Headaches aren’t uncommon. In fact, almost everyone will experience at least one headache in his or her lifetime, and many will deal with them off and on throughout their lives. However, some headaches are worse than others. These may be migraines.

During a migraine, the temporal artery, an artery that lies outside the skull and just under the temple, enlarges or dilates. This enlargement stretches the nerves that are coiled around the temporal artery and causes them to release chemicals that can cause inflammation, pain, and even greater enlargement of the artery. As the artery grows larger, the pain becomes worse.

Migraines affect 28 million Americans each year, or about 14 percent of the population. Your headache symptoms may actually be a sign of a migraine. Here’s how to tell the difference between a common headache and a migraine.

When Is a Headache More Than a Headache?

Nearly 90 percent of headaches are tension headaches—simply put, they are a pain in your head. These headaches are most often associated with and made worse by fatigue, sleep deprivation, and stress, and they are typically treated with over-the-counter medicine or rest. Conversely, only about 10 percent of headaches each year are migraine headaches, making this type much rarer. People with migraines may experience nausea, vomiting, dizziness, abdominal pain, vision trouble, and pain behind the eyes. A migraine sufferer may experience several of these symptoms at once in addition to the headache, or may have only one in addition to the headache. Each person’s experience is different, and symptoms may change with each onset of a migraine.

Comparing Headaches and Migraines

  • Pain characteristics: Migraine sufferers report deep throbbing, pounding, and pulsating pain. Tension headaches can range from dull pressure throughout the head to a tight squeeze on the head or around the neck.
  • Gender: Both migraine and tension headaches plague women more than men. In fact, 70 percent of migraine sufferers are women. This may be due to hormone fluctuations brought on by menstruation or menopause.
  • Sensitivities: A migraine may cause sensitivity to light, sound, or smells. Tension headaches rarely cause these sensitivities.
  • Location of pain: Pain behind or near the eye on one side of the head or the other is another mark of a migraine. This divided pain in the head occurs with 60 percent of migraines. Pain throughout the head, across the forehead, or at the base of the neck is a mark of a tension headache.
  • Severity of pain: A migraine can be quite painful; sufferers report pain that is moderate to very severe. Tension headaches are typically only mild to moderately painful.
  • Nausea: Nausea, vomiting, and upset stomach are all common with migraine headaches but rarely occur during a tension headache.
  • Visual aura: A visual aura (bright, flashing lights or dots that appear in the field of vision) can occur before a migraine begins, though it’s not common even among people with previous migraines. Other types of auras may occur, too. These include vision loss, a pins-and-needles sensation in the arms and legs, and speech or language problems.
  • Prodrome: A day or two before a migraine occurs, your body may begin giving you warning signs. These subtle changes include constipation, diarrhea, feelings of irritability or depression, neck stiffness, and hyperactivity. These symptoms typically do not occur before a tension headache.
  • Length of headache: A migraine headache may develop and worsen over a period of several hours or days. A tension headache often develops and resolves much more quickly, typically within a day.
  • Triggers: Stress, fatigue, and sleep deprivation are the most common triggers for a tension headache, but people who suffer from migraines report a variety of triggers. The most common ones include bright lights (photophobia), loud noises (phonophobia), exposure to odors such as perfume or smoke, changes in sleep patterns, alcohol or caffeine consumption, and skipping meals.

Other types of headaches

A cluster headache is an intense headache with one to three painful episodes, or clusters, each day. Patients who have cluster headaches report the pain to be severe and searing, with the center of the pain typically located behind one eye. People with cluster headaches also may experience red, teary eyes, something that is not common in migraines or tension headaches. This type of headache is more common in men than women.

A sinus headache is not actually a headache but is instead a painful response to nasal congestion or runny nose. When the sinuses are inflamed or irritated, you may experience pain across your forehead and cheeks. This pressure may feel like a headache and cause symptoms of a headache.