Is it a headache or a migraine?

Short answer

A migraine is not a severe headache — it is a different neurological condition, and pain is only one part of it. The quickest way to tell them apart is not intensity but company: a migraine usually sits on one side, throbs, gets worse when you move, and brings nausea or a real intolerance of light and sound. A tension headache presses on both sides like a band, stays mild to moderate, and does not do those things. The distinction matters because migraine has treatments a tension headache does not.

Not sure which one you get? Take the 2-minute survey — it asks the questions a neurologist would start with.

Note: this article explains how doctors distinguish tension-type headache from migraine and is not medical advice. It cannot diagnose you, and it does not replace a clinician — but knowing which pattern you have makes any appointment far more useful.

"It is just a bad headache" is the most expensive mistake here

Most people who get migraines spent years calling them headaches. It is an easy thing to believe, and it is not your fault — the word "migraine" gets used loosely for any painful headache, and if nobody has ever walked you through the difference, "a really bad headache" is the obvious label.

But it is the one mistake that quietly costs the most, because it changes what you reach for. If you think you have an ordinary headache, you take a painkiller and wait. If it is actually a migraine, there is a whole category of treatment you never try — medication designed for migraine specifically, taken at the first sign, and prevention if attacks are frequent. Calling it "just a headache" closes the door on all of that.

And this is not a rare mix-up. In a US population survey, only 48% of people who met the diagnostic criteria for migraine had ever been given that diagnosis by a doctor. A larger survey a few years later put it at 56%. Both are decades old and US-only, but the direction is consistent: roughly half of migraine goes unnamed, and "I just get bad headaches" is the sentence it hides behind.

The one table that does most of the work

These features come close to the actual diagnostic criteria used by doctors. You do not need all of them — a few on one side is usually enough to tell which way you lean.

If you scan that and land mostly in the left column, you are probably dealing with tension-type headache. Mostly right, or a strong yes on "worse when I move" plus nausea or light sensitivity, and it is worth having migraine properly assessed.

What each one actually is

Tension-type headache is the everyday one — the most common headache there is. The defining features, close to the formal criteria, are: both sides, a pressing or tightening (not pulsing) quality, mild to moderate intensity, and no worsening from routine activity like walking or climbing stairs. Crucially, it does not bring nausea, and at most one of light or sound sensitivity — not both. The most consistent physical finding is tenderness in the muscles of the scalp, temples and neck when pressed.

Migraine is a neurological condition, not a pain problem that happens to be severe. The pain criteria — at least two of: one-sided, pulsating, moderate-to-severe, worsened by or causing you to avoid physical activity — are only half of it. The other half is what comes with it: nausea or vomiting, or sensitivity to light and sound together. An untreated attack lasts anywhere from 4 hours to 3 days. That is why a migraine can wipe out a day in a way a tension headache never does.

What a migraine actually feels like, beyond the pain

This is the part that surprises people, and it is often what finally makes the distinction click. A migraine frequently is not just "head hurts". It can come in phases.

Before the pain, hours or up to two days ahead, there can be a warning stretch: unusual tiredness, mood shifts, a stiff neck, food cravings, yawning, or feeling unusually thirsty. Many people learn to recognise this and know an attack is coming.

Aura, in some people, is a specific neurological warning that usually lasts 5 to 60 minutes before or as the pain begins: zigzag lines or a blind spot spreading across your vision, tingling that creeps up an arm, or trouble finding words. Aura is dramatic the first time and often mistaken for something more sinister, but it is a recognised part of migraine. Not everyone with migraine gets aura, and getting aura does not make the migraine worse.

After the pain lifts, there is often a "hangover": a day of fatigue, difficulty concentrating and feeling generally flattened. A tension headache does not leave that wake.

If any of that sounds familiar, you are almost certainly not describing an ordinary headache — you are describing a migraine, and the vocabulary matters when you talk to a doctor.

The traps that make people guess wrong

"It can't be a migraine, it's on both sides." One-sided is typical, not required. Plenty of migraines are on both sides, and plenty of people have some attacks on one side and some on the other.

"It can't be a migraine, I don't get aura." Most people with migraine do not get aura. Aura is a feature some people have, not the definition.

"It's only a migraine if it's unbearable." Migraines range from moderate to severe. A migraine treated early, before it peaks, can stay moderate — that does not demote it to a tension headache.

"I have both, so I can't tell." Very common, and real — many people genuinely get both kinds on different days. That is exactly what a headache diary is for: it separates the two by their features rather than making you guess in the moment.

"Migraine is rare, so it's probably just tension." The opposite is closer to the truth. Tension-type headache is the most common headache overall, but migraine is far from unusual — it is one of the most common neurological conditions there is, more frequent in women, and it peaks during exactly the years people are busiest with work and family. If your bad days involve nausea, one-sidedness or light sensitivity, the base rate is not a reason to dismiss migraine. It is a reason to take the possibility seriously, because the odds it is migraine are higher than most people assume.

