Migraine vs. Headache: How to Tell the Difference and When to Get Help
A neurologist and headache specialist explains how migraine is different from other headaches and when to consider medication.
Light and sound sensitivity, brain fog, nausea, dizziness — the symptoms of a migraine attack can interrupt daily life and make it hard to function.
Migraine is a neurological disorder that affects over 40 million people in the U.S. and over one billion people worldwide. While a headache is a common symptom, migraine is associated with a range of non-pain symptoms, which include vision changes, sensory sensitivity and vomiting.
“Migraine is more than ‘just a headache,’” says Dr. Moises Dominguez, a neurologist and headache specialist at NewYork-Presbyterian/Weill Cornell Medical Center and director of the headache medicine fellowship program at Weill Cornell Medicine. “Some patients who have migraine with aura can even experience symptoms that may mimic a stroke. The good news is that effective treatment options exist.”
Health Matters spoke with Dr. Dominguez about how to spot the signs of migraine, understand possible triggers, and how to find relief.
What is the difference between migraine vs. a headache?
Dr. Dominguez: The term headache describes a symptom: pain anywhere in the head.
Migraine, by contrast, is a neurological disorder. So, a headache is the symptom, and migraine is one condition that can cause it.
People describe migraine pain as an intense and throbbing headache that lasts for hours or days.
What are the symptoms of migraine?
Dr. Dominguez: Migraine exists on a spectrum, and no two people’s migraine attacks are exactly alike.
A migraine attack typically involves a headache with at least two of these four pain characteristics:
- One-sided
- Throbbing
- Moderate to severe pain intensity
- Pain that worsens with activity
Along with the headache, an attack must include at least one of two associated features:
- Light and sound sensitivity
- Nausea or vomiting
An attack usually lasts four to 72 hours if untreated or undertreated.
What are the warning signs that a migraine is starting?
Dr. Dominguez: There are two phases that can signal the start of a migraine attack:
Prodrome: Some people will experience subtler symptoms before a migraine attack starts, such as:
- Excessive yawning
- Craving salty or sugary foods
- Neck stiffness
- Light sensitivity
- Fatigue
- Irritability
Aura: About 20% to 30% of people with migraine experience an aura — a temporary (5 minutes to one hour), reversible symptom that typically occurs before the headache phase of migraine. However, it is worth noting that an aura can occur at the same time the headache starts, or even in the absence of headache.
There are different types of aura, but the most common is visual aura, where people can experience a small blind spot that gradually grows and obscures their vision. For example, while reading, you might find text missing from the page. People may also see shimmering, sparkling lights that gradually expand and later fade.
Patients may also experience numbness on half of their body. Less commonly, some people develop speech problems, where they can’t find the words they want to say, or the words come out jumbled. Some even get hemiplegia, where half of their body becomes weak, making it difficult to move an arm or leg. Other aura types are significantly rare.
Hormones are one of the factors behind migraine's higher prevalence in women.
What causes a migraine attack?
Dr. Dominguez: The exact cause of migraine isn't fully understood, but genetics play an important role.
Migraine tends to run in families, and people with migraine appear to have a brain that is more sensitive to certain stimuli and more prone to attacks.
A trigger doesn't cause migraine; it simply sets off an attack in someone who is already predisposed. Triggers can stack, meaning several may need to line up before an attack develops.
Common triggers include:
- Stress (even excitement or relief after a stressful period)
- Weather changes
- Certain foods and beverages, like chocolate or alcohol
- Too much or too little caffeine
- Sleep pattern disruption
- Skipping meals
- Hormonal changes
I ask my patients to keep a diary and note what they think their triggers might be. Identifying patterns can help reduce a person's vulnerability to attacks through targeted lifestyle changes, such as dietary adjustments, improvements in sleep, or stress management.
Are migraine attacks associated with hormonal fluctuations?
Dr. Dominguez: Hormones are one of the factors behind migraine's higher prevalence in women — migraine attacks are three to four times more frequent in women than in men.
Many women with migraine notice that their attacks are linked to their menstrual cycle, often striking in the days just before or during their period. These menstrual-related attacks tend to last longer and may be harder to treat.
What kinds of medications can relieve migraine symptoms?
Dr. Dominguez: Migraine treatment generally has two components: acute therapy and prevention. Many patients benefit from both.
We don't currently have a cure for migraine, so the goal of the treatments is to relieve attacks when they occur and reduce how often they happen over time.
Acute, or as-needed, treatment is taken at the start of an attack to stop it and relieve symptoms. The key is to treat it as early as possible. Options include:
- Acetaminophen
- Ibuprofen
- Naproxen
- Caffeine combination medications
When those treatments aren't enough, there are migraine-specific prescription medications including triptans (the first drug class developed specifically for migraine), and gepants, a newer class of oral and nasal medications, which block the Calcitonin Gene-Related Peptide (CGRP) protein that plays an important role in migraine attacks.
A nasal spray or injectable medication often works faster than a pill because it bypasses the gut and is absorbed quickly. This can be especially useful when nausea makes it hard to keep a pill down.
I also consider preventive treatment for patients when attacks are frequent (four or more headache days a month), long-lasting, or significantly disabling, or when acute medications alone aren't providing enough relief.
Preventive treatment is taken regularly (daily, monthly, quarterly) to reduce severity and how often attacks happen. Traditionally used preventive treatments include antihypertensive, antidepressant and antiseizure medications. These remain useful, but we now have migraine-specific preventive treatments that target the CGRP protein.
What are the signs to seek medical attention?
Dr. Dominguez: If you’re having disabling, frequent or recurring attacks, such as four or more days a month, it’s worth seeing a healthcare provider. Once migraine is diagnosed, effective treatment can be implemented because having frequent attacks is a risk factor for developing more over time.
For some, migraine can become chronic, which is when headaches happen at least 15 days per month for more than three months, with migraine symptoms on at least half of those days.
There are also certain warning signs we call "red flags," which warrant prompt medical evaluation, as they may signal a more serious underlying cause. Red flags include:
- Sudden, explosive headache that peaks within seconds to minutes
- New or different headache symptoms you’ve never had before
- A headache that appears for the first time in someone over 50
- A headache accompanied by fever or a stiff neck also requires immediate medical attention to rule out a condition such as meningitis
The bottom line: if your headaches are becoming more frequent or persistent, or you’re developing new symptoms, reach out to your doctor.
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