Do You Have A Tension Headache Or Migraine? Here's How To Tell

When a headache hits, it can leave you scrambling for relief: pain medicine, a dark room, or maybe both. But not all headaches are the same. Some are mild and stress-related, while others knock you off your feet with nausea and throbbing pain.

Finding the right treatment option can come down to whether you’re dealing with a tension headache or a migraine. These two are the most common types of headache. While they can overlap, their causes and symptoms aren’t identical. Understanding which one you’re experiencing can help you treat it more effectively (and even prevent future episodes).

Let’s break down how to tell these conditions apart.

What is a tension headache?

A tension headache - the most common headache type – typically feels like a tight band squeezing your head, with steady, dull pressure on both sides. These headaches are often mild to moderate, and can last from 30 minutes to a few days.

Triggers for tension headaches include stress, poor posture, eyestrain from screens, or clenching your jaw. And while they can be annoying and sometimes distressing, they don’t usually disrupt your life or regular activities.

What is a migraine?

A migraine is a neurological condition that causes intense, throbbing pain, usually on one side of the head. Migraine episodes can last from four to 72 hours and often include nausea, vomiting, or sensitivity to light and sound.

Migraine triggers can include hormonal changes, certain foods, or lack of sleep. These headaches are generally significantly more disabling than tension headaches.

About a quarter of migraine sufferers also experience an aura—visual disturbances such as flashing lights—before the pain hits. After a migraine subsides, you also might feel drained, foggy, or moody for up to a day. This is called “the postdrome phase, or “migraine hangover.” About 8 in 10 people with migraines suffer from migraine hangovers, experiencing fatigue, difficulty concentrating, or irritability.

Key differences between tension headache and migraines

Both tension headaches and migraines can cause head pain that disrupts your day. But there are some clear signs that can help you tell them apart.

Tension headaches tend to cause a steady, pressure-like pain on both sides of the head, while migraines usually bring a more intense, throbbing pain on one side, often with nausea or sensitivity to light and sound.

Here’s a quick comparison to help you spot the difference:

What causes and triggers these headaches?

Both tension headaches and migraines share some potential triggers. Stress, poor sleep, dehydration, skipped meals and even caffeine withdrawal can cause both types of headaches.

However, there are also some triggers that are specific to migraines and tension headaches.

Common migraine triggers include:

• Hormonal shifts (especially around menstruation)
• Certain foods (aged cheese, red wine, processed meats)
• Sensory overload (bright lights, strong smells)

Common tension headache triggers include:

• Muscle strain or tight shoulders from poor posture or too much desk time
• Eye strain from screens
• Clenching your jaw or grinding your teeth
• Environmental factors like bright lights, loud noises, or weather changes (e.g., barometric pressure).

It’s important to remember that triggers for both types of headaches can also vary from person to person. If you’re not sure what’s causing your headaches, consider keeping a headache diary. Jot down details about when your headaches start, the type of pain you experience, symptoms, and any other details you can think of. This practice can help you identify patterns so that you can stop headaches before they begin.

How can you treat tension headaches and migraines?

Once you’ve identified what triggers your headaches, the next step is learning how to manage and treat them—both in the moment and for long-term relief. Treatment often depends on the type and severity of your headache, but most approaches fall into two main categories: relieving pain when it occurs and preventing future episodes.

Treating tension headaches

Tension headaches are often linked to muscle tightness, stress, or eye strain. Fortunately, most mild-to-moderate cases respond well to simple treatments:

• Over-the-counter (OTC) pain relievers such as ibuprofen, aspirin, or acetaminophen can ease pain.
• Stretching and movement, like gently rolling your neck and shoulders or practicing restorative yoga postures, can release tension.
• Reducing screen time and taking regular breaks helps minimize eye strain.
• Stress management techniques like deep breathing, meditation, or mindfulness can calm the nervous system.
• Physical therapies such as massage, chiropractic adjustments, physical therapy, or acupuncture may also provide relief.

Treating migraines

Migraines can be more severe and complex than tension headaches. They often require a mix of medications and self-care strategies.

