Key takeaways

  • A tension-type headache feels like a tight band of pressure on both sides of the head; a migraine is usually a throbbing pain on one side, often with nausea and light or sound sensitivity.
  • Migraine is a neurological disorder, not just a bad headache. The WHO ranks it among the leading causes of disability worldwide.
  • Women are 2-3 times more likely than men to have migraine, largely because of oestrogen changes across the menstrual cycle, pregnancy and menopause.
  • Triptans treat migraine but not tension headaches. Simple painkillers like paracetamol or ibuprofen help both, but are often not enough for migraine.
  • Using painkillers more than 10-15 days a month can trigger medication overuse headache, a paradoxical worsening that needs preventive treatment instead.
  • Sudden 'thunderclap' pain, headache with weakness, slurred speech or vision loss, a new severe headache in pregnancy, or any headache that feels different from your usual pattern needs urgent medical care.

What is a tension-type headache?

Tension-type headache (TTH) is the most common headache of all, affecting up to 70-80 percent of adults at some point in life. It is the everyday headache most people simply call "a headache".

A tension headache typically feels like a tight band or steady pressure around the head, a dull ache across the forehead and temples, or a heavy weight on top of the head. The defining features doctors look for are:

  • Pain on both sides of the head, not just one
  • A pressing or tightening quality, not throbbing
  • Mild to moderate intensity that lets you carry on with your day
  • Not made worse by routine activity like walking or climbing stairs
  • No nausea or vomiting, and at most only mild light or sound sensitivity

Attacks last anywhere from 30 minutes to a few days. When they happen fewer than 15 days a month it is called episodic TTH; 15 or more days a month for at least three months is chronic TTH.

The exact cause is not fully understood, but tightness and tenderness in the muscles of the head, neck and jaw, along with overly sensitive pain pathways, play a role. Common contributors are stress, poor sleep, long hours at a screen, eye strain, skipped meals, dehydration, caffeine withdrawal and slouched posture.

Most tension headaches ease with rest, water, and an over-the-counter painkiller such as paracetamol 500-1000mg (Crocin, Dolo, Calpol; around Rs 1-5 a tablet) or ibuprofen 400mg (Brufen, Combiflam; Rs 5-15 a tablet) taken early. Caffeine-containing combination tablets (Saridon, Anacin) are popular in India and do work, but should be used sparingly to avoid medication overuse headache. Fixing the triggers — better sleep, fewer screen breaks, regular meals and managing stress — matters just as much as the tablet.

Tension headaches almost never need a brain scan or specialist. They mainly need to be told apart from migraine, because migraine often needs different medicine.

What is a migraine?

Migraine is far more than a severe headache. It is a genuine neurological disorder with a genetic basis, identifiable triggers and several phases, and it can be highly disabling.

The headache itself is usually:

  • One-sided (though it can swap sides or, less often, affect both)
  • Throbbing or pulsating rather than a steady pressure
  • Moderate to severe, often bad enough to stop you working or studying
  • Worse with movement — walking or climbing stairs makes it pound harder
  • Accompanied by nausea or vomiting, and sensitivity to light and sound (you crave a dark, quiet room)

A full migraine often unfolds in phases: a prodrome (subtle warning signs such as yawning, food cravings, mood change or neck stiffness hours to a day before), sometimes an aura, then the headache, and finally a postdrome — a drained, hungover feeling that can linger for a day.

About one in four people with migraine experience aura: temporary neurological symptoms that build over 5-60 minutes and then fade, usually just before or during the headache. The most common is visual — flashing lights, shimmering zigzag lines or a blind spot. Aura can also be sensory (numbness or pins and needles spreading up one arm or across the face) or affect speech. Aura matters beyond the discomfort: it changes which contraceptives are safe and slightly raises stroke risk, so it is always worth mentioning to a doctor.

Migraine affects roughly 12-15 percent of adults, but the burden falls heavily on women — about 18-25 percent of women versus 6-9 percent of men, peaking between ages 25 and 45. Indian epidemiological data echo these figures, with women affected two to three times as often as men. Migraine also runs in families: a parent or sibling with migraine raises your own risk two to three fold.

