The three most common headache types feel distinct. Migraine is usually a one-sided, throbbing, moderate-to-severe pain lasting 4 to 72 hours that gets worse with activity and comes with nausea or sensitivity to light and sound. Tension-type headache is usually a both-sided, pressing or tightening, mild-to-moderate band of pain that is not worsened by activity and has little or no nausea. Cluster headache is a severe, one-sided pain around the eye or temple lasting 15 to 180 minutes, striking in bouts, with tearing, a runny or blocked nostril, or a drooping eyelid on the same side and a sense of restlessness. Sorting out which one you have decides the treatment, and any sudden, worst-ever, or new-after-50 headache needs urgent evaluation first.
TL;DR: The three common headache types feel different and need different treatment. Migraine is a one-sided, throbbing, moderate-to-severe pain that lasts 4 to 72 hours, worsens with activity, and brings nausea or light and sound sensitivity. Tension-type headache is a both-sided, pressing, mild-to-moderate band of pressure that activity does not worsen, with little nausea. Cluster headache is a severe one-sided pain around the eye lasting 15 to 180 minutes, in bouts, with tearing, nasal congestion, or a drooping eyelid on the same side. Getting the type right decides the treatment, and any sudden, worst-ever, or brand-new headache after 50 needs urgent evaluation first.
Naming the headache is the part people skip, and it changes everything that follows. A migraine, a tension-type headache, and a cluster headache respond to different treatments, so the plan starts with figuring out which one you have. This page walks through how each one feels and how they are told apart.
Why does the type of headache matter?
Because the same word, headache, covers conditions with different biology and different answers. A treatment that helps a migraine may do nothing for a tension headache, and cluster headache has its own urgent playbook. Matching the treatment to the type is what separates relief from a cabinet full of things that did not work.
There is a second reason. A small number of headaches are warning signs of something serious, and knowing the usual patterns makes the unusual ones easier to spot.
What is a migraine?
Migraine is a recurrent headache disorder, defined by attacks that last 4 to 72 hours when untreated. The pain is often on one side, throbbing or pulsing, moderate to severe, and it gets worse when you move around, which is why people want to lie still in a dark room.
An attack usually comes with at least one of nausea or vomiting, sensitivity to light, and sensitivity to sound. Some people also get an aura beforehand, a wave of visual or sensory changes lasting minutes. The formal criteria ask for at least five attacks with this pattern before the label fits, which is part of why a careful history matters.
What is a tension-type headache?
Tension-type headache is the most common kind, and it feels different from migraine. The pain is usually on both sides, pressing or tightening rather than throbbing, like a band around the head, and mild to moderate rather than severe. Routine activity does not make it worse, so people generally keep functioning through it.
It also travels light on other symptoms. There is no nausea or vomiting, and at most one of light or sound sensitivity, rather than the fuller cluster of symptoms that comes with migraine. Episodes can last from half an hour to several days.
What is a cluster headache?
Cluster headache is less common and unmistakable once you have seen it. The pain is severe or very severe, strictly on one side, centered around or behind the eye, the brow, or the temple, and each attack lasts 15 to 180 minutes. As the name suggests, attacks come in clusters, from one every other day up to eight a day during a bout.
What sets it apart is the set of signs on the same side as the pain: a red or watering eye, a stuffy or running nostril, sweating on the forehead, a drooping or swollen eyelid, or a small pupil. Most people also feel restless and agitated during an attack, pacing rather than lying still, which is the opposite of the migraine instinct.
How do they compare side by side?
| Feature | Migraine | Tension-type | Cluster |
|---|---|---|---|
| Location | Often one side | Both sides, band-like | One side, around the eye |
| Quality | Throbbing, pulsing | Pressing, tightening | Severe, boring, piercing |
| Intensity | Moderate to severe | Mild to moderate | Severe to very severe |
| Duration | 4 to 72 hours | 30 min to 7 days | 15 to 180 minutes |
| Activity | Worse with movement | Not worsened | Restless, cannot sit still |
| Other symptoms | Nausea, light and sound sensitivity | Little to none | Tearing, nasal congestion, droopy eyelid on one side |
Headaches do not always read from a textbook, and some people have more than one type. That overlap is why the pattern over time, rather than a single bad day, is what leads to the right diagnosis.
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When should a headache be checked urgently?
Most headaches are not dangerous, but a few patterns deserve prompt medical attention rather than a wait-and-see approach. Seek care quickly if you have:
- A sudden, severe, worst-ever headache that peaks within seconds to a minute.
- A brand-new headache after age 50, or a clear change in your usual pattern.
- A headache with fever and a stiff neck, confusion, or a rash.
- Any new neurological sign, such as weakness, numbness, trouble speaking, or vision loss.
- A headache after a head injury, or one that steadily worsens over days to weeks.
- A headache that starts with exertion, coughing, or sex, or wakes you from sleep.
These do not mean something is certainly wrong, but they are the situations where a timely evaluation matters more than a home remedy.
How do we sort it out at Fishtown Medicine?
The diagnosis of a primary headache is clinical, which means it rests on a careful history rather than a scan in most cases. We map the pattern: how long attacks last, where and how the pain sits, what comes with it, what triggers and eases it, and how it has changed over time. We rule out the red flags and the medical mimics, and we order imaging only when the history points to a reason for it.
From there the plan follows the type. Migraine has a wide toolkit, including drug-free options like neuromodulation and evidence-based prevention, and treating early in the attack matters, which is why understanding the stages of a migraine helps. Tension-type headache often responds to addressing sleep, stress, posture, and jaw tension. Cluster headache needs its own specific acute and preventive approach, and prompt care.
Guidance from the Clinic
Key Takeaways
- Migraine is one-sided, throbbing, 4 to 72 hours, worse with activity, with nausea and light and sound sensitivity.
- Tension-type is both-sided, pressing, mild to moderate, not worsened by activity, with few other symptoms.
- Cluster is severe, one-sided, around the eye, 15 to 180 minutes, in bouts, with tearing or congestion and restlessness.
- The type decides the treatment, so the diagnosis is worth getting right before trying remedies.
- Some headaches are red flags. Sudden worst-ever, new after 50, or with neurological signs means urgent evaluation.
Scientific References
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211.
- Kandel SA, Mandiga P. Cluster Headache. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
- Lipton RB, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343-349.
Related at Fishtown Medicine
- The 4 Stages of a Migraine Attack - the warning phase and why treating early works
- Neuromodulation for Migraine - a drug-free option for migraine treatment and prevention
- Chronic vs. Episodic Migraine - when attacks become frequent, and how to reverse it
- Migraine in Women - the hormonal pattern behind many attacks
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