Headache Types: How to Tell Them Apart

Written and medically reviewed by Tae Ho Guak, MD, board-certified neurologist · Reviewed July 2026 · Editorial policy

The phrase I hear most often in the clinic: “I thought I had migraines, but it turned out to be tension-type headaches.” The first step in treating headaches is accurate classification. Different types require different medications and management. Here I summarize the key differences between the 4 major headache types.

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1. Migraine

• Pain pattern: One or both sides, pulsating/throbbing
• Intensity: Moderate to severe, interferes with daily life
• Duration: 4–72 hours
• Associated symptoms: Nausea/vomiting, photophobia, phonophobia; aura in some
• Prevalence: ~17% of adults; 2–3× more common in women

2. Tension-Type Headache

• Pain pattern: Bilateral, pressing/tightening like a band around the head
• Intensity: Mild to moderate
• Duration: 30 minutes – 7 days
• Associated symptoms: Usually none — absence of nausea and photophobia is the key difference from migraine
• Triggers: Stress, posture, sleep deprivation

3. Cluster Headache

• Pain pattern: Around one eye, stabbing/piercing
• Intensity: Extremely severe (sometimes called the “suicide headache”)
• Duration: 15–180 minutes, 1–8 attacks per day
• Associated symptoms: Tearing, nasal congestion, eye redness, drooping eyelid
• Demographics: More common in men and smokers

4. Secondary Headache

Headache caused by another underlying condition (tumor, hemorrhage, inflammation). Less than 10% of all headaches, but can be life-threatening if missed. Go to the ER immediately if warning signs appear.

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Self-Check — What Type Is Your Headache?

ID Migraine™ 3-question test: ① Sensitivity to light ② Interference with daily activities ③ Nausea or vomiting — If 2 or more apply, migraine is likely. Confirm with a neurology consultation.

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