Migraine or Just a Headache? How to Tell, and What Actually Works

Calling a migraine a headache is like calling a seizure a twitch. It undersells the thing badly, and it is one reason migraine goes undertreated for years while people work through a drawer of paracetamol. The distinction is not academic: the two respond to different treatments, and migraine now has options that did not exist a decade ago. Here is how to tell which you have.

The difference, in practical terms

A tension-type headache is typically a dull, pressing pain on both sides, often described as a band around the head. It is usually mild to moderate, does not get worse when you move, and generally responds to an ordinary painkiller and to dealing with whatever caused the tension.

Migraine behaves differently. The pain is often one-sided and throbbing, moderate to severe, and it gets worse with physical activity, which is why people with migraine want to lie still in the dark. Attacks last anywhere from 4 to 72 hours untreated. What really separates it is the company the pain keeps: nausea, sometimes vomiting, and marked sensitivity to light and sound. If you routinely need to shut yourself in a dark, quiet room and feel sick, that is migraine rather than a tension headache, regardless of what anyone has told you.

The phases most people do not know about

Migraine involves more than the painful part, and recognising the earlier phases is genuinely useful because treatment works far better when taken early. Up to a day or two before, many people experience a premonitory phase: yawning, food cravings, neck stiffness, mood changes, unusual fatigue or increased urination. People often notice the pattern in hindsight.

Around a quarter of people get an aura, usually visual, typically zigzag lines, flickering shapes or a blind spot that expands over five to twenty minutes and resolves within an hour. Aura can also involve tingling that spreads up an arm, or difficulty finding words. After the headache resolves comes the postdrome, the so-called migraine hangover, where people feel drained and foggy for a day. Knowing these phases matters because the premonitory symptoms are your window to act before the pain establishes itself.

Triggers, and why the list is misleading

The standard trigger list includes stress, hormonal changes, missed meals, poor sleep, weather changes, bright lights, strong smells, alcohol and certain foods such as aged cheese and cured meats. All of these are real for some people, and the list is misleading for two reasons.

First, triggers are usually cumulative rather than individual. A glass of wine on a well-slept, unstressed day may cause nothing, while the same glass after a bad night and a skipped lunch tips you over. Chasing a single culprit food often produces a needlessly restricted diet and no fewer attacks. Second, some apparent triggers are actually early symptoms. Chocolate cravings and a stiff neck are classic premonitory features, so the chocolate people blame is frequently a consequence of the attack already beginning rather than its cause. A headache diary that records sleep, meals, stress and cycle timing alongside attacks is far more useful than a food elimination experiment.

Treating an attack

The single most important principle is speed. Migraine treatment taken early in an attack works considerably better than the same drug taken two hours in, once nausea and delayed stomach emptying have set in. Waiting to see whether it becomes a bad one is the most common self-defeating decision people make.

Simple painkillers such as ibuprofen or aspirin, taken early and at an adequate dose, work for many attacks, and adding an anti-nausea medication helps both the sickness and absorption. When those are not enough, triptans are the standard next step and are specific to migraine. If one triptan does not work, another often does, so a single failure is not the end of the option. Newer drugs called gepants, including rimegepant and ubrogepant, target the CGRP pathway rather than constricting blood vessels, which makes them an option for people who cannot take triptans because of cardiovascular risk. One caution deserves emphasis: taking acute painkillers on more than about ten to fifteen days a month can cause medication overuse headache, a self-sustaining daily headache that only improves when the painkillers are withdrawn.

Prevention, when attacks are frequent

If you have more than about four migraine days a month, or attacks that disable you regardless of frequency, prevention is worth discussing rather than enduring. Established preventives were mostly borrowed from other fields: beta blockers, certain antidepressants such as amitriptyline, and anti-seizure medications such as topiramate. They work for many people and are taken daily rather than during attacks.

The genuine change in the last few years is the CGRP class, developed specifically for migraine. Monoclonal antibodies given monthly or quarterly, and daily gepants such as atogepant, reduce attack frequency in people who failed older options, with generally better tolerability. Alongside medication, the unglamorous factors carry real weight: consistent sleep and wake times, regular meals, hydration, managing stress, and regular aerobic exercise all reduce frequency in trials. Magnesium and riboflavin have modest supporting evidence and are commonly suggested as low-risk additions.

When to see a doctor

See a doctor if headaches are frequent enough to affect work or family life, if you are using painkillers more than twice a week, or if you have never had a proper diagnosis. Migraine is diagnosed clinically, and most people do not need a scan.

Seek urgent care for a sudden severe headache that peaks within seconds, the worst headache of your life, a headache with fever and a stiff neck, with confusion, weakness, difficulty speaking or vision loss, a headache after a head injury, one that is worse when lying down or wakes you consistently, a new headache after age 50, or a headache with a rash that does not fade under pressure. Those patterns need assessment rather than a diary. This is general information and not medical advice, but the practical message is that migraine is treatable and many people are still using the wrong drug at the wrong time.

Frequently asked questions

How do I know if it is a migraine or a tension headache?

Migraine is typically one-sided, throbbing, worsened by movement, and accompanied by nausea and sensitivity to light or sound. Tension headache is a dull band-like pressure on both sides that does not worsen with activity.

What is a migraine aura?

A neurological warning phase affecting around a quarter of people, usually visual, with zigzag lines, flickering shapes or an expanding blind spot developing over five to twenty minutes, sometimes with tingling or word-finding difficulty.

Why should I take migraine medication early?

Because absorption and effectiveness drop once the attack is established and the stomach empties more slowly. The same drug taken early works considerably better than taken two hours in.

Can painkillers make headaches worse?

Yes. Taking acute painkillers on more than roughly ten to fifteen days a month can cause medication overuse headache, which only improves when the painkillers are withdrawn under guidance.

When should a headache be checked urgently?

A sudden severe headache peaking within seconds, the worst of your life, with fever and stiff neck, confusion, weakness, speech or vision changes, after a head injury, or a new headache after age 50.

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• Magnesium: Why Everyone Is Suddenly Talking About It

  A supplement with modest evidence in migraine prevention.

This article is for general informational purposes only and is not medical advice. Always consult a qualified healthcare professional about your individual situation, and never start or stop a medication without your doctor. See our Medical Disclaimer.