The Differences Detween Migraines and Headaches

The differences between headaches and migraines will depend on the type of headache being analyzed and the presence or absence of aura.

Written and verified by el biólogo Samuel Antonio Sánchez Amador.

Last update: 06 July, 2023

Headaches are one of the most common ailments in the general population. According to the Spanish Society of Neurology (SEN), 85 to 90% of people have at least one episode of headache every year and this is the main reason for outpatient consultation, representing between 19 and 32% of visits to the GP. Do you know the differences between migraines and headaches?

Although they seem interchangeable terms, in reality, migraines and headaches refer to clinical pictures that are a bit different. Migraines are acute, stabbing events with certain associated physical symptoms, while headaches are usually milder. If you want to know more about these conditions, keep reading.

Migraine and headache: Definitions and concepts

Before exploring the differences between the two terms, it’s important to define them and know the physiological mechanism that causes them. We’ll tell you about the particularities of each of them in the following lines.

What are headaches?

Headaches are one of the most common clinical events in the world. This term refers to pain and discomfort located in any part of the head, including the cranial cavity, the structures that connect the skull with the trunk and muscles.

Interestingly, as indicated by the StatPearls portal , the brain parenchyma doesn’t have nociceptors (cells responsible for perceiving pain). Therefore, headaches are the result of the sensation of pain in structures attached to the brain mass, such as blood vessels, meninges, muscle fibers, facial structures, and cranial or spinal nerves.

Stretching, dilation, constriction, or any stimulation of the nociceptors within these structures can cause the perception of a headache. In any case, the pathological mechanisms that explain the sensation experienced during a headache haven’t been fully elucidated, despite the multiple studies carried out.

What are migraines?

The Navarra University Clinic (CUN) defines migraines as “a type of vascular headache characterized by throbbing hemicranial pain, nausea, photophobia, and occasional vomiting.” As we’ll see below, the differences between migraines and headaches aren’t as numerous as might initially be thought, as indeed, migraines are a type of primary headache.

Initially, migraines were believed to arise from vasodilation and vasoconstriction of the blood vessels supplying the brain. Today, the vascular nature of migraines is in question, as it’s believed that certain neuronal failures are what actually cause intra- and extracranial symptoms.

According to the neurogenic theory, patients with migraines present hyperexcitability in the occipital cerebral cortex. This dysfunctionality would be the cause that, in the face of certain stimuli, propagated cortical depressions occur (triggers of the aura phenomenon). Through different chemical mediators, the trigeminal nerve would subsequently be activated, causing pain.

The differences between migraines and headaches

Not only clinics agree that migraines are a type of headache. In fact, the World Health Organization (WHO) itself defines them as “a primary headache, which usually appears at puberty and affects, above all, people between 35 and 45 years of age.” Talking about the differences between migraine and headaches is possible, but always bear in mind that one is included in the other.

Next, we’ll show you some of the distinctions between both clinical terms, with special emphasis on their typology, epidemiology, and treatments. Keep reading.

Different types

“Headaches” are anything that can be identified as pain in any part of the head. Migraines are a variant within this large group, but there are others (tension headaches, cluster headaches, and rebound headaches, for example). Broadly speaking, all headaches can be categorized into the following groupings:

• Primary headaches: These include migraines, tension headaches, cluster headaches, chronic daily headaches, and trigeminal nerve neuralgia. Primary variants account for 95% of headaches.
• Secondary headaches: These account for 5% of all headaches and generally encompass the most feared variants. These headaches are of rapid onset and have a clear cause, such as bleeding, heart attacks, tumors, brain infections, or the use of certain medications.

Below, we’ll explore some of the headache variants in more depth, including the typology of migraines as well.

Tension headaches

As indicated by the United States National Library of Medicine, this is the most common type of headache in the world, as its episodic variant occurs in 80% of the population at least once. Tension headaches occur when the muscles of the face, neck, and scalp become tight or contract.

This abnormal activity in the muscles of the head region can be due to stress, depression, head trauma, or anxiety disorders. There are several types of tension headaches:

1. Uncommon episodic tension headache.
2. Frequent episodic tension headache.
3. Probable tension headache.
4. Chronic tension headache. This last variant affects only 3% of the general population.

Cluster headache

Cluster headaches occur in cyclical periods and are one of the most painful subtypes within this large group. Flare-up periods can last from weeks to months, and come in the form of excruciating pain located in, behind, or around one eye. It can radiate to one side of the face, head, and neck.

The causes of cluster headaches are unknown, but as the Mayo Clinic indicates, abnormalities in the biological clock and the hypothalamic axis appear to be involved. In these cases, there are no specific triggers, such as muscle tension in a tension headache. Symptoms appear in flare-ups at the same time every day and last from 15 minutes to 3 hours.

