Headaches vs. Migraines: Understanding the Differences for Better Diagnosis & Treatment

Why doesn’t medicine relieve your headaches? The answer is that not all headaches are the same. Nor do they respond to the same treatments. In fact, the term “headache” covers migraine headaches, tension-type headaches, cluster headaches, and sinus headaches. Understanding the differences between these conditions is crucial for effective diagnosis and treatment. This article provides a comprehensive overview of headaches and migraines, highlighting symptoms, characteristics, and differences.

Migraine Headache Symptoms and Characteristics At a Glance

Before looking in depth at headaches vs. migraines, it is helpful to start with an at-a-glance comparison between migraine headache characteristics and those of other headache types, including pain characteristics, associated symptoms and duration.

How to identify 4 types of headaches

Migraines, tension headaches and cluster headaches are primary headaches. These headaches are not caused by a different medical condition, such as a sinus infection. Instead, they are categorized as primary headaches based on their specific symptoms and diagnostic criteria (International Headache Society, 2018).

1. Migraine Headaches and Migraine Aura

Migraines are a type of primary headache disorder characterized by intense, throbbing pain usually localized to one side of the head, but the pain can also affect both sides of the head.

Migraines are particularly debilitating headaches because they often come with such a wide range of associated symptoms. In addition to intense pain, nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia) can last for 4 hours to 3 days depending on the individual and whether treatment is administered promptly (Dodick, 2018). Migraine severity and migraine duration can affect the choice of treatment and management strategies.

Some migraines are preceded by an aura. About a third of people will have warning signs 24 to 48 hours before a migraine. This is called migraine aura or prodrome. This pre-headache phase typically lasts 5 to 60 minutes and may include additional symptoms, including visual disturbances (e.g., flashes of light, blind spots, even temporary loss of vision) or other neurological disturbances like tingling in the face or limbs (Goadsby et al., 2017). In rare cases, migraine aura can include weakness on one side of the body (Schurks et al., 2008).

Migraine severity can vary. Mild migraines may often be managed with over-the-counter pain relievers and may not significantly affect daily functioning (Lipton et al, 2001). However, even mild migraines can raise the risk of developing Medication Overuse Headache (MOH) due to frequent use of medications such as NSAIDs. Using a migraine preventative such as Petadolex or Dolovent to reduce migraine severity and frequency of attacks can reduce the need for pain-killers. Severe migraines often requiring emergency room treatment, prescription medications like Triptans or CGRP inhibitors and lifestyle adjustments (Buse et al, 2012).

2. Tension Headaches vs. Migraines

Tension headaches are the most common primary headache disorder. Often mistaken for migraines, tension headaches have different characteristics, including how tension headache pain usually affects both sides of the head. Unlike the intense pain of a migraine, tension headache pain is usually described as a dull, aching, or pressure-like sensation—as if a too-tight band is wrapped around the head.

Tension headaches don’t usually involve nausea or vomiting.Nor do they typically include sensitivity to light or sound.

Prescription migraine medications are not typically effective for tension headaches. Instead, tension headaches respond better to over-the-counter painkillers and muscle relaxants (Schoenen et al.,2006).

3. Cluster Headaches vs. Migraines

Cluster headaches produce severe pain around one eye.  Also, burning or piercing pain characterizes cluster headaches vs. migraine pain that tends to be experienced more as intense, throbbing pain. They are called “cluster” because these headaches (typically lasting between 15 minutes and 3 hours) occur in clusters over weeks or months, followed by a headache-free period. Migraines do not follow a regular pattern. (Goadsby et al., 2006)

Nasal congestion and agitation are common symptoms. Where migraines typically include nausea, vomiting and sensitivity to light and sound, cluster headache symptoms do not. They are more likely to include autonomic symptoms like tearing of the eyes as well as restlessness.

Treating cluster headaches requires fast-acting medicines because the pain tends to come on and go away quickly. As with migraines, the goal is to decrease the pain, shorten the headache period and prevent new attacks. Triptans, oxygen and local anesthetics like lidocaine are among treatment options for stopping cluster headaches once they’ve begun.

4. Sinus Headaches vs. Migraines

Sinus headaches are caused by inflammation of sinus passages. Though they are not categorized as primary headaches, they are often mistaken for migraines which are primary headaches. Another difference is that instead of intense migraine “head pain,” sinus headaches produce “face pain”: forehead, cheeks and around the eyes. It is described as a deep, constant ache associated with sinus pressure and congestion. (Kobayashi et al., 2002)

Very different symptoms for sinus headaches vs. migraines. Sinus headache symptoms are more like a cold, with nasal congestion and perhaps a fever vs. migraine nausea and light/sound sensitivity. (Fokkens et al., 2020) Ear pain, acute aching in the teeth, bad breath, and tiredness also occur with sinus headaches. Chronic sinusitis and acute sinusitis have similar symptoms.

Treating the underlying sinus infection usually resolves a sinus headache.

When does a headache become chronic?

Conclusion

While tension, cluster and sinus headaches are often mistaken for migraines, several characteristics define actual migraine headaches, including unilateral pain that lasts up to three days and significantly impairs daily activities. Nausea and vomiting are also typically associated with migraine vs. other types of headaches.

Understanding the differences between various types of headaches vs. migraines is essential in developing accurate diagnosis and personalized treatment plans that are effective in providing relief.