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Medically reviewed by Dr. Charisse Litchman, MD, FAHS on August 18, 2020
Migraine headaches are usually on one side of your head (though which side it occurs on may vary from migraine to migraine), throbbing, and pretty painful. They are often associated with nausea and vomiting, dizziness, confusion, and sensitivity to light, smells or noise. Migraine headaches usually last 4 to 72 hours if left untreated, and when they do finally go away, you can feel tired and “hungover” for another day or two.
Sometimes migraines are accompanied by “auras” which vary from person to person. The most common symptoms of auras are seeing flashing lights or zig-zag lines, loss of part of your vision, difficulty speaking, vertigo (room spinning), and numbness and weakness of one side of the body. These auras generally last 5 minutes to an hour. Typically the headaches occur intermittently, and patients experience basically the same symptoms each time. These headaches occur more often in women and movement may make them worse.
Tension headaches are usually felt over both temples and are more of a pressure or tight feeling than throbbing. These headaches are uncomfortable but not debilitating and typically not be worsened by lights, sounds, or smells. Tension headaches do not cause nausea, vomiting or dizziness. Tension headaches can last from 30 minutes to a few days. These headaches occur more often in women.
Chronic Migraines are migraines that occur one to 15 days per month. At least 8 of those headaches will fit the description of migraines but the rest may seem more like tension headaches. Even so, all of these headaches are migraines.
Cluster Headaches differ from both migraines and tension headaches. These are among the most severe headaches. They are always one sided and the side is the same for every cluster headache. The pain is concentrated in the eye, above the eye or in the temple and it only lasts 15 minutes to three hours. On the same side as the headache people often experience a drooping eyelid, redness around the eye, tearing from the eye and/or a runny nose. You may feel restless and agitated during one of these headaches. These headaches “cluster”, occurring up to eight times a day for weeks to months. During a cluster, you will feel no symptoms or pain in between the headaches. You may have no clusters of headaches for weeks to months. These headaches are more common in men and often occur mostly at night.
Medication Overuse Headaches are caused by taking too many anti-inflammatories like ibuprofen (greater than 15 days per month), by too much caffeine intake (greater than 100 mg per day) found either in coffee, tea or some over-the-counter medications (like some Excedrin formulas), and by using narcotic painkillers more than 10 days per month. They can also be caused by taking medications prescribed to you to stop your migraines too frequently. These headaches occur over 15 days per month and can feel like either a migraine or a tension headache.
There are other primary headaches (which means they are not caused by an underlying medical illness) than those described above but they are much less common. Secondary headaches are those caused by an underlying medical illness, and your medical provider may suspect this based on the description of your headache and abnormalities on your examination. The features that may raise suspicion are tenderness over one of your temples along with painful chewing and muscle aches, symptoms that have come on rapidly (especially if associated with a fever and stiff neck), pain that starts suddenly and is at its worst in less than a minute, headaches that start after age 50, headaches that get worse by a change in position, worsening of a headache type you have suffered from for a long time, and history of concussion or head trauma within the last 3 months. If a secondary headache is suspected, you should seek an in-person visit with a health care provider.