Headache or Migraine? How to Tell the Difference and Why It Matters for Women

Headaches are extremely common, but not every headache is a migraine.

The two terms are sometimes used interchangeably, particularly when head pain is severe, but migraine is a neurological condition that can involve considerably more than pain alone. Understanding the difference can help people recognise potential triggers, choose appropriate treatment and know when a change in symptoms deserves medical attention.

For women in particular, hormones can add another layer of complexity. Migraine is more common in women than men and attacks can sometimes be influenced by the menstrual cycle, pregnancy, contraception and the hormonal changes surrounding menopause.

What is the difference between a headache and a migraine?

A headache describes pain felt somewhere in the head or face and can have many possible causes.

One of the most common forms is a tension type headache. This often produces a pressing or tightening sensation on both sides of the head and may feel as though something is being wrapped tightly around it. The pain is generally mild to moderate and everyday physical activity does not usually make it significantly worse.

Migraine is different.

A migraine attack commonly causes moderate to severe throbbing or pulsating pain, often on one side of the head, although it can affect both sides. Movement may make the pain worse.

People may also experience nausea, vomiting and marked sensitivity to light or sound. An untreated migraine attack can last anywhere from several hours to several days.

These additional symptoms are often what distinguish migraine from an ordinary headache.

Migraine does not always begin with the headache

Another important difference is that migraine can involve symptoms before, during and after the period of head pain.

Some people notice early signs several hours or even a day or two before the headache develops. These can include unusual tiredness, yawning, changes in mood, food cravings, thirst or stiffness in the neck.

Some people also experience migraine with aura.

Aura usually develops shortly before the headache and can involve visual changes such as flashing lights, blind spots or zigzag patterns. Others experience tingling, numbness, dizziness or difficulty speaking.

Aura symptoms usually develop gradually and should generally resolve within an hour.

Not everyone with migraine experiences aura and somebody can have different types of migraine attack at different times.

Why are migraines particularly relevant to women?

Women are more likely to experience migraine than men, and reproductive hormones appear to be one reason for this difference.

Oestrogen levels naturally rise and fall throughout the menstrual cycle. In some women who are susceptible to migraine, the fall in oestrogen that occurs shortly before menstruation appears to contribute to attacks.

This is why some women notice that migraine follows a predictable monthly pattern.

Migraine attacks occurring just before or around the beginning of a period are often referred to as menstrual migraine. NHS guidance notes that these attacks can be longer and more severe than migraine occurring at other times.

Keeping a migraine diary can be particularly helpful if there appears to be a hormonal pattern.

Recording when attacks happen alongside periods, sleep, food, caffeine, stress and medication can make it much easier to identify whether menstruation is genuinely associated with symptoms.

Hormones are not the only trigger

Although hormones can influence migraine, it is important not to blame every attack on the menstrual cycle.

Migraine triggers vary substantially between individuals.

Commonly reported triggers include stress, tiredness, disrupted sleep, missing meals, dehydration, excessive caffeine and alcohol.

Sometimes several triggers occur together.

For example, a particularly stressful week may lead to less sleep, more coffee and irregular meals. The resulting attack may therefore have several contributing factors rather than one obvious cause.

This is another reason a headache diary can be useful. Instead of trying to avoid every food or activity ever associated with migraine, it can help identify patterns that are genuinely relevant to the individual.

Hormonal contraception deserves particular attention

Headaches are commonly reported by people using hormonal contraception, although this does not necessarily mean the contraception itself is responsible in every case.

Migraine with aura is more important clinically.

Women who experience migraine with aura are not usually advised to use combined hormonal contraception containing oestrogen, such as the combined contraceptive pill, patch or vaginal ring. This is because migraine with aura and oestrogen containing contraception are both associated with an increased risk of ischaemic stroke.

Someone who develops migraine with aura for the first time while using combined hormonal contraception should therefore seek advice from a healthcare professional rather than continuing without review.

Other contraceptive options may be more appropriate depending on individual circumstances.

What about headaches during pregnancy?

Headaches can occur during pregnancy and migraine sometimes changes during this period. Some women find their migraine attacks improve, while others continue to experience them.

However, new or severe headaches during pregnancy should not automatically be assumed to be migraine.

A severe headache later in pregnancy can be one of the symptoms of pre-eclampsia, particularly when accompanied by problems such as visual disturbances, pain below the ribs, vomiting or sudden swelling.

A new, severe or unusual headache during pregnancy therefore deserves appropriate medical assessment.

Medication choices can also change during pregnancy, so someone who normally treats migraine with prescription or pharmacy medicines should check that their treatment remains appropriate.

How are migraine attacks treated?

Treatment depends on the individual, the frequency and severity of attacks and any other medical conditions.

Some people find that appropriate pain relief taken early in an attack is sufficient. When ordinary painkillers are not effective, migraine-specific medicines called triptans may be considered.

One example is sumatriptan tablets, which are used to treat a migraine attack after it has begun. It is not intended to prevent future migraine attacks.

Sumatriptan acts on serotonin receptors involved in migraine and can help relieve the headache as well as associated symptoms such as nausea and sensitivity to light and sound.

It is not suitable for everyone, particularly some people with cardiovascular conditions, so appropriate clinical assessment is important.

Ana Carolina Goncalves, Superintendent Pharmacist at Pharmica online pharmacy, explains:

“One of the most useful things someone with recurring headaches can do is pay attention to the pattern rather than focusing only on how painful an individual headache feels. Migraine often comes with other features such as nausea, sensitivity to light or sound and, in some people, aura. For women, recording where attacks fall within the menstrual cycle can also help identify whether hormonal changes may be contributing and gives a healthcare professional much more useful information when considering treatment.”

Taking too much headache medicine can cause another problem

When headaches occur frequently, it can be tempting to repeatedly take painkillers or migraine medicines.

However, using acute headache treatments too frequently can contribute to medication overuse headache.

This can create a difficult cycle in which medication is being taken for increasingly frequent headaches while excessive use of the medicine itself may be helping maintain the problem.

The NHS advises people with migraine not to take painkillers on more than two days each week without seeking medical advice.

Anyone who regularly needs treatment several times a week should therefore discuss their headache pattern with a healthcare professional rather than simply increasing medication use.

When should a headache be taken more seriously?

Most headaches are not caused by a serious underlying condition, but certain symptoms need urgent assessment.

A headache that suddenly reaches extreme intensity, sometimes described as a thunderclap headache, requires emergency medical attention.

Urgent help is also appropriate when severe headache occurs alongside symptoms such as weakness on one side of the body, confusion, difficulty speaking, loss of vision, seizures or significant drowsiness.

A new headache following a serious head injury also requires assessment.

Women should take particular care with headaches during pregnancy or shortly after giving birth, especially if the headache is severe, unusual or accompanied by visual changes or other concerning symptoms.

Less urgent but persistent changes also matter. Headaches that are becoming progressively more frequent, lasting longer than usual or behaving differently from a person's established migraine pattern are worth discussing with a doctor.

Focus on the pattern, not simply the pain

The difference between headache and migraine is not simply that migraine hurts more.

Migraine is a neurological condition involving a characteristic collection of symptoms, while headaches can occur for many different reasons.

For women, hormonal fluctuations can influence how and when migraine attacks occur, particularly around menstruation, but hormones should not automatically be blamed for every recurring headache.

Keeping a record of symptoms, recognising associated features and seeking advice when the pattern changes can make migraine much easier to understand and manage.

Most importantly, a person who regularly experiences headaches does not have to simply tolerate them. Establishing what type of headache is occurring is often the first step towards finding an appropriate way to manage it.