Migraine vs. Headache: Differences in Symptoms & Treatments

Key takeaways

To better manage migraine and headache:

• Learn the key differences between migraine and headache to understand which condition you’re experiencing.
• Treat a headache with over-the-counter pain relief, ice, and avoid common headache triggers.
• Treat a migraine with prescription medicine, devices to relieve pain, or cognitive behavioral therapy.
• Seek emergency care for a severe or sudden headache or stroke symptoms like vision loss or trouble speaking.

To many, the word “migraine” is the same as “headache.” While both conditions can cause head pain and disrupt your day, migraine is so much more than just a headache. Migraine is a neurological condition that likely results from circuit problems in the brain. Migraine includes varying symptoms, not just head pain. Migraine attacks can be chronic and can interrupt your life if left untreated.

Neurologist and researcher Andrea Harriott, MD, PhD with the Mass General Brigham Neuroscience Institute explains what migraine disorders are, how migraine and headache differ, and how to get relief from migraines.

What is a migraine?

Migraine is a neurological disorder that affects more than 40 million people in the United States. Migraine is 3 to 4 times more common in women than men and tends to peak in intensity between the ages of 20 to 40.

Migraine symptoms

Most people are familiar with the headache or head pain phase of a migraine attack, but migraine can include a variety of symptoms with or without head pain.

Symptoms of migraine include:

• Moderate to severe throbbing head pain, usually on one side of the head
• Sensitivity to light, sound, or smells
• Stomach upset, including nausea or vomiting
• Visual changes like seeing flashing lights or zigzag lines
• Changes in mood or irritability
• Fatigue, concentration problems, or brain fog

Phases of migraine

Migraine symptoms can occur in phases. Not all people will experience every phase. Understanding the phases of migraine can be important to help you identify an oncoming migraine attack and treat it early. Treating migraine attacks early can reduce symptom severity and the length of the attack.

The four phases of a migraine attack are:

1. Prodrome

The beginning phase of a migraine attack, starting a few hours to a few days before the headache, is called prodrome. It can include unexplained mood changes, food cravings, fluid retention, trouble concentrating, neck discomfort, or fatigue.

2. Aura

The aura phase of migraine includes visual symptoms like seeing flashing or bright lights, zigzagging lines, or dark spots in your vision. Other symptoms like tingling sensations or—rarely—muscle weakness can happen during the aura phase. The aura phase typically starts 5 minutes to an hour before the headache phase and lasts up to an hour before resolving completely.

Only about 1 in 3 to 5 people who get migraine attacks experience aura symptoms.

3. Headache

This phase of a migraine attack can last from hours to days, though it’s also possible to have a migraine aura attack without a headache.

The headache phase includes moderate to severe head pain, usually on one side of the head. People may describe the pain as throbbing, sharp, burning, or stabbing.

4. Postdrome

Often called “the migraine hangover,” this phase of a migraine attack happens after the headache resolves. People often report fatigue, changes in appetite, brain fog and mood changes during this phase. The postdrome phase of a migraine attack can last up to 2 days before you feel healthy again.

Migraine vs. headache

While migraine may include headache, not every headache is a migraine.

“A regular headache wouldn’t have these other severe symptoms,” says Dr. Harriott. “Headaches also don’t typically progress in clear stages like a migraine attack.”

Dr. Harriott continues, “Some people experience sensitivity to light or sound with a headache, but typically you wouldn’t experience the full range of migraine symptoms or phases for something like a tension headache.”

Headache can happen on its own or conditions like high blood pressure or an infection can cause a headache. Neuropathy (nerve pain due to damage to the nerves) or other nerve conditions, dehydration, stress, lack of sleep, or tight muscles in your neck and shoulders can also cause headache.

Where migraine pain is typically on one side of the head, pain from other types of headache can be in many other areas—across the bridge of the nose, behind the eyes, across the forehead, at the base of the skull, over the top of the head, or a combination of spots.

When a headache is an emergency

Headache and migraine symptoms can overlap with symptoms of a stroke. If you experience any stroke symptoms, it’s important to call 9-1-1 immediately. Stroke symptoms include:

• Severe or sudden headache escalating to maximum intensity over seconds with unknown cause (some people describe it as “the worst headache of their life”)
• Sudden loss of vision in one or both eyes (migraine visual symptoms are usually seeing things like lines or flashing) or double vision
• Sudden onset face, arm and or leg weakness
• Sudden onset inability to speak or understand speech
• Sudden onset trouble walking

Migraine triggers vs. headache triggers

If you can identify the triggers that tend to cause your migraine or headache, you can find ways to minimize or eliminate them.

Dr. Harriott explains, “Migraine is a complex neurological disorder that involves both genetic and environmental factors. It likely involves increases in excitability of the brain, which can cause the visual symptoms in migraine aura, or result in other symptoms, like increases in sensitivity to sensory stimulation like noise or temperature.”

Common triggers for migraine and headache include:

• Stress
• Dehydration
• Lack of sleep
• Loud noises or bright lights
• Too much caffeine or caffeine withdrawal

Dr. Harriott explains how migraine can be triggered by additional factors. “Another area of the brain called the hypothalamus is involved in feelings of thirst, hunger, sleep, and hormone regulation,” she says. “All of which are associated with triggering migraine attacks.”

Migraine attacks can also be caused by:

• Changes in hormones (such as before or during your menstrual cycle or if you’re on hormone therapy)
• Specific foods including aged cheese, processed meats, artificial sweeteners, and pickled or fermented foods
• Changes in the weather, particularly in atmospheric pressure
• Overuse of pain medications, including ones that have been used to treat migraine
• Sleeping too much or too little
• Smoking or using tobacco products

Treatments for migraine and headache

“There are two ways to treat migraine. The first is symptomatic treatment that you can take during your migraine,” says Dr. Harriott. “The second is preventive treatment to reduce the number of migraine attacks that you have per month.”

Some of the treatment options include:

• Lifestyle modifications like reducing caffeine and alcohol consumption, or quitting smoking
• Nutritional supplements like riboflavin, feverfew, coenzyme Q10 or magnesium (talk to your doctor before starting any supplements or medications)
• Over-the-counter medications like ibuprofen
• Migraine specific medications like triptans and CGRP blockers
• Prescription drugs that help prevent migraines, reduce pain severity, and frequency.
• Behavioral therapies like cognitive behavioral therapy (CBT) and meditation
• Neuromodulation devices that change nerve activity through magnets or electrical currents (talk to your doctor about at-home and in-office options)

It’s important to talk to your doctor to get more information about which options might be the best to combat your migraines and provide relief.

Migraine and headache prevention

“There is no one-size-fits-all prevention for migraine and headache,” says Dr. Harriott. “Some people identify things that trigger their headaches and can naturally avoid them. While others do not have any triggers for their headaches. For some people, applying ice packs during a headache can be helpful for pain relief.”

Whether you’ve identified your personal triggers or not, to help prevent migraine and headache Dr. Harriott recommends you:

• Eat a well-balanced, healthy diet
• Get adequate sleep and exercise
• Stay well hydrated
• Recognize and manage external stressors

Your doctor can help you determine if you need migraine preventive medication or other options to support you long-term.

Dr. Harriott says, “While migraine affects billions of people worldwide, it’s a treatable condition with a growing number of medications, including monthly self-injections that can dramatically improve the quality of life for migraine sufferers and bring symptom relief.”