Quick answer: a tension headache usually feels like a dull, tight band or pressure on both sides of the head and doesn’t stop you from doing things. A migraine is typically a throbbing pain, often on one side, that is worse with activity and comes with nausea or sensitivity to light and sound. Migraines usually last 4 to 72 hours if untreated.
Side-by-side comparison
| Feature | Migraine | Tension headache |
|---|---|---|
| Pain type | Throbbing or pulsing | Dull, pressing, tight band |
| Severity | Moderate to severe | Mild to moderate |
| Location | Often one side, can be both | Usually both sides |
| Effect of activity | Worse with movement | Not usually worse |
| Nausea or vomiting | Common | Uncommon |
| Light and sound sensitivity | Common, often both | Absent, or only one |
| Aura (flashing lights, zigzag lines, tingling) | Happens in some people | No |
| Duration | 4 to 72 hours | 30 minutes to several days |
| Typical trigger | Hormones, sleep changes, skipped meals, certain foods, stress | Stress, poor posture, eye strain, tight neck muscles |
Many people have both. Mixed or overlapping headaches are common, which is why a diagnosis from a doctor is more reliable than guesswork.
How a migraine feels
A migraine often comes in stages. Some people get a warning phase hours or a day before, with mood changes, yawning, food cravings or neck stiffness. About one in four people with migraine have an aura lasting 5 to 60 minutes, such as zigzag lines, blind spots or tingling. Then comes the headache, usually with nausea, and light and sound that feel unbearable. Afterwards, many people feel drained or foggy for a day, a “migraine hangover”.
How a tension headache feels
Tension headaches are the most common headache type. The pain is steady and squeezing, like a tight hat or band, sometimes spreading to the neck and shoulders. You can usually keep working, though you feel uncomfortable. Nausea is not typical.
What triggers each one
Migraine: changes in sleep, skipped meals, dehydration, hormonal shifts around periods, bright lights, strong smells, weather changes, alcohol (especially red wine), and for some people caffeine or certain foods. Triggers differ widely, so a headache diary helps.
Tension: stress, long hours at a desk, poor posture, clenched jaw, eye strain, lack of sleep.
What can help
For tension headaches: simple pain relievers such as paracetamol (acetaminophen) or ibuprofen, a warm or cool compress, gentle neck and shoulder stretches, regular breaks from screens, and stress management.
For migraines: treat early, as soon as you feel it starting, with the medicines your doctor recommends. Rest in a dark, quiet room. Some people need prescription migraine treatments or preventive medicine if attacks are frequent.
Be careful with painkillers. Using pain relievers on more than two to three days a week, week after week, can cause medication-overuse headache, which keeps the cycle going. If you find yourself reaching for tablets that often, see your doctor.
Habits that help both: regular sleep, regular meals, enough water, moderate exercise, limiting alcohol, and managing stress. For related lifestyle advice, see our guide to causes of chronic fatigue.
Start a headache diary
Write down the date, time, pain type, how long it lasted, what you ate, how you slept, your stress level, your period (if relevant), and what helped. After a month, patterns often become clear, and your doctor will find it very useful.
Red flags: get urgent medical help
Seek emergency care if a headache:
- Starts suddenly and is the worst of your life (a “thunderclap” headache)
- Comes with fever and a stiff neck
- Comes with weakness, numbness, confusion, trouble speaking or loss of vision
- Follows a head injury
- Comes with a seizure
- Starts after age 50 for the first time, or looks very different from your usual pattern
- Happens during or just after pregnancy with high blood pressure
See a doctor soon if headaches are becoming more frequent or severe, wake you from sleep, or interfere with work and daily life.
Frequently asked questions
Can a tension headache turn into a migraine?
They are different conditions, but frequent tension headaches can occur in people prone to migraine, and one can trigger the other.
Do migraines always cause nausea?
No. Nausea is common, but some people have migraine without it. Light and sound sensitivity or a throbbing pain on one side are other clues.
How long should I wait before seeing a doctor for headaches?
If headaches occur more than a few times a month, are getting worse, or you need painkillers often, make an appointment.
Does caffeine help or hurt?
A small amount can help some headaches, but too much, or sudden withdrawal, can trigger them.
Cura Editorial Team
Contributor at Cura Health Journal.