Headaches are one of the most common health complaints, but not all headaches are the same. Understanding migraine and tension headaches is important because the way you manage them is entirely different.
The World Health Organization estimates that almost half of adults worldwide experience a headache at least once a year, and migraines alone affect more than 1 billion people globally. That makes migraines the third most prevalent illness in the world and a leading cause of disability.
Tension headaches, sometimes called stress headaches, are even more widespread. But while both conditions involve head pain, they have different root causes, triggers, and treatments. Below are 10 key differences that help you tell them apart.
1. Type of Pain
The pain itself is one of the clearest differences. Migraines often bring a throbbing, pulsating pain that feels like your head is pounding with every heartbeat. It can intensify when you move, climb stairs, or try to focus on a task. The sensation is usually described as sharp, rhythmic, and difficult to ignore.
Tension headaches, in contrast, produce a dull, steady ache. Instead of a pulsing sensation, it feels like someone is tightening a band around your head. The discomfort builds slowly and creates a heavy, pressing feeling rather than sharp or stabbing pain. This steady nature is why many people can continue working or going about their day despite a tension headache.
2. Location of Pain
Where the pain shows up also separates a migraine and tension headache. Migraines often affect one side of the head, either left or right. The pain might shift sides between attacks, but it’s usually concentrated in one area. Sometimes, migraines also radiate behind one eye, making it feel as though the eye itself is in pain.
Tension headaches, on the other hand, tend to affect both sides of the head evenly. The pain often spreads across the forehead, temples, and sometimes the back of the head or neck. Because tension headaches are tied to muscle tightness, they can also extend into the shoulders. If your headache feels symmetrical and broad, it’s more likely a tension headache than a migraine.
3. Intensity of Pain
Intensity is another major difference between migraine and tension headache. Migraines are usually moderate to severe, and many people find them disabling. The pain can be so intense that normal activities, like driving, working, or even having a conversation, become nearly impossible. For many, a migraine means lying down in a dark, quiet room until the attack passes.
Tension headaches are milder by comparison. While they can be uncomfortable and distracting, they don’t usually stop you in your tracks. People often describe the pain as nagging rather than overwhelming. That doesn’t mean they should be dismissed, but if your headache is so painful that you can’t function, you’re likely experiencing a migraine rather than a tension headache.
4. Duration of the Headache
How long the pain lasts is another clue when comparing a stress headache or migraine. Migraines can linger for hours or even days. Without treatment, they typically last anywhere from 4 to 72 hours. The lingering nature makes migraines especially disruptive, as the pain often overlaps with work schedules, social events, or family responsibilities.
Tension headaches are more variable. They can last as little as 30 minutes or stretch across several hours, but they rarely drag on for days. Some people get frequent tension headaches throughout the week, each lasting a few hours at a time. If your headache lasts multiple days and feels like it’s grinding you down, you’re likely dealing with a migraine.
5. Accompanying Symptoms
One of the clearest signs that you’re dealing with a migraine rather than a tension headache is the presence of extra symptoms. Migraines often come with nausea, vomiting, and extreme sensitivity to light, sound, or even smells. Many people also experience an “aura,” which involves visual changes like flashing lights, zigzag lines, or blind spots before the headache begins.
Tension headaches are much simpler in presentation. The pain is usually the only symptom. You may feel a bit tired or irritable, but you won’t usually get the full-body effects of a migraine. If you find yourself needing to shut out all light and sound or struggling with nausea, it’s far more likely you’re experiencing a migraine.
6. Triggers
Triggers highlight another difference between migraine and tension headache. Migraines are often triggered by neurological sensitivity. Common triggers include hormonal changes, lack of sleep, weather shifts, certain foods (like aged cheese, processed meats, or red wine), and overstimulation from light or noise. Because triggers vary widely, many people with migraines keep a headache diary to identify their personal patterns.
Tension headaches, in contrast, are usually brought on by lifestyle or physical strain. Long hours hunched over a computer, poor posture, dehydration, and emotional stress are common culprits. While stress can contribute to both migraines and tension headaches, the pathways are different, tension headaches stem from muscle tightening, while migraines involve changes in brain chemistry.
7. Impact on Daily Life
When comparing migraine vs tension headache, think about how much each condition affects your daily routine. Migraines can be completely disabling. Many people with migraines need to stop what they’re doing, lie down, and wait for the pain to relieve. For those with chronic migraines, this level of disruption can interfere with jobs, relationships, and mental health.
Tension headaches are disruptive, but less so. You may feel drained, irritable, or less productive, but most people can still manage their responsibilities. The real problem with tension headaches is their frequency. Even though they’re milder, recurring headaches several times a week can erode your overall quality of life.
8. Response to Pain Relievers
How the headache responds to treatment is also telling. Tension headaches usually improve with over-the-counter medications like acetaminophen, ibuprofen, or aspirin. A bit of rest, hydration, or a warm compress often helps as well. For most people, these simple strategies are enough to soothe the discomfort.
Migraines are more stubborn. While some people do find relief with standard painkillers, many require migraine-specific medications such as triptans or CGRP inhibitors. Even then, not every treatment works for every patient. If you find that common pain relievers barely touch your headache, you might be dealing with a migraine rather than a tension headache.
9. Frequency
Frequency patterns also help explain the difference between migraine and tension headache. Migraines can happen occasionally or become chronic. People with chronic migraine experience headaches 15 or more days per month, with at least 8 of those having migraine features. This level of frequency can significantly reduce quality of life and often requires medical treatment.
Tension headaches are far more common overall. Almost everyone will have one at some point in their life, and many people get them regularly during stressful times. While tension headaches may happen more often, they’re usually shorter and less intense than migraines. If you notice headaches showing up nearly every week but remaining relatively mild, they’re likely tension headaches.
10. Long-Term Health Considerations
The final difference lies in long-term health risks. Migraines are considered a neurological disorder and are associated with other health concerns. Research has linked migraines, especially those with aura, to an increased risk of stroke, particularly in women under 45. Migraines are also tied to higher rates of anxiety and depression, partly due to the stress of living with a disabling condition.
Tension headaches don’t carry the same risks. They’re uncomfortable, yes, but they don’t usually point to deeper neurological issues. Instead, they tend to be situational, flaring up during stressful periods and easing when lifestyle habits improve. This makes them less concerning from a long-term medical standpoint, though frequent tension headaches still deserve attention.
Listening to What Your Headaches Are Telling You
Headaches are more than discomfort; they’re signals from your body about what’s happening beneath the surface. Whether it’s a migraine disrupting your nervous system or a tension headache triggered by stress and posture, the patterns behind the pain can tell you a lot about how you’re living and coping.
The real value in knowing the difference isn’t only about naming the headache; it’s about making better choices for your health, your habits, and your future. Paying attention to these signals, and acting on them early, is often the difference between managing pain and letting it control you.