The quickest way to tell a migraine from a tension headache is how it feels and what comes with it. A migraine is usually a moderate to severe throbbing pain, often on one side of the head, that gets worse when you move and often comes with nausea and sensitivity to light and sound. A tension headache is usually a dull, pressing or tight pain on both sides of the head, like a band, and most people can carry on with their day. Both usually respond to simple painkillers, rest and avoiding triggers, but sudden, severe or unusual headaches need urgent medical help.
Headaches are among the most common health problems worldwide. The World Health Organization estimates that around 40% of people (about 3.1 billion in 2021) had a headache disorder. This guide compares the two most common types, explains typical triggers, and sets out what helps and when to see a doctor.
Migraine vs tension headache at a glance
| Feature | Migraine | Tension-type headache |
|---|---|---|
| Type of pain | Throbbing or pulsing | Dull, pressing or tightening, like a band |
| Location | Often one side of the head | Both sides of the head, face or neck |
| Effect of movement | Usually worse with movement | Usually not affected; daily activities are possible |
| Other symptoms | Nausea or vomiting; sensitivity to light and sound; sometimes aura | Tender head, neck or shoulders; nausea is not typical |
| How long it lasts | 4 hours to 3 days | At least 30 minutes, sometimes several days |
| First-line relief | Painkiller taken early, rest in a dark room, triptans if prescribed | Simple painkillers, rest, exercise, heat or cold packs |
Sources: NHS migraine and tension headache pages; WHO headache disorders fact sheet.
Migraine symptoms
According to the NHS, the main symptom of migraine is a throbbing headache, often on one side, that gets worse when you move. You may also feel or be sick and find light and noise hard to bear. An attack usually lasts from 4 hours to 3 days.
Warning signs before an attack
Some people notice early symptoms a few hours or days before the headache. The NHS lists tiredness and yawning, food cravings or feeling thirsty, mood changes, a stiff neck, and needing to pee more often.
Migraine with aura
Some people get warning signs called an aura just before the headache. Aura symptoms can include seeing zigzag lines or flashing lights, pins and needles, feeling dizzy, or difficulty speaking. The NHS says aura usually lasts no longer than an hour; aura lasting longer needs urgent advice.
Who gets migraine?
Migraine often runs in families and is more common in women, says the NHS. Some women have migraine linked to their periods (menstrual migraine), and migraine often improves after the menopause. The WHO lists migraine as one of the leading causes of disability among neurological conditions.
Tension headache symptoms
The NHS describes tension headaches as pain on both sides of the head, face or neck, with a feeling of pressure or tightening; the head, neck or shoulders may feel tender. They are common and usually not a sign of anything serious. You can usually carry on with normal activities. They last at least 30 minutes and sometimes several days. The WHO notes that they affect more women than men and that occasional (episodic) tension-type headache is very common.
Other headache types worth knowing
Migraine and tension-type headache are the most common, but not the only, headache disorders. The WHO describes cluster headache as rare, affecting fewer than 1 in 1,000 adults, with brief but extremely severe attacks of pain in or around one eye, often with a watery, red eye, that can recur up to several times a day. Medication-overuse headache, covered below, develops when painkillers for headache are taken too often. Headaches can also accompany everyday illnesses such as colds and flu. If your headaches do not fit either pattern in the table, or have changed in character, it is worth getting them assessed rather than self-treating.
Common triggers
Migraine triggers
The exact cause of migraine is not fully understood, but the NHS says it is thought to involve temporary changes in nerves and blood vessels in the brain. Common triggers include:
- periods and other hormonal changes
- stress, anxiety or depression, and tiredness
- missing meals
- too much caffeine
- lack of exercise
Tension headache triggers
- stress
- sleep problems
- caffeine
- taking painkillers too often
The NHS's general headache page adds other common causes of headaches: colds and flu, drinking alcohol, bad posture, eyesight problems, not eating regular meals, not drinking enough fluids, and hormonal changes. If you work long hours at a desk, regular breaks, a comfortable screen height and up-to-date glasses address two of these (posture and eyesight).