Sinus headache

Sinus headaches are associated with inflammation, congestion, or infection of the sinuses. They’re linked to periods of sinusitis, which are, in turn, generally caused by allergic or viral processes in the upper airways. A runny nose, loss of smell, and the feeling of a “stuffy head” are common symptoms of this type of headache.

Migraine

We’ve explored some of the primary headaches, and as we’ve said, migraines are another one. Although the causes of this type of headache haven’t yet been fully elucidated, we know of certain factors that predispose a person to suffer from them, such as hormonal changes, stress, sensory stimuli, changes in sleep, and certain physical factors.

In turn, migraines can be divided into several categories:

1. Migraine without aura: This is a headache attack lasting from 4 to 72 hours, typically unilateral and throbbing in nature, with moderate/severe intensity. It’s associated with a rejection of light (photophobia) and loud noises (phonophobia). In addition, it worsens with physical exercise.
2. Migraine with aura: Consists of reversible attacks that last a few minutes, with very characteristic symptoms. Known as a classic migraine, this variant presents visual and sensory alterations of the aura type, such as flashes of light, blind spots, and other changes in vision, or tingling in the hand or face.
3. Chronic migraine: The variant without aura lasts up to 72 hours, while the variant with aura doesn’t usually last for more than 60 minutes. At the same time, chronic migraines last 15 or more days in a month for more than 3 months and have migraine characteristics on at least 8 or more days in a month.

In summary, there are many types of primary headaches, including migraines. In turn, migraines are differentiated into 3 pathological variants, depending on the duration of the condition and the symptoms presented.

Different epidemiological figures

The global prevalence of headaches in adults is approximately 50%, at least once every year. Between half and 3/4 of the population between the ages of 18 and 65 has suffered a headache in the last 12 months regardless of the interval analyzed. Of all people with headaches, 30% have migraines.

Tension headaches are much more common than migraines. As indicated by documents from the Global Year Against Headache, the probability of presenting this type of headache throughout life is 52%, however, the prevalence of migraines in the same interval is 18%.

With these data, we want to emphasize that the majority of headaches are tension-type, and not the migraine type. For this reason, the typical “headaches” experienced by the general population tend to be caused by muscle contraction, stress, and anxiety. Migraines are less common and more alarming, especially if they present with an aura.

Differences between migraines and headaches: The treatment isn’t the same

From now on, we’re going to assume that most readers refer to tension headaches when talking about headaches, as, for example, sinus pain should be treated very differently from other types of variants within this group. In general, tension headaches are treated using the following approaches:

• Pain relievers: Aspirin, ibuprofen, and naproxen are some of the most commonly used pain relievers to treat headaches in patients with tension headaches.
• Combination medications: For example, acetaminophen can be combined with caffeine or sedatives in a single drug to gain some effectiveness in symptomatic relief.
• Tricyclic antidepressants: As we’ve said, tension pain comes from muscle contractions and tensions, generally derived from emotional states such as depression and anxiety.

Treatment for tension headaches is fairly generic. On the other hand, migraines can be tackled with other more specific medications. Some of them are the following:

• Triptans: Quickly and simply put, these medications block pain pathways in the brain. They’re taken in pill form, but they also come in injectable forms and as nasal sprays. They’re very useful to alleviate the symptoms of migraines, but their use isn’t recommended in people with cardiovascular problems.
• Dihydroergotamines: Their action as a vasoconstrictor can be useful to eliminate migraine attacks.
• Lasmiditan: Lasmiditan is a novel drug that belongs to the class of so-called “selective serotonin receptor agonists.” It greatly improves symptoms such as pain, photophobia, nausea, and phonophobia. It’s indicated in migraines with or without aura.

Therefore, another of the differences between migraines and headaches is that the treatment will vary according to each type. Tension headaches are usually treated with generic drugs, while migraines, due to their aggressive symptomaticity, require more specific drugs.

Are there really so many differences between headaches and migraines?

Sometimes we use medical terms interchangeably without knowing what they mean at all. “Headaches” and “migraines” aren’t interchangeable, as migraines are a type of headache, but not all headaches have the symptoms of migraines. For example, a sinus and tension headache has little to do with the photophobia, nausea, and dizziness of a migraine with aura.

Although all the above may seem a bit complex, if there’s one idea we want to you retain from this article, it’s that most headaches are tension headaches and consist of sustained and mild pain, due to muscle tension and contractures. On the other hand, migraines usually appear pulsatile, unilateral, and much more aggressive.

Although they seem like very different pictures, a cluster headache can be mistaken for a migraine without aura if you don’t have enough medical knowledge. Therefore, in the face of any abnormality of this type, the best thing you can do is go to the doctor. Only a professional can make the relevant diagnosis and prescribe the appropriate medications.