People use "migraine" to mean any bad headache. Clinically it is a specific condition with defined features, and the distinction matters because the treatment is different. A tension headache responds to rest and a basic pain reliever. A migraine often does not, and reaching for the wrong treatment repeatedly is how people end up undertreated for years. This post translates the formal diagnostic criteria into plain language and gives you a validated three-question screen you can use today.
What makes a migraine a migraine
The International Classification of Headache Disorders, third edition (ICHD-3), is the standard neurologists use to define headache types. For migraine without aura, the diagnosis rests on a pattern of attacks meeting specific criteria (ICHD-3). In plain language, a migraine attack:
- Lasts 4 to 72 hours untreated. A headache that comes and goes in 20 minutes is not a migraine.
- Has at least two of these four pain features: it is one-sided, it throbs or pulses, it is moderate to severe, and it gets worse with routine activity like walking or climbing stairs.
- Comes with at least one of these: nausea or vomiting, or sensitivity to both light and sound.
You need a few of these attacks over time to make the diagnosis, not a single episode. The point of listing them is that migraine has a fingerprint. It is not just a headache that hurts more. It is a headache with a particular set of companions.
The companions are the tell
The feature that most reliably separates migraine from a tension headache is what comes with the pain.
A tension headache is usually a dull, pressing, both-sided ache, like a band around the head. It does not throb, it does not get dramatically worse when you move, and it does not bring nausea or send you looking for a dark quiet room.
A migraine does the opposite. The pain often throbs, often favors one side, gets worse when you move, and arrives with nausea or a powerful need to avoid light and sound. People with migraine frequently describe lying still in the dark because anything else is unbearable. That instinct to shut out the world is one of the most specific signals there is.
Aura, when it happens
Some people get aura, a set of neurological symptoms that usually precede the headache by 5 to 60 minutes. The classic aura is visual: shimmering zigzag lines, a blind spot that expands or flashing shapes. Aura can also involve tingling that marches up an arm, or trouble speaking. Aura resolves and is then typically followed by the headache.
Only a minority of people with migraine get aura, so its absence does not rule migraine out. Its presence, the gradual onset and full resolution of a visual or sensory disturbance, is a strong pointer toward migraine and away from a routine headache. Sudden, maximal neurological symptoms are a different matter and need urgent evaluation, not a migraine diagnosis at home.
The 3-question screen you can use
There is a validated three-question screen called ID Migraine, designed for exactly this question. In the validation study it asked whether, in the last three months, your headaches came with:
- Nausea or an upset stomach
- Sensitivity to light (much more than when you do not have a headache)
- Limitation of your ability to work, study, or do what you needed to do for at least one day
Answering yes to at least two of the three points strongly toward migraine. In the study this had a sensitivity of 0.81 and a specificity of 0.75, with a positive predictive value of 0.93 (Lipton et al., Neurology 2003). In plain terms, if you answer yes to two or three, the odds you have migraine are high.
This screen is not a diagnosis. It is a fast way to decide whether what you have is worth treating as migraine and worth raising with a clinician.
Why the distinction changes treatment
Getting this right matters because the medications diverge.
A tension headache usually responds to acetaminophen or an NSAID and rest. A migraine often does not respond well to those, and the drugs that do work, the triptans, are migraine-specific. They target the trigeminovascular pathway that drives migraine rather than just dulling pain. Someone treating monthly migraines with over-the-counter painkillers that barely touch them is both suffering unnecessarily and, if they take those painkillers often enough, risking medication-overuse headache on top of the original problem.
The label is not academic. It points you at the treatment that has a real chance of working.
When a headache needs urgent care, not a label
A few headache features mean stop classifying and seek care now: the worst headache of your life that peaks in seconds, a headache with fever and a stiff neck, a headache with new weakness, numbness, confusion or trouble speaking that is not a typical aura, a headache after a head injury, or a new headache pattern after age 50. These can signal something other than migraine and need evaluation rather than home treatment.
The bottom line
Migraine is a defined condition, not a synonym for a severe headache. It runs 4 to 72 hours, the pain often throbs and worsens with movement, and it arrives with nausea or with light and sound sensitivity. The ID Migraine three-question screen, nausea, light sensitivity and disability, sorts most cases quickly. Getting the label right is what gets you to the treatment that actually works.
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If your headaches fit the migraine pattern, a licensed clinician can confirm it and discuss treatment that targets migraine specifically. Start an online visit.
This article is for general education and is not a substitute for personalized medical advice from a licensed clinician.