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Tough Headache vs. Migraine: What’s the Difference?

Learn the different head pain types—so you can choose your best path for treatment.

In the world of head pain, there are headaches—and there are migraines. While not the most common type of head pain (that would be a tension headache), migraines affect some 29.5 million Americans every year and can be debilitating and exhausting.1, 2 Being able to distinguish between a migraine and a headache is crucial in order to follow the most effective treatment plan, but how can you tell the difference?

Level of Pain

While all types of head pain are, well, painful, migraines rank as the most common type to send sufferers to see their doctor.2 Migraine sufferers can experience pain that is moderate to severe, and debilitating enough to render them incapable of completing everyday activities.2 A tension or sinus headache, on the other hand, may be less severe (although still painful). They are typically characterized by mild to moderate pain. Cluster headaches affect about one in 1,000 adults and are considered more rare than other types of headaches.3  They are brief, but frequently recurring (up to several times a day) and extremely severe headache.3

Duration of Pain

One way to distinguish the difference between a tough headache and a migraine is by how long it lasts. Cluster headaches tends to occur in “cluster periods” that typically last 6-12 weeks.4 During the cluster period headaches usually occur every day, sometimes several times a day. A cluster headache may only last 15 minutes to up to three hours, around the same time each day, often after you go to bed.4 Tension headaches can last anywhere from 30 minutes to a full week, but the pain is often dull and manageable, if unpleasant.5

Migraine attacks, on the other hand, last roughly four to 72 hours, and even once they have passed, the sufferer may experience after-effects of what is referred to as the post-drome. This includes energy depletion, confusion, dizziness, and mood changes, for up to 24 hours following the migraine attack.6

Location, Location, Location

Where it hurts can give you a clue as to which type of head pain you are experiencing. Migraines typically are characterized by throbbing on one side of the head.7 Cluster headaches may be felt in or around one eye (or more generally, one side of the head) and the pain often radiates to other areas of your face, head, neck and shoulders.4 Sinus headaches, as the name suggests, are concentrated around the bridge of the nose, cheekbones, and forehead. Tension headaches, meanwhile, can be experienced as pain across the entire forehead, which is often described as a band being squeezed around the head.1

Accompanying Symptoms

Migraines may be distinguished from bad headaches by their secondary symptoms, which can include sensitivity to light and noise, nausea or vomiting, dizziness, weakness, and auras. Visual auras—such as geometric lines, bright light, or shiny waves that a person typically sees in the 5 to 15 minutes before a migraine strikes, but an aura can occur up to 24 hours beforehand. Aura occurs in approximately 15 percent of migraine sufferers.8, 9, 10

Those who suffer from cluster headaches may also experience associated symptoms, such as excessive tearing, redness in the eye on the affected side, and stuffy or runny nose.4

Whether it’s a migraine or bad headache, how you experience head pain is highly individualized. Keeping a journal of the intensity, duration, pain location, and accompanying symptoms can help you gain a better understanding of your experience, along with which type of headache you have. To further understand your head pain, please talk to your doctor.

Show References

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1. "Tension Headache." Mayo Clinic. Mayo Foundation for Medical Education and Research, 30 June 2016. Web. http://www.mayoclinic.org/diseases-conditions/tension-headache/home/ovc-20211413.

2. "Migraine." Womenshealth.gov. N.p., 12 June 2017. Web. https://www.womenshealth.gov/a-z-topics/migraine#b.

3. “Headache Disorders.” World Health Organization, Apr. 2016, www.who.int/mediacentre/factsheets/fs277/en/.

4. "Cluster Headache." Mayo Clinic. Mayo Foundation for Medical Education and Research, 15 June 2016. Web. http://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/dxc-20206299.

5. “2.1 Infrequent Episodic Tension-Type Headache.” ICHD-3 Beta The International Classification of Headache Disorders 3rd Edition (Beta Version), International Headache Society, www.ichd-3.org/2-tension-type-headache/2-1-infrequent-episodic-tension-type-headache/. Access date: 28 September 2017

6. "What Is Migraine?" Migraine Research Foundation. N.p., n.d. Web. http://migraineresearchfoundation.org/about-migraine/what-is-migraine/.

7. "Headaches: In Depth." National Center for Complementary and Integrative Health. U.S. Department of Health and Human Services, 10 Nov. 2016. Web. https://nccih.nih.gov/health/pain/headachefacts.htm.

8. "Migraine Aura." Mayo Clinic. Mayo Foundation for Medical Education and Research, 28 June 2016. Web. http://www.mayoclinic.org/diseases-conditions/migraine-with-aura/multimedia/migraine-aura/vid-20084707.

9. "Migraine." MedlinePlus Medical Encyclopedia. N.p., 5 Jan. 2016. Web. https://medlineplus.gov/ency/article/000709.htm.

10. "Headache FAQ." National Headache Foundation. N.p., n.d. Web. http://www.headaches.org/headache-faq/.

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