Migraine: throbbing, often one-sided pain, worse with movement, lasting 4-72 hours, with nausea and light or sound sensitivity, sometimes an aura first. Tension headache: steady band-like pressure on both sides, not worsened by movement, and you can function through it.
The dark-quiet-room instinct is itself a migraine tell. Trigger patterns differ: migraines track cycles, sleep changes, skipped meals, and stress letdown; tension tracks stress, posture, and jaw clenching. The distinction pays: tension responds to plain pain relievers, while migraines often need triptans taken early, and 4-plus migraines a month earns preventive therapy. The shared trap: any acute pain reliever used more than 10 to 15 days a month becomes the cause via medication-overuse headache. Neither label covers the red flags: thunderclap onset, worst-of-life pain, fever with stiff neck, or new weakness or vision loss, which are emergencies. Headaches stealing 4-plus days a month is a doctor visit, not stoicism.
What to do
Common questions
Is it a migraine or a headache?
The split is character plus company. A tension-type headache, the ordinary kind, is a steady, band-like pressure or tightness on both sides of the head, mild to moderate, not worsened by moving around, and you can push through your day with it. A migraine is a different animal, per MedlinePlus: throbbing or pulsing pain, often (not always) one-sided, moderate to severe, made worse by routine movement like climbing stairs, lasting 4 to 72 hours untreated, and arriving with company: nausea or vomiting, and sensitivity to light and sound (the dark-quiet-room instinct is diagnostic in itself). Some migraines add an aura: 20 to 60 minutes of visual zigzags, blind spots, or tingling before the pain starts. Migraine also runs in triggers and patterns: menstrual cycles, sleep changes, skipped meals, certain foods, weather shifts, stress letdown (the Saturday migraine), while tension headaches track stress, posture, and jaw clenching more diffusely. Why the distinction matters: treatments differ. Tension headaches respond to plain acetaminophen or ibuprofen and lifestyle fixes; migraines often need triptans (prescription migraine-specific drugs that work best taken early in the attack) plus trigger management, and frequent migraines (4-plus a month) earn preventive therapy. The shared trap: using any acute pain reliever more than 10 to 15 days a month creates medication-overuse headache in both groups. And the red flags that are neither migraine nor tension: sudden thunderclap onset, worst-of-life pain, headache with fever and stiff neck, or new weakness or vision loss, which are emergency patterns covered elsewhere. If headaches are stealing 4-plus days a month, that is a doctor visit, not stoicism.