Migraine vs Tension Headache: How to Tell the Difference (Australian Guide)

Migraine vs Tension Headache: The Short Answer

Tension-type headaches and migraines are the two most common kinds of headache in Australia, and they are easy to confuse because both cause head pain. But they are different conditions, and telling them apart helps you match the right self-care and know when something needs medical attention. This guide focuses on the differences between the two and what may help each. For a full run-through of every headache type and the OTC products available for them, see our companion guide on how to treat different types of headaches.

How to Tell Them Apart

There is no single test you can do at home, but four features do most of the work: where the pain sits, what it feels like, what comes with it, and how long it lasts.

Location: where the pain sits

A tension headache is usually felt on both sides at once — a tight band or pressure wrapping around the forehead, or a dull ache spreading from the back of the head and neck. A migraine is more often one-sided, although it can switch sides between attacks or spread across the whole head.

Quality: what the pain feels like

Tension headaches tend to be a steady, pressing or tightening ache — mild to moderate, and not usually made worse by walking around or climbing stairs. Migraines are more often throbbing or pulsating, moderate to severe, and tend to get worse with routine physical activity, which is why people having a migraine often want to lie still.

Associated symptoms: what comes with it

This is often the clearest signpost. Migraines frequently bring nausea or vomiting and a strong sensitivity to light and sound, so a dark, quiet room feels like relief. Some people also get an aura beforehand — visual changes such as flashing lights, zigzag lines or blind spots, or sometimes tingling or pins and needles — typically lasting 5 to 60 minutes before the headache. Tension headaches do not usually cause nausea, vomiting or aura, and any sensitivity to light or sound is mild at most.

Duration: how long each lasts

Tension headaches can last anywhere from about 30 minutes to several days. An untreated or under-treated migraine typically lasts from 4 to 72 hours, and the after-effects — feeling drained, washed out or foggy — can linger for another day.

Triggers: what tends to set each off

Tension headaches are often linked to stress, poor posture, long stretches at a screen, eye strain, tiredness, dehydration and tight neck or shoulder muscles. Migraine triggers vary a lot from person to person, but commonly reported ones include stress (or the let-down after stress), missed meals, dehydration, poor or changed sleep, hormonal changes around periods, bright or flickering lights, strong smells, alcohol — particularly red wine — and, for some people, certain foods. Keeping a simple headache diary can help you spot your own pattern.

Tension Headache vs Migraine: Side-by-Side

Matching Self-Care to Each Type

Naming the headache type points you towards the right first steps. The detail below is general information, not a personal recommendation — for which medicine suits you, ask your pharmacist.

For a tension headache

Simple analgesics are the usual starting point. Paracetamol or ibuprofen, taken at the first sign rather than after the pain has settled in, may help ease the symptoms of a tension headache. Alongside medicine, the non-drug steps often matter just as much: taking a screen break, correcting your posture, gently stretching the neck and shoulders, applying heat to tight muscles, drinking water and easing stress where you can.

• radio_button_uncheckedTry paracetamol or ibuprofen early, at the recommended dose on the label
• radio_button_uncheckedTake regular breaks from screens and check your posture
• radio_button_uncheckedApply a warm pack to tight neck and shoulder muscles
• radio_button_uncheckedStretch the neck and shoulders gently
• radio_button_uncheckedStay hydrated and address stress and tiredness

For the differences between paracetamol and ibuprofen — including which one tends to suit which situation and who should be cautious with each — see our dedicated comparison. Combination products that add caffeine are also available; a pharmacist can talk you through whether one is appropriate for you.

For a migraine

Timing is the key difference. The same simple analgesics — paracetamol, ibuprofen or aspirin — may help a migraine, but they work best when taken early in the attack; waiting until the pain is severe tends to reduce how well they work. Soluble or rapid-acting forms are sometimes preferred because they are absorbed faster, which can matter if nausea has slowed your stomach. Resting in a dark, quiet room and sipping fluids can also bring relief.

• radio_button_uncheckedTake simple pain relief early, at the first sign of an attack
• radio_button_uncheckedRest in a dark, quiet room and limit screens
• radio_button_uncheckedSip water or an electrolyte drink if you can tolerate it
• radio_button_uncheckedA cool pack on the forehead or neck helps some people
• radio_button_uncheckedNote the trigger in a headache diary for next time

When over-the-counter options are not controlling your migraines, a GP can discuss prescription treatments. These include migraine-specific medicines called triptans, anti-nausea medicines, and — for frequent attacks — preventive options taken regularly to reduce how often migraines occur. Triptans are prescription-only in Australia and are not suitable for everyone, so they need a GP assessment.

When Pain Relief Becomes the Problem

There is a catch worth knowing about. Using pain-relief medicines too often can lead to a medication-overuse headache (sometimes called a rebound headache), where the very medicine you are taking starts to bring headaches on more often. It is one of the more common reasons an occasional headache turns into an almost-daily one.

Red Flags: When a Headache Needs a Doctor

Most tension headaches and migraines are not dangerous, but a small number of headaches signal something more serious. The features below are not part of an ordinary headache and need prompt medical assessment — when in doubt, seek care.

Call 000 for a sudden severe headache or any headache with stroke-like symptoms such as facial droop, arm weakness or trouble speaking. For headaches that are new, changing, frequent, or not responding to the usual measures, book in with your GP — even if none of the emergency signs above are present.

Frequently Asked Questions

How do I tell if it's a migraine or a tension headache?

Look at the location and the extras. A tension headache usually feels like pressure or a tight band across both sides of the head with no nausea or light sensitivity. A migraine is more often one-sided and throbbing, gets worse with movement, and brings nausea or sensitivity to light and sound — sometimes with a visual aura beforehand.

How long do tension headaches last?

A tension headache can last anywhere from about 30 minutes to several days. Most ease within a few hours, particularly if you address the trigger — such as stress, posture or dehydration — and rest. A migraine, by contrast, typically runs from 4 to 72 hours.

What are common migraine triggers?

Triggers vary from person to person, but commonly reported ones include stress (or the let-down afterwards), missed meals, dehydration, changes to sleep, hormonal changes around periods, bright or flickering lights, strong smells, alcohol — especially red wine — and certain foods. A headache diary is the simplest way to find your own pattern.

What is a medication-overuse headache?

It is a headache caused by taking pain-relief medicines too often. Using them on 10 or more days a month can set up a cycle where the medicine itself triggers more headaches. If you are using headache relief more than about twice a week regularly, speak with a pharmacist or GP about a better long-term plan rather than increasing the dose.

How is a cluster headache different from a migraine?

Cluster headaches are far less common and have a distinctive pattern: severe one-sided pain centred around one eye, often with a watering or red eye, a droopy eyelid or a blocked nostril on the same side, coming in bouts. Unlike a migraine, people with a cluster headache tend to be restless rather than wanting to lie still. Cluster headaches usually need medical assessment — see our headache types guide and talk to your GP.

When should I see a doctor for a headache?

See your GP if headaches are frequent (for example 15 or more days a month), getting worse, not responding to over-the-counter options, or you are relying on pain relief most days. Seek urgent care for any of the red flags above — a sudden 'thunderclap' headache, a headache with fever and stiff neck, headache with vision, speech or weakness changes, or a new severe headache after age 50.