If your head pain is throbbing on one side along with nausea, light or sound sensitivity, or a visual aura, you are more likely dealing with a migraine than a routine headache. ICHD-3 sets the diagnostic benchmarks the American Migraine Foundation uses to guide patients, and our healthcare team relies on the same criteria. A sudden, worst-ever headache or new neurological symptoms need urgent attention right away.
TL;DR:
- Migraines typically last several hours to days, are one-sided, pulse, and often accompanied by nausea, sensitivity to light or sound, unlike tension headaches.
- True sinus headaches usually involve facial pressure and congestion without the specific migraine features, often mistaken for migraines.
- Using acute medications more than 10 to 15 days per month for over three months increases the risk of medication-overuse headaches that turn episodic migraines into daily cycles.
- Early treatment with triptans or alternative medications is most effective when migraine symptoms are recognized promptly, ideally during initial warning signs.
- Keeping a headache diary for two to four weeks helps identify patterns, triggers, and whether attacks meet migraine diagnostic criteria, guiding effective management.
Table of Contents
- Key symptom differences between migraine and other headaches
- Common headache types: tension, cluster, sinus, and more
- Diagnosis and red flags: when to seek urgent care
- Treatment overview: acute relief, prevention, and overuse risk
- Triggers and prevention: reducing frequency and severity
- How to track headaches and what to bring to an appointment
- Our perspective on assessment and care
- How we can help you get answers
- FAQ
- Sources
Key symptom differences between migraine and other headaches
Migraine pain tends to show up on one side of the head, pulses or throbs, and ranges from moderate to severe. It usually gets worse with movement, and it often brings nausea, vomiting, or sensitivity to light and sound. About a quarter of people with migraine also experience aura, which can include visual disturbances like flashing lights or zigzag lines before the headache even starts.
Tension-type headaches feel different. They usually produce a dull, pressing sensation on both sides of the head, without nausea, and they rarely stop you from going about your day. Sinus headaches, meanwhile, are often confused with migraine because both can cause facial pressure and congestion.
- Migraine: one-sided, pulsing, moderate to severe, worsened by activity, often with nausea or light sensitivity
- Tension-type: both sides, dull or pressing, mild to moderate, rarely disabling
- Sinus-related: facial pressure, congestion, often mistaken for migraine when true sinus infection is absent
According to ICHD-3 criteria, a typical untreated migraine attack lasts several hours to a few days, which is far longer than most tension headaches. One practical clue: if a migraine-specific medication resolves the pain and a general pain reliever does not, that response itself points toward migraine.
Common headache types: tension, cluster, sinus, and more
Headaches fall into two broad categories. Primary headaches, like migraine and tension-type, are conditions in their own right. Secondary headaches are symptoms of something else, such as an infection or injury.
- Tension-type headache. The most common type, marked by a steady, band-like tightness and usually tied to stress, poor posture, or fatigue.
- Cluster headache. Rare but severe, with sharp pain around one eye, tearing, nasal congestion, and attacks that cluster in groups over weeks.
- Sinus headache. Often mistaken for migraine; true rhinosinusitis usually comes with fever, thick nasal discharge, and tenderness over the sinuses rather than classic migraine features.
- Cervicogenic headache. Originates in the neck and radiates upward, frequently tied to posture or old injury; physical therapy approaches like those described in cervicogenic headache rehabilitation can help when neck mechanics are the root cause.
- Medication-overuse headache. Develops when acute headache medications are used too often, turning occasional headaches into a near-daily problem.
Diagnosis and red flags: when to seek urgent care
Diagnosing migraine starts with your history: how long attacks last, what symptoms accompany them, and how often they occur. ICHD-3 requires at least five attacks with typical migraine features, including duration and specific symptoms, before a migraine diagnosis is confirmed. Imaging is not usually needed for typical migraine, but it becomes important when something doesn't fit the pattern.
Certain symptoms always deserve urgent evaluation:
- A thunderclap headache that peaks within one minute
- New weakness, numbness, confusion, or trouble speaking
- Headache with fever or stiff neck
- Headache following a head injury
- A brand-new headache pattern after age 50
- Pain that steadily worsens over days rather than resolving
Pro Tip: If your headache feels completely different from your usual pattern, treat that change itself as a reason to get checked, even if the pain level seems familiar.
Our guide to recognizing symptoms you shouldn't ignore walks through sudden warning signs in more depth. For guidance on choosing between the emergency room and urgent care, our comparison of urgent care versus primary care can help you pick the right setting for a worsening but familiar migraine versus a true emergency.
Treatment overview: acute relief, prevention, and overuse risk
Acute migraine treatment works in tiers. Over-the-counter options like NSAIDs and acetaminophen handle milder attacks. Triptans are the go-to prescription option for moderate to severe migraine, while newer gepants and ditans offer alternatives for people who cannot take triptans. Antiemetics address the nausea that often comes along for the ride, and dihydroergotamine (DHE) is reserved for harder-to-treat cases.