Why getting the label right changes your options

This is the whole reason the distinction is worth your attention.

If it is tension-type headache, the mainstays are simple pain relief used sparingly, plus attention to the usual drivers — stress, posture, sleep, screen time.

If it is migraine, a different toolkit opens up. There is medication designed specifically for migraine attacks, and the guidance from the American Headache Society is explicit that you should treat at the first sign of pain rather than waiting to see how bad it gets — in one trial, treating while pain was still mild produced a substantially higher rate of being pain-free at two hours than treating once it was moderate or severe. And if attacks are frequent, there is preventive treatment: the thresholds are tiered by how much attacks disrupt your life, starting as low as three to four headache days a month. Most people never learn any of this exists, because nobody ever told them it was migraine.

There is also a cost to over-treating. Taking acute painkillers too often — 15 or more days a month for ordinary painkillers, 10 or more for migraine-specific ones or combinations — can create a headache of its own, called medication-overuse headache. People who think they "just get headaches" and medicate through them are the ones most at risk of this.

What your own data can show

A wearable cannot diagnose either condition — that is a clinical judgement based on the features above. But it can do something genuinely useful: help you tell the two apart over time, instead of trying to remember in the moment.

What to look at. Whether your bad-head days line up with poor sleep, with a drop in heart rate variability below your own range, or with unusually high stress the day before — the "let-down" pattern, where an attack lands after the pressure comes off, is well documented in migraine. If your worst days cluster after stress drops, or after short and broken sleep, that is a migraine-shaped pattern rather than a tension-headache one.

Welltory measures heart rate, heart rate variability and sleep from your phone or wearable, so the days around a bad head become a record you can compare rather than a memory you have to reconstruct.

What it cannot do. It cannot tell a migraine from a tension headache on its own, and a single reading means nothing. The value is in the pattern across weeks, matched against a simple note each day of whether your head hurt and how.

A two-week diary that settles most cases

You do not need any equipment for this — just fourteen days and a few words each time your head hurts.

Each time, note: one side or both; throbbing or pressing; mild, moderate or severe; did moving make it worse; any nausea, or trouble with light and sound; how long it lasted; and what the day before looked like — sleep, stress, missed meals.

At the end, the pattern usually reads itself. Entries that are one-sided, throbbing, worse with movement, with nausea or light sensitivity, lasting most of a day → migraine. Entries that are both-sided, pressing, mild, no nausea, gone in a few hours → tension-type. If you have both kinds, you will see both — which is itself the answer, and a useful thing to show a doctor.

Still not sure which one you get?

The survey walks through these same questions in the order that separates the two fastest, and takes two minutes: start the survey.

When a headache is neither, and needs urgent attention

Most headaches are tension-type or migraine. These features are not, and they are not a wait-and-see situation. They come from the SNNOOP10 list, a standard set of warning signs for a headache caused by something other than a primary headache disorder:

• A headache that reaches maximum intensity within seconds — the "worst headache of my life" — seek emergency care.

• Fever with a stiff neck.

• Weakness, numbness, confusion, trouble speaking, or vision changes that do not resolve.

• A first-ever headache after age 65, or a clear change in a pattern you have had for years.

• A headache with a history of cancer, or with a condition affecting the immune system such as HIV.

• A headache clearly worse when lying down or when coughing, sneezing or straining.

• A headache that follows a head injury.

• A new headache in pregnancy or just after birth.

Aura that lasts more than an hour, or your first-ever aura, is also worth getting checked promptly rather than assuming it is migraine.

How to bring this up with your doctor

Lead with the pattern, not the word. Do not open with "I think I have migraines" or "I just get headaches" — both invite a quick, wrong answer. Open with what you counted: "I get headaches about ten days a month. On maybe four of them the pain is one-sided and throbbing, gets worse if I move, and I feel sick and can't stand bright light. Those last most of a day and leave me wiped out. The others are milder, both sides, and gone by evening."

Bring the diary. Four to eight weeks of the entries above. That table is precisely what a doctor uses to separate tension-type headache from migraine, and it is far more useful than any single description.

What to ask for.

• Whether the worse days meet the criteria for migraine. Ask in those words — it moves the conversation from reassurance to a diagnosis.

• What to take at the first sign of an attack rather than at its peak.

• Whether preventive treatment applies, if you get four or more headache days a month.

• Whether the number of days you take painkillers could be adding to the problem.

If you are brushed off. Ask for it to be recorded: "migraine considered and ruled out because…". It is a fair request, and it tends to make the answer more careful. If the pattern continues, asking to see a headache specialist is reasonable.

How we made it

Written from the International Classification of Headache Disorders (3rd edition) for the diagnostic criteria of tension-type headache, migraine without aura, and migraine with aura, plus guidance from the American Headache Society and the American Migraine Foundation and population data on how often migraine goes undiagnosed. Where a belief is common but wrong — that migraine is always one-sided, or always involves aura — we say so in the text.

Written by the Welltory science team Data analysis by the Welltory data team Reviewed by Anna Elitzur, MD

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