Keep a headache diary
Both the NHS and the WHO recommend keeping a diary or calendar. Note the date, time, what you ate and drank, sleep, stress, period dates, medicines taken and how bad the pain was. Patterns often emerge after a few weeks and are very useful to your doctor.
Relief: what helps during an attack
For a migraine
- Take a painkiller early. The NHS says ibuprofen or paracetamol work best when taken as soon as symptoms start.
- Lie down in a quiet, dark room and sleep if you can.
- Prescription medicines. If painkillers do not help, a doctor may prescribe triptans or a newer type of medicine called gepants, and anti-sickness medicine for nausea.
For a tension headache
- Simple painkillers such as paracetamol, ibuprofen or aspirin. The NHS notes paracetamol is the first choice in pregnancy and that aspirin should not be given to children under 16.
- Heat or cold on the head or neck, and a low, firm pillow.
- Exercise, yoga or massage, which may ease tension.
- Cut down on caffeine if you drink a lot.
Always follow the dose on the pack, and check with a pharmacist if you take other medicines or have a health condition.
Beware of painkiller overuse
Taking painkillers too often can itself cause frequent headaches, known as medication-overuse headache (or rebound headache). The WHO estimates it affects up to 5% of some populations. The NHS advises not taking painkillers for migraine on more than 2 days a week. The NICE guideline says treatment usually involves stopping the overused medicines for at least a month, with a doctor's support; headaches often get worse for a while before they improve. Do not stop prescribed preventive medicines without medical advice.
Preventing headaches
The WHO says healthy lifestyle measures are often all that is needed to reduce headaches. Helpful habits include:
- regular, good-quality sleep (see our guide to better sleep habits)
- regular meals and enough fluids
- regular exercise
- limiting alcohol and caffeine (our caffeine and alcohol guide explains timing)
- managing stress, for example with relaxation techniques; see everyday stress management
Preventive treatment for migraine
If migraines are frequent or severe, a doctor may suggest preventive treatment. The NHS lists options including beta blockers, some antidepressants and some epilepsy medicines, as well as acupuncture, relaxation therapy or cognitive behavioural therapy (CBT), and vitamin B2 (riboflavin). Which one suits you depends on your health, other medicines and whether you might become pregnant, so this is a decision to make with your doctor.
When to see a doctor
See a GP if:
- headaches are severe, getting worse or happening several times a week
- migraine attacks happen more than once a week or are hard to control
- painkillers do not help
- migraine attacks come with your periods
Get urgent help
Get urgent medical advice if a migraine lasts longer than 72 hours, aura lasts longer than an hour, or you have a headache while pregnant or soon after giving birth. Also get urgent advice if a headache comes with vision problems, is triggered by coughing or bending, comes with vomiting, or with jaw pain or a tender scalp.
Call your local emergency number or go to an emergency department if a headache:
- starts suddenly and is extremely painful (a "thunderclap" headache)
- comes with weakness or numbness on one side, slurred speech, confusion, drowsiness, memory or balance problems, or loss of vision
- follows a seizure or a recent head injury
- comes with a high temperature, stiff neck or a rash that does not fade when a glass is pressed on it
Frequently asked questions
Can you have both migraine and tension headaches?
Yes. Many people have more than one type of headache. A headache diary helps you and your doctor tell them apart and treat each one appropriately.
Is a migraine just a bad headache?
No. Migraine is a neurological condition. The headache is often throbbing and one-sided and comes with other symptoms such as nausea and sensitivity to light and sound, and some people have aura.
Does caffeine help or cause headaches?
Both are possible. The NHS lists too much caffeine as a trigger and advises cutting down. A diary can show whether caffeine is part of your pattern.
Can dehydration cause a headache?
The NHS lists not drinking enough fluids among common causes of headaches, and drinking water is one of its first self-help steps. Our guide to staying hydrated has practical tips.
Are tension headaches a sign of something serious?
The NHS says tension headaches are not usually a sign of anything serious. A headache with any of the warning signs above needs prompt medical attention.
Disclaimer: This article is for general information only and is not medical advice. It does not replace a diagnosis or treatment plan from a qualified professional. Please consult your doctor before changing your diet, exercise, medicines or supplements, and seek urgent care for any warning signs mentioned above.
