Migraine or headache? How to tell the difference and when to see a doctor.

The quick answer: A migraine is more than a bad headache. It often causes throbbing or one-sided pain plus nausea, light or sound sensitivity, or visual and sensory changes. A new, sudden or dramatically different headache needs prompt medical attention, especially with weakness, confusion, fever, stiff neck or vision loss.

A headache can make it hard to work, sleep or think clearly. But the word “headache” describes a symptom, not one single condition. Migraine is a neurologic disorder that can cause head pain along with symptoms elsewhere in the body—and some migraine attacks cause little or no head pain at all.

Looking at the full pattern can help. Where does it hurt? How quickly did it start? What else is happening? And is this similar to headaches you have had before? Those details are often more useful than pain intensity alone.

What does a typical tension-type headache feel like?

A tension-type headache often feels like pressure, tightness or a band around the head. The pain is commonly mild to moderate, may affect both sides and usually is not made substantially worse by routine activity. Stress, poor sleep, prolonged screen time and muscle tension can contribute.

What does a migraine feel like?

Migraine symptoms vary, but the pain is often moderate to severe, pulsating or throbbing, and may affect one side of the head. Movement can make it worse. Many people also need to retreat from light, sound or strong smells.

• Nausea or vomiting. Stomach symptoms are common during a migraine attack.

• Sensitivity to light or sound. Normal lighting, conversation or household noise may feel overwhelming.

• Aura. Some people see flashing lights or zigzag lines, develop blind spots, feel tingling or have temporary difficulty speaking before or during an attack.

• Brain fog and fatigue. Difficulty concentrating can begin before the pain and continue after it improves.

• Neck discomfort. Neck stiffness or pain can be part of migraine rather than a separate injury.

A quick comparison

When should you talk with a clinician?

Schedule an evaluation when headaches are new, are happening more often, interfere with normal life, wake you from sleep, require frequent pain medicine or no longer respond to your usual plan. A clinician can also help if you are not sure whether your symptoms fit migraine or another headache type.

When is a headache an emergency?

Get emergency help now for a headache that reaches maximum intensity within seconds or about a minute, follows a significant head injury, or occurs with fainting, confusion, seizure, weakness, numbness, trouble speaking, new vision loss, high fever, stiff neck, persistent vomiting or severe eye pain. Do not wait for a virtual visit.

How Hoag On-Demand can help

For a familiar migraine, a recurring headache without emergency warning signs or uncertainty about the next step, Hoag On-Demand offers 24/7 virtual urgent care from board-certified Hoag Nurse Practitioners. Your provider can review the timing and pattern of symptoms, discuss treatment options and determine whether you need in-person evaluation, imaging, a referral or follow-up care.

Because several conditions can resemble migraine, the goal of a virtual visit is not simply to label the pain. It is to assess your risk, help you feel better safely and connect you with the right level of care.

Frequently asked questions

Can a migraine happen without a headache?

Yes. Some people experience aura, dizziness, nausea, light sensitivity or other migraine symptoms with little or no head pain. New neurologic symptoms still need medical evaluation because other conditions can look similar.

Can sinus pressure actually be migraine?

Sometimes. Migraines can cause facial pressure, nasal congestion or watery eyes. A clinician can look at the full pattern, including fever, nasal discharge, allergy symptoms and migraine features.

Should I get imaging for every new headache?

No. Imaging is not needed for every headache, but it may be recommended when the history or examination suggests a secondary cause. A clinician can help decide what is appropriate.

Can Hoag On-Demand treat migraine at night or on weekends?

Hoag On-Demand is available 24 hours a day, seven days a week. Emergency warning signs require 911 or emergency department care instead.