Migraine vs. Tension Headache: How to Tell the Difference
Migraine and tension-type headache are treated very differently, yet are often confused. Here is how to tell them apart by pain type, symptoms, and triggers.
Why telling them apart matters
Migraine and tension-type headache are the two most common headaches — and they are treated very differently. A tension headache usually responds to rest and a simple painkiller; a migraine may need a triptan, trigger management, and sometimes a preventive. Misreading one for the other means months of the wrong treatment. The good news is that a handful of features separate them reliably.
The quick comparison
| Feature | Migraine | Tension-type headache |
|---|---|---|
| Pain type | Throbbing, pulsating | Dull, pressing, tight “band” |
| Location | Usually one-sided | Both sides of the head |
| Intensity | Moderate to severe | Mild to moderate |
| Movement | Worse with activity | Not worsened by activity |
| Nausea | Common | Rare |
| Light/sound sensitivity | Common | Uncommon (maybe one, not both) |
| Aura | Sometimes | Never |
| Typical duration | 4–72 hours | 30 minutes to 7 days |
If your headache is one-sided, throbbing, made worse by climbing stairs, and comes with nausea or light sensitivity, it is far more likely a migraine.
The single most useful question
If you only ask yourself one thing, ask: “Does routine physical activity make it worse?” Migraine is aggravated by movement — people want to lie still in a dark room. Tension headache is not; you can usually keep working through it. This one feature, combined with nausea and light sensitivity, separates the two most of the time.
Why people get it wrong
- A migraine without the classic throbbing can feel like “just a bad tension headache.”
- Both can be triggered by stress, poor sleep, and skipped meals, so the triggers overlap.
- Many people have both — tension headaches between migraine attacks — which blurs the picture.
This is exactly why a written record beats memory. When you log pain type, location, nausea, and whether activity made it worse, the pattern that separates your migraines from your tension headaches becomes obvious within a few weeks. (See our guide on tracking your triggers.)
When to see a doctor
See a doctor promptly if a headache is sudden and severe (“worst headache of my life”), follows a head injury, comes with fever and a stiff neck, or is accompanied by confusion, weakness, or vision loss. These are not features of ordinary migraine or tension headache.
How Trackwell helps you classify
The Trackwell migraine tracker records pain type, location, activity impact, nausea, and light/sound sensitivity for every headache day — the exact features that distinguish migraine from tension headache — and rolls them into a doctor summary so the pattern is clear at your next appointment.
If you want to try the structure first, download the free 1-month sample →. No payment, no account.