Quick answer
Migraine often causes moderate to severe throbbing pain, commonly on one side, with nausea or sensitivity to light and sound. A tension-type headache more often feels like pressure or a tight band on both sides. Symptoms can overlap, so the pattern over several attacks matters. A sudden “worst-ever” headache, new weakness, speech or vision change, confusion, seizure, fever with neck stiffness, or headache after a head injury needs urgent medical care.
The word “headache” describes a symptom. Migraine is a neurological condition with a recognisable attack pattern. Two people can point to the same temple yet need different assessment because the pain, associated symptoms and warning signs are different.
This guide helps you compare common patterns, build a useful headache diary and prepare for a consultation. It does not replace an examination when a headache is new, changing or accompanied by neurological symptoms.
Migraine vs tension headache: the practical difference
Pain intensity alone does not identify migraine. Doctors look at the quality and location of pain, whether normal movement makes it worse, nausea, light or sound sensitivity, aura, attack duration and what happens before and after the pain. A tension-type headache often causes steady pressure without the fuller migraine pattern.
Three patterns worth separating
Use the whole attack pattern rather than one symptom.
Migraine pattern
Throbbing or pulsating pain, often one-sided, with nausea or light and sound sensitivity. Activity may worsen it.
Tension pattern
Pressure or a tight-band feeling, often on both sides, usually without vomiting or marked sensory sensitivity.
Secondary warning
A sudden, new or sharply different headache with neurological signs, fever or injury needs medical assessment.
The four possible phases of migraine
Not every person experiences every phase. Recognising what happens before and after the pain can make the diagnosis and diary more useful.
Migraine can extend beyond the pain
Changes may begin hours before the headache and continue after it settles.
Prodrome
Mood change, food cravings, neck stiffness, fatigue or frequent yawning may appear early.
Aura
Some people notice flashing lights, zigzags, tingling, dizziness or speech difficulty before pain.
Attack
Head pain may last 4 to 72 hours and can occur with nausea and sensory sensitivity.
Postdrome
Tiredness, poor concentration or a washed-out feeling can remain after the pain eases.
Common migraine triggers and why a diary helps
A trigger is not the same as the cause of migraine. Attacks often follow a combination of changes rather than one food or event. The useful question is what repeatedly happened in the 24 hours before an attack.
- Too little, too much or irregular sleep
- Skipped meals, long gaps between meals or dehydration
- Stress, a sudden drop in stress, travel or schedule changes
- Menstrual or other hormonal changes
- Bright light, strong odours, heat or prolonged screen exposure
- A change in caffeine intake, alcohol or selected foods in a consistent personal pattern
- Weather changes for some patients
What to record in a headache diary
A short, consistent record is more useful than trying to remember the worst attacks during a consultation. Track enough detail to compare patterns without turning the diary into a burden.
Six details that improve the consultation
Record each attack on the same day whenever possible.
Timing
Date, start time, end time and how quickly the pain developed.
Pain
Side, location, pressure or throbbing quality, and severity out of 10.
Associated signs
Aura, nausea, vomiting, light or sound sensitivity, dizziness and neck symptoms.
Context
Sleep, meals, water, periods, stress, screens, travel and weather.
Medicine
Name, dose, time taken and how much relief it gave.
Impact
Work missed, sleep disturbed and the time needed to function normally again.
Dr. Akshata’s clinical perspective
In my clinic, I first ask when the headache pattern began and whether it has changed. I note one-sided or two-sided pain, throbbing or pressure, nausea, light and sound sensitivity, aura, menstrual timing, sleep, meals, screen exposure, neck tension and medicine frequency. I also ask how many headache days occur each month and how long recovery takes. I review blood pressure, existing diagnoses, current medicines and available reports. If the headache is sudden, new, progressively worsening or linked with neurological signs, I advise medical evaluation before planning routine follow-up. For a stable migraine pattern, I use the diary to compare attack days, duration, rescue-medicine use and ability to return to normal activity.
Does migraine always need a scan?
Migraine is usually diagnosed from the history and neurological examination. A scan is not required for every familiar, stable migraine pattern. A doctor may recommend imaging or specialist review when the examination is abnormal, the pain is sudden or different, the pattern keeps worsening, an injury occurred, or other warning signs are present. Do not order or avoid a scan based only on an online checklist.
How migraine care is planned
Treatment depends on attack frequency, severity, disability, other health conditions and medicine use. Some patients need clinician-prescribed acute treatment, preventive medicine or both. In my practice, I individualise homeopathic care around the person’s verified migraine pattern and track it alongside sleep, meals, hydration and medical treatment. I do not advise stopping prescribed migraine medicines without the treating clinician. Progress means fewer headache days, shorter attacks, less rescue-medicine use and better function, measured over time.
Headache warning signs: when to seek urgent care
A new severe headache should not be assumed to be migraine. Seek urgent medical help when any of the following is present.
- A sudden headache that reaches maximum intensity within seconds or minutes
- New weakness, numbness, facial droop, speech difficulty, confusion or loss of consciousness
- New loss of vision, seizure or severe balance difficulty
- High fever with a stiff neck or a new widespread rash
- Headache after a significant head injury
- A migraine attack lasting more than 72 hours or aura lasting more than one hour
- A new or severe headache during pregnancy or soon after delivery
- A major change in a familiar headache pattern
Daily habits that support a steadier migraine plan
Routine does not remove every attack, but it reduces avoidable variation and makes true triggers easier to recognise.
- Keep sleep and wake times as consistent as your schedule allows
- Avoid long gaps between meals and keep water available through the day
- Use regular screen breaks and adjust glare if light is a trigger
- Keep caffeine intake modest and consistent rather than changing it sharply
- Build gradual physical activity around your fitness and medical advice
- Review frequent painkiller use with a clinician because overuse can contribute to recurring headache
Related Pages
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