Headache vs migraine: What's the difference and when should you worry?

You've probably said it before: "I have a migraine." But did you actually? The difference between a headache and a migraine is something most people overlook, and the words get used all the time interchangeably.

Misidentifying what you have can mean reaching for the wrong treatment or missing a warning sign that deserves a doctor's attention. If you've ever wondered if my headache is actually a migraine, or found yourself Googling migraine symptoms at midnight, here's what you actually need to know.

What's actually causing your headache?

A headache is pain or pressure in the head or neck, and the causes are more varied than most people realise. Tension headaches bring dull, pressure-like pain on both sides of the head. Sinus headaches cause pain around the face and forehead due to congestion.

But a significant number of recurring headaches are linked to your eyes. "The most common eye-related cause of headache all around the world is HARE — Headaches Associated with Refractive Errors, which include short-sightedness, long-sightedness, and astigmatism," says Dr Anuneet Sinha, Consultant Eye Surgeon based in Delhi NCR. "If these are uncorrected, they lead to headaches."

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Then there's the modern culprit. "Too much near vision — what we see nowadays is Computer Vision Syndrome. That causes the muscles to overstress, the nerves to overstimulate, and that itself leads to headaches. It has become very common after COVID." If your headaches cluster around long screen days, this might be your answer.

What makes a migraine different?

A migraine is a neurological disorder — not just a bad headache. Dr Sinha puts it simply: "Migraine has different symptoms altogether," and identifying it is often a process of elimination. "Once you keep ruling out the other causes, then you go and think about migraine."

The pain itself behaves differently. Unlike a tension headache's dull, bilateral pressure, migraine pain typically throbs or pulses on one side of the head, is moderate to severe in intensity, and worsens with physical activity or sensory input like light, sound, or smell.

Migraines also come in stages. Before the headache hits, some people experience mood swings, fatigue, neck stiffness, or food cravings: this is called the prodrome phase. Some then experience an aura. "With aura, you get blinking lights or floaters within the eye," Dr Sinha explains, though he notes that "migraine comes even without the aura, where you don't get these blinking lights or associated symptoms." Only about 15–25% of migraine sufferers experience auras.

What makes migraine truly distinct is how much it brings along — nausea, vomiting, dizziness, and extreme sensitivity to light and sound are common. And it doesn't pass quickly. While a tension headache typically resolves in a few hours, a migraine can last anywhere from 4 to 72 hours.

Lifestyle changes that actually help

For migraines, prevention matters as much as treatment. Lifestyle plays a significant role — consistent sleep, stress management, and avoiding personal trigger factors can meaningfully reduce the frequency of attacks.

Common triggers include disrupted sleep, skipped meals, alcohol, bright or flickering lights, and hormonal changes. Keeping a headache diary for a few weeks is one of the simplest ways to identify your own pattern before it identifies you.

For screen-related headaches, the 20-20-20 rule helps — every 20 minutes, look at something 20 feet away for 20 seconds. And if you haven't had your eyes checked recently, that appointment might resolve things faster than any painkiller.

When to seek medical intervention

"Anything which is regularly happening, you should seek medical attention immediately," says Dr Sinha. The upside of getting checked is peace of mind: "Once you've visited a doctor, you can rule out that there's nothing serious going on."

Seek emergency care if your headache comes on suddenly and severely, follows a head injury, is accompanied by vision loss or confusion, or is simply the worst headache you've ever had. These can point to neurological causes that need immediate attention.

For everyday stress headaches or mild tension pain, rest, hydration, and a screen break are usually enough. But if it keeps coming back, stop guessing and see someone.