How to tell the difference between a headache and a migraine

There are really, really bad headaches and then there are migraines. As a lifelong migraine sufferer, I know a migraine is in my future because my body gives me advance warning in the form of a dull headache the day before and bouts of blurred vision, which are known as "aura."

According to Dr. Vernon Williams, a neurologist and director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine at Kerlan-Jobe Orthopaedic Clinic in Los Angeles, "Headaches and migraines are caused when the blood vessels, muscles, and nerves in the head are overstimulated. When these pain-sensitive structures become overactive, or when chemical activity in the brain is altered, we feel the uncomfortable sensations of a headache."

So, what differentiates a common headache from a migraine? There are some very specific things that make migraines … migraines. Additionally, if you think you may suffer from migraines, you can take this migraine quiz and then seek the opinion and advice of a professional.

​Regular headaches occur in multiple locations in the head

Let's start by talking about regular headaches, which are painful, uncomfortable, and interfere with the general enjoyment of life. They happen in multiple locations.

"Most headaches are found in the back, front, or top of the head," Dr. Mark Khorsandi of the Migraine Relief Center and a migraine surgeon based in Houston, told me. "It feels like a tightness and can limit your concentration."

Headaches are relieved by non-Rx medications

Dr. Khorsandi also explained that "regular" headaches "can range anywhere from 30 minutes to a few days, but diminish with help from over the-counter-medication." You can pop a few Tylenol and resume your day, going about your basic activities despite being in the throes of a headache, no matter the intensity.

​Headaches are usually relegated to the head

Dr. Williams acknowledged that basic headaches are noxious, telling me, "A headache is an unpleasant sensation in any region of the head or upper neck. It may appear as a dull ache, a throbbing feeling or a sharp pain, and intensities of the pain vary with whatever is causing it," he said. "Though most people associate a headache with pain in the brain, the actual pain felt is stemming from the tissues that surround the brain. A headache can be brief – lasting less than an hour – or linger for several days."

But here's the essential takeaway — regular headache pain is localized. There aren't additional symptoms in other parts of the body, as is the case with migraines.

​Migraines come with heightened sensitivities

Now that we've gone over the basics of regular headaches, let's go over what migraines are and what sets them apart.

"A migraine is clinically defined as a specific type of headache that is felt more intensely, and usually has accompanying symptoms in addition to the pain felt in the head," Dr. Williams explained. He lists common migraine symptoms as "pounding or throbbing pain that is moderate to severe and feels as if it is engulfing the entire head or shifting from one side of the head to the other," as well as heightened sensitivities to sound, odors, or light.

That's why migraines often have me lying in a dark, quiet room — it's an effort to quell my super acute senses.

​Migraines have triggers

Dr. Asher Goldstein, the CEO and founder of Genesis Pain Centers, told me that migraines almost always have triggers. "Generally, migraine headaches are differentiated by auras and triggers," he said. "A trigger is something specific that sets off a migraine."

Common triggers are stress, an adverse reaction to a food, hunger, and dehydration.

​Migraines have more specific locations

The eyes have it! As Dr. Khorsandi explained, "Migraines are usually located behind the eye." Indeed, my eyes almost always feel like ticking bombs during my worst migraines and I don't want to use my peepers for anything, hence why I prefer to curl up in a fetal position in both darkness and silence.

​Migraines are accompanied by visual disturbances

One of the key indicators of a migraine is the additional symptoms besides the debilitating pain, like visual disturbances also known as auras.

"Migraines can come with a variety of other symptoms including aura, vomiting, sensitivity to light and sound, and visual distortions," said Dr. Khorsandi. Dr. Williams further detailed the auras as "troubles including blurriness, bright/flashing dots, wavy or jagged lines." I am plagued by auras before the migraine arrives. It's the disturbance in the force, the calm before the storm, and serves a warning so I can attempt to deal with what's to come.

Sally Morgan, a holistic physical therapist and certified craniosacral therapist who also suffered from migraines, reminded me of another side effect of migraines that we don't think of often — bumps and bruises. She said, "Visual acuity lessens during migraine attacks and people report walking into a wall or knocking things over accidentally during a headache." Been there, done that.

​Migraine pain increases with duration

Unlike a typical headache in which the pain gradually decreases as time goes on, migraine pain increases during its duration.

"Migraine patients often describe the pain as throbbing and deep and can get worse as they try to go about their daily lives," said Dr. Khorsandi. "The cause of migraine is unknown, but 'triggers' such as food and fragrances can make them appear. They often last for several hours or days and require prescribed medication to relieve symptoms."

​Migraines are accompanied by nausea

Wade Cooper, a doctor of osteopathic medicine and director of Michigan Medicine's Headache and Neuropathic Pain Clinic, told me it's most likely a migraine if it's "severe, or has a throbbing sensation, along with light and sound sensitivity or nausea."

But Dr. Williams details the assortment of stomach issues associated with migraines, including "loss of appetite, nausea, vomiting, or an unsettled stomach." Clearly, migraines have way more additional symptoms and physical disruptions.

