dark room, you can't tolerate normal light or noise, movement makes it worse — that's a meaningfully different event than a headache you can work through with some ibuprofen and a glass of water. These criteria are also the starting point for how migraine actually gets diagnosed — there's no blood test for it, so a clear pattern matters.
Side by Side
Hello, World!
A Familiar Scenario
Say you get a headache most Sunday evenings — right side, pulsing, bad enough that light from the TV feels like too much, and you end up lying down in a dark room until it passes. You've called this "a bad headache" for years, maybe blamed it on the wine at dinner or the stress of the week ahead. Run it against the table above: one-sided, throbbing, worse with light, disruptive enough to change your evening. That's not a bad headache. That's migraine, showing up on a predictable schedule you never had a name for.
The Sinus Headache Confusion
Here's a specific, well-documented example of how often this gets misdiagnosed: studies have found that roughly 88 to 90% of people who self-diagnose a "sinus headache" actually meet the clinical criteria for migraine. One frequently cited study followed nearly 3,000 people who identified their pain as sinus-related — the large majority turned out to have migraine instead.
The confusion makes sense. Migraine can genuinely cause nasal congestion, facial pressure, and watery eyes — the same symptoms people associate with sinus problems. A true sinus headache, caused by an actual sinus infection, is comparatively rare, and it typically resolves within a week of the infection clearing. If facial pain and pressure keep recurring without an infection driving it, migraine is the far more likely explanation. If you want to learn more about the migraine diagnosis process, you can read more on there here
The Other Headache Types Worth Knowing
Tension-type headache, migraine, and sinus headache cover most of what people experience, but they don't cover everything. A few more are worth knowing — some because they're genuinely common, some because they signal something that needs medical attention:
Cervicogenic headache originates in the neck, not the head — a problem in the cervical spine or its surrounding muscles refers pain upward, often starting at the base of the skull and wrapping toward the front. It's frequently mistaken for tension-type headache or migraine, but it responds to treating the neck, not the head.
TMD-referred headache comes from the temporomandibular joint (TMJ) and the muscles around it. Jaw clenching, grinding, or joint dysfunction can radiate pain into the temples, forehead, or behind the eyes — a pattern that gets missed constantly, because the source (the jaw) is nowhere near where the pain shows up.
Hypertension headache is caused by significantly elevated blood pressure, usually felt as pressure on both sides of the head. It's uncommon at normal or mildly elevated blood pressure, but a sudden, severe headache alongside very high blood pressure readings is a genuine medical emergency, not a wait-and-see situation.
Cluster headache is rare and severe — often described as the most intense head pain a person can experience — occurring in clusters of attacks over weeks, with symptoms like a red or watery eye and nasal congestion on one side.
Post-traumatic headache follows a head injury or concussion, sometimes starting immediately, sometimes days later, and can persist for months. It often shares features with both migraine and tension-type headache, which makes it easy to misclassify.
New daily persistent headache (NDPH) is exactly what it sounds like: a headache that starts on a specific, often clearly remembered day and simply doesn't stop. It's rare, poorly understood, and worth a specialist's attention specifically because of how unusual that presentation is.
Medication overuse headache happens when frequent use of pain relievers, ironically, starts causing more headaches than it resolves. It's common in people managing chronic migraine, and it's a case where cutting back on medication, done carefully and with medical guidance, is part of the fix.
When It's an Emergency, Not a Diagnosis Question
Everything in this post is about differentiating headache types that, while disruptive, aren't urgent. Some headaches are urgent. Get emergency care, not a blog post, if a headache comes with any of these:
The worst headache of your life, especially if it hit suddenly and peaked within seconds to minutes
A headache with fever, stiff neck, confusion, or a rash — possible signs of meningitis
A headache after a head injury, especially with confusion, repeated vomiting, or worsening symptoms
New neurological symptoms alongside the headache — slurred speech, one-sided weakness or numbness, vision loss, difficulty understanding speech
A severe headache with a seizure
A new, severe headache during pregnancy or postpartum, or alongside very high blood pressure
None of the differentiation in this post is meant to replace that judgment. If something feels acutely wrong, act on that first and sort out the label later.
Why the Distinction Changes Your Treatment
Using the crrect name makes a difference, in how each ype of headache or migraine is treated. Tension-type headache typically responds to rest, hydration, and over-the-counter pain relief. Migraine often doesn't respond the same way, because the mechanism driving it is different — a nervous system that reacts more intensely to a stack of triggers, not a simple muscle tension problem.
The threshold framework applies specifically to migraine, not headache in general. Raising your threshold means changing how your nervous system responds before it tips into an attack — a meaningful intervention for migraine's underlying mechanism, and not the relevant approach for a tension headache from a stressful Tuesday.
Getting the label right isn't about being precise for its own sake. It's the first step toward treating the actual thing you have, instead of a vaguer, less accurate version of it.
If you've spent years calling it a headache, or years wondering why "just relax" never worked, this is worth sitting with. The distinction was never just wording.
If you're ready to understand your own pattern in more depth, Naming It walks through the full mechanism and subtypes, and its section on getting a diagnosis covers exactly what a real appointment for this looks like. And if you're ready to do something with that understanding, that's exactly what The Migraine Resilience Academy is built for.
— Dr. Brenna Erickson DC, The Migraine Whisperer
The Migraine Whisperer is Dr. Brenna Erickson's practice focused on helping people with chronic and complex migraine build the conditions for real, lasting neurological resilience. She practices at Stockheart Whole Health in Minneapolis and works with clients online through the Migraine Resilience Academy.
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