- Oral tablets: convenient first choice when nausea is mild
- Nasal sprays and orally disintegrating tablets: useful when swallowing pills is difficult
- Injectable or IV formulations: preferred when vomiting prevents oral absorption
Non-oral formulations are recommended for patients with significant nausea or vomiting, since they bypass the gut and reach the bloodstream faster. Treating a migraine as early as possible, ideally during the earliest warning signs, consistently improves how well acute medication works.
For people with frequent or disabling attacks, preventive therapy shifts the goal from treating individual attacks to reducing how often they happen. Common options include beta-blockers, certain anticonvulsants, and newer CGRP-targeted medications designed specifically for migraine prevention.
One risk worth understanding clearly: medication-overuse headache develops when acute medications are used on 10 to 15 or more days per month for over three months, depending on the drug class, and it can turn occasional migraines into a daily headache cycle. Breaking that cycle typically requires a supervised withdrawal plan paired with a preventive strategy, rather than simply stopping cold.
Triggers and prevention: reducing frequency and severity
Migraine triggers vary from person to person, but common ones include irregular sleep, dehydration, skipped meals, stress, hormonal shifts, certain foods, and sudden weather changes. Keeping a simple log helps you spot your own patterns rather than guessing.
- Keep sleep and wake times consistent, even on weekends
- Stay hydrated and eat on a regular schedule
- Reduce caffeine gradually rather than stopping abruptly
- Build in stress management, even short daily breaks
Pro Tip: Cutting caffeine too quickly can trigger a withdrawal headache, so taper over one to two weeks instead of stopping all at once.
When lifestyle steps and medication aren't enough, behavioral approaches like cognitive behavioral therapy or biofeedback can work alongside preventive treatment, particularly for people whose attacks are tied closely to stress.
How to track headaches and what to bring to an appointment
A headache diary helps you and your clinician spot patterns in timing, symptoms, and triggers, which makes diagnosis and treatment planning far more precise. Track these details for each attack:
- Date, start time, and how long it lasted
- Pain location, quality, and intensity
- Associated symptoms like nausea or light sensitivity
- Possible triggers from the hours before onset
- Medication taken, timing, and how well it worked
- Impact on your work, sleep, or daily activities
Two to four weeks of tracking usually reveals a pattern. Bring the diary to your appointment and ask directly whether your symptoms meet migraine criteria or whether a referral to a headache specialist makes sense.
Our perspective on assessment and care
Headache evaluation begins with a thorough history, using diagnostics when something doesn't fit a typical pattern, and managing straightforward cases in primary care. When attacks are frequent, disabling, or resistant to standard treatment, referral to neurology may be appropriate. Keep a diary, treat early, and schedule a visit if red flags appear or headaches keep disrupting your life.
— Garden State Medical Group
How we can help you get answers
We offer primary care visits built around exactly this kind of evaluation: a detailed history, a physical exam, and a clear plan for acute and preventive treatment. When your pattern needs a closer look, our onsite radiology and diagnostic testing can rule out other causes without sending you elsewhere, and our chronic care management programs support ongoing headache management alongside other health needs.
- Schedule an in-person or telemedicine visit for a headache evaluation
- Ask about diagnostic imaging if your pattern includes red flags
- Enroll in chronic care management if attacks are frequent or disabling
If your headaches come with red flags, or keep interrupting your work and sleep, book a primary care appointment with us and let's get you a clear plan.
This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.
FAQ
How can you tell if it's a headache or migraine?
A migraine usually causes one-sided, throbbing pain along with nausea or sensitivity to light and sound, while a typical tension headache produces milder, pressing pain on both sides without those extra symptoms. ICHD-3 criteria require attacks lasting 4 to 72 hours with specific symptom combinations for a migraine diagnosis.
What are the 5 C's for migraines?
There is no single, universally recognized "5 C's" framework in migraine medicine, and definitions circulating online vary widely. Rather than rely on an informal list, it's more reliable to track your own symptoms, timing, and triggers and review them with a clinician using established diagnostic criteria.
What are the main causes of migraines?
Migraine results from a combination of genetic sensitivity and triggers such as poor sleep, dehydration, stress, hormonal changes, certain foods, and skipped meals. No single cause explains every case, which is why tracking your own patterns matters more than following a generic trigger list.
Can migraines cause headaches that feel like sinus pressure?
Yes, migraine commonly produces nasal congestion and facial pressure that mimics a sinus headache, which is one reason many sinus-labeled headaches turn out to be migraine once evaluated. Testing whether migraine-specific treatment resolves the pain can help confirm which one you're dealing with.
Why do McDonald's fries and Coke help migraine?
This isn't a recognized medical treatment, and no clinical guidance supports it as a go-to remedy. The combination of salt and caffeine may offer mild, temporary relief for some people, but relying on it instead of appropriate medication or evaluation can mask a pattern that needs proper diagnosis.
Sources
- ICHD-3: migraine without aura
- Migraine in the emergency department: When to go to the ED for migraine | American Migraine Foundation
- Medication-overuse headache — review (NCBI Bookshelf)
- Managing migraines at home: MedlinePlus Medical Encyclopedia