​Migraines are known for their throbbing quality

There is another headache called the "Occipital Neuritis," according to Dr. Michael E. Platt. "This headache comes from the occipital nerve sheath at the base of the skull," he told me. "It commonly shoots into the back of the eye, and can even cause a visual field defect. The headache is often excruciating and is always mistaken by doctors as being a migraine headache."

So what makes it different? Dr. Platt notes it is "a steady piercing pain, and not throbbing like a migraine headache."

​Sinus headaches are often misdiagnosed migraines

Dr. Cooper also notes that "most 'sinus headaches' that are bad enough to take you to a doctor's office are actually migraines. They just feel like a sinus headache because of where the pain is and how sick you feel."

So don't self-diagnose or misdiagnose your migraine as a sinus headache. The analysis is best left to a professional.

​Migraines do not respond to over-the-counter meds

For me, taking a Tylenol or Advil or Excedrin was akin to popping a placebo. It did nothing more than upset my stomach if I took multiple pills.

Dr. Murray Grossan noted that a migraine does not respond to Tylenol or Motrin but does respond to Imitrex or other tryptophans. I can attest that once I started taking prescribed Imitrex, my headaches would go away. Prior to Imitrex entering my life and my bloodstream, I had to wait it out for days at a time, leading to decreased productivity and lots of wasted time.

​Migraine sufferers usually have migraine history

Rada Jones, an emergency physician and a migraine sufferer for 27 years, notes that intensity is a factor — migraines start light and get worse. However, intensity is not the most important factor.

"The most relevant, however, is a history of migraines," Dr. Jones told me. "A recurring headache with a similar pattern and other symptoms, frequently familial, which usually starts at a young age and continues through middle age or later. People seldom start having migraines after 30." Instead, she noted that people will have bad headaches and call them migraines, when that's not the case.

​Migraines are a lifelong disease

Dr. Jones is also quick to explain that migraines are akin to chronic conditions that don't go away and that the sufferer must learn to adjust to and deal with them. "A migraine, like diabetes or arthritis, is a lifelong disease. One has it or one doesn't," she said.

Migraines are more than just headaches

Dr. Brian Grosberg, director of the Hartford Healthcare Headache Center and program director of the Headache and Facial Pain Fellowship in the Department of Neurology at the University of Connecticut School of Medicine, affirmed to me, "A migraine is more than just a headache."

How so? In very complex ways, that's how! "It is a neurological condition with a complex process that begins in the brain and produces many symptoms beyond headache," Dr. Grosberg stated. "People who have migraine are born with a nervous system that processes information differently than those who do not have migraine. Their brains are 'more excitable,' reacting to light and sound and other stimuli at a lower threshold than the brain of someone without migraine."

​Migraines can interrupt daily life

While an intense headache is annoying and disruptive, a migraine can interrupt the sufferer's daily life, incapacitating them and grinding their usual routines to a halt. "With migraine, sufferers may have difficulty performing their regular daily activities and typically prefer to rest in a dark and quiet area," said Dr. Grosberg.

"This is in contrast to the most common type of 'regular' headache that people experience which is tension-type headache. This type of headache can last from 30 minutes to one week and often affects both sides of the head in a 'band-like' distribution. The pain may be a pressure or ache, mild to moderate in intensity, and is not associated with light and sound sensitivity or nausea. With tension-type headache, people can often function during their daily activities."

Morgan furthered, "Many people with migraines cannot function during an episode whereas with other headaches, you can rally and get through your day."

You can deal with debilitating migraines

You can deal with migraines by knowing your triggers and managing them. As Williams reminded me, everyone's triggers are different, but the generalized triggers are as follows: change in stress, hunger and dehydration, lack of sleep, too much sleep, direct pressure to the head (via hats or helmets), rigorous physical activity, and diet (chocolate, alcohol, MSG, aged cheeses, processed meats, aspartame, high levels of caffeine) have been associated with migraines.

Also, keep a headache diary so that you and your doctor can monitor the symptoms, intensity, and what brings them on. Lastly, don't be afraid to seek professional help.

Know the different types of headaches, too

Noah Kubissa, a doctor of physical therapy, conducted research that looked at the differences between migraines and cervicogenic headaches, since he suffers from both. A cervicogenic headache "is posture or activity related and can be improved with modifications. The pain from these headaches usually is felt from the back of the neck radiating to the side of head, temple area, and even behind eye. Generally, there is a muscle or muscles from neck and shoulder causing this pain. Frequently, individuals with cervicogenic headaches also have some jaw related issues, limited opening/closing, grinding of teeth and clicking or popping in jaw."

So how does one differentiate between the two? The Flexion Rotation Test. You will need someone else to help you perform this test, per Dr. Kubissa. "Lie on your back, bend your neck so your chin is in contact or close to contact with chest. then rotate head to both sides," he said. "If greater than a 15-degree difference is noticed between both sides, then the headache is caused by limited neck range of motion. To find out the cause, you need to see a qualified medical professional. Frequently, such as in my case, there is both a cervicogenic and migraine component. Therefore, sometimes it is difficult to classify as one or the other."

Don't let headaches run your life. Combat them.