• OTC pain relievers may help mild cases, but more persistent migraines typically need prescription options.
• Abortive medications (like triptans, e.g., sumatriptan) can stop a migraine if taken early in an attack.
• Preventive medications such as beta-blockers or calcitonin gene-related peptide (CGRP) inhibitors are prescribed for frequent migraines. The CGRP inhibitors block pain-signaling proteins and come as injectables (Aimovig, Ajovy, Emgality, Vyepti) or oral options (Qulipta for prevention; Nurtec and Ubrelvy for acute relief).
• Self-care techniques, like resting in a dark, quiet room, applying a cold compress, and staying hydrated, can make a big difference during an episode.
• Neuromodulation devices (like Cefaly, Nerivio, or Relivion) use mild electrical or magnetic pulses to modulate nerve activity and may help reduce pain intensity or frequency.

With migraines, treatment often involves finding the right combination of medication, devices, and lifestyle habits. Working with a healthcare provider can help tailor a plan to your unique pattern of symptoms and triggers.

Side effects of migraine medications

While migraine medications can provide significant relief, they may come with side effects. Triptans (such as sumatriptan) may cause dizziness, fatigue, or a tightening sensation in the chest. CGRP inhibitors (like Aimovig) can sometimes lead to mild injection-site reactions or constipation.

It’s also important to avoid overusing OTC pain relievers such as ibuprofen or acetaminophen—doing so can cause rebound headaches, where medication overuse actually makes headaches more frequent.

If you experience side effects or notice your headaches worsening, talk to your doctor. They can help adjust your medication type, dose, or schedule to find the safest and most effective option for you.

Can you prevent future headaches naturally?

Yes! Many headaches can be prevented through consistent lifestyle habits that support your body’s overall balance. Natural prevention strategies can make a powerful difference for both tension headaches and migraines:

• Sleep: Aim for 7–8 hours each night to keep your body and mind rested.
• Diet: Eat balanced meals regularly to prevent low blood sugar, and avoid known trigger foods (such as processed meats, caffeine, or artificial sweeteners).
• Hydration: Drink at least 8–10 glasses of water daily to prevent dehydration-related headaches.
• Exercise: Engage in 30 minutes of moderate activity (like walking) most days to boost circulation and reduce stress.
• Stress management: Practice yoga, mindfulness, or journaling to help lower tension levels.
• Tracking: Use a headache diary or an app (like Migraine Buddy) to identify patterns in triggers, timing, or diet.
• Muscle relaxation: Stretch regularly, maintain good posture, and improve workplace ergonomics to reduce strain.
• Bodywork: Chiropractic care, massage, and acupuncture can all play a role in long-term prevention and relief.

Can you have both (mixed headaches)?

Yes, some people experience mixed headaches, blending tension headache and migraine symptoms (e.g., bilateral pain with nausea). Chronic headaches (15 or more days per month) may signal this overlap. A doctor can diagnose and tailor treatment, often combining stress management and migraine meds.

Can children get migraines?

Yes, migraines affect about 10% of kids, often starting around puberty. Symptoms mirror adults’ but may include more stomach pain or vomiting.

A pediatrician or family medicine physician can assess and suggest age-appropriate treatments, and a visit to the doctor is definitely warranted with symptoms such as vision changes or trouble concentrating, as well as headaches that wake kids from sleep, worsen with coughing, or come with fever, confusion, or weakness.

When should you see a doctor about a headache?

Headaches and migraines are both common conditions. Still, there are times when it’s important to get checked by a healthcare provider — especially if your pain is severe, frequent, or affecting your daily life.

Talk to your doctor if you:

• Have headaches that keep coming back or are getting worse over time
• Notice that over-the-counter medicines no longer help
• Experience headaches that disrupt work, sleep, or everyday activities

Seek medical attention right away if you have:

• A sudden, severe headache that feels like “the worst headache of your life”
• Vision changes, confusion, weakness, or slurred speech
• A headache that begins after a head injury
• A new or different type of headache, especially if you’re over age 50
• A headache accompanied by fever, neck stiffness, or nausea and vomiting that doesn’t improve

These symptoms don’t always mean something serious is happening, but they do warrant prompt evaluation to rule out conditions like bleeding, infection, or other neurological problems.

How Sesame can help

If headaches are affecting your daily routine, you don’t have to guess what’s causing them or manage the pain on your own. With same-day online migraine visits through Sesame, you can talk to a licensed healthcare provider who will help you identify whether your symptoms point to a migraine, tension headache, or something else.

Your clinician can also recommend effective treatments, from lifestyle strategies and over-the-counter guidance to prescription medications or preventive options when appropriate.