Triggers vary from person to person, but the common ones are hormonal shifts (menstruation, ovulation, pregnancy, perimenopause, the pill), stress (and the let-down after stress — the classic "weekend migraine"), too little or too much sleep, skipped meals, dehydration, alcohol, bright lights, strong smells, heat and weather changes. Keeping a simple diary often reveals your personal pattern. Because hormones are such a powerful trigger for women, many find their attacks track the phases of their menstrual cycle.

How to tell migraine from a tension headache

When you are in the middle of an attack, a few practical clues usually settle which one it is.

| Feature | Migraine | Tension headache |
| --- | --- | --- |
| Location | Usually one side | Both sides, band-like |
| Quality | Throbbing, pulsating | Pressing, tight, dull |
| Intensity | Moderate to severe, often disabling | Mild to moderate |
| Effect of activity | Worsens with movement | Little change |
| Nausea / vomiting | Common | Absent |
| Light & sound sensitivity | Common | Absent or mild |
| Aura | Sometimes | Never |
| Behaviour | Want to lie still in the dark | Can usually carry on |

A quick self-check used by doctors worldwide, the ID Migraine screen, asks three questions about your headaches over the last three months: were they disabling, did they come with nausea, and did light bother you? Two "yes" answers strongly point to migraine.

It is worth knowing that many women have both — a migraine some days and a tension headache on others. They sit on a spectrum, which is exactly why the labels matter. Migraine-specific medicines called triptans abort a migraine but do nothing for a tension headache, while simple painkillers help both but are usually enough only for the tension type. If your headaches are severe, one-sided and come with nausea or light sensitivity, treat them as migraine and speak to a doctor about triptan-based treatment.

Women with frequent, hormone-linked attacks may be dealing with chronic migraine driven by hormonal triggers, which benefits from a dedicated prevention plan.

Menstrual migraine and hormonal headache patterns

For many women, migraines are not random — they cluster around the period. This is menstrual migraine, and it is extremely common: roughly half to two-thirds of women with migraine notice their attacks worsen around menstruation.

The trigger is the sharp drop in oestrogen in the days just before bleeding starts. Doctors recognise two patterns: pure menstrual migraine, where attacks happen only in the window from two days before to three days after the period begins, and the more common menstrually-related migraine, where they happen then but at other times too. Menstrual attacks tend to be longer, more severe and harder to treat than attacks at other times of the cycle. Our in-depth menstrual migraine guide covers the full treatment toolkit.

Knowing the timing opens up smart options:

  • Acute treatment — a triptan or an NSAID such as naproxen, taken as soon as the attack starts.
  • Mini-prophylaxis — for predictable cycles, a short preventive course started about two days before the period is due (for example naproxen 500mg twice daily, or a longer-acting triptan like frovatriptan or naratriptan) through the high-risk window.
  • Hormonal strategies — taking combined contraceptive pills continuously (skipping the placebo week) can smooth out the oestrogen drop. But this carries an important caveat below.

Migraine, the pill and stroke risk: combined oral contraceptives are not recommended for women who have migraine with aura, because together they raise the risk of stroke. Progestin-only methods — the mini-pill, implant, hormonal IUD or DMPA injection — do not carry this restriction and are usually preferred for women with aura. If you are choosing contraception with migraine in mind, our overview of birth control pills in India and the copper IUD versus Mirena comparison are good starting points, but the final choice should be made with a doctor.

Migraine shifts across a woman's life. Pregnancy improves migraine in 60-70 percent of women, usually after the first trimester, thanks to steady high oestrogen — though severe new headaches in pregnancy always need checking (see red flags below). Perimenopause, the years of erratic hormones before periods stop, is often the worst phase, while migraine frequently settles after menopause. If menopause is changing your headache pattern, see menopause headaches and why menopause can cause nausea and headaches. Hormone replacement therapy can help or hurt depending on the dose and route, so it should be tailored individually.

Red flags: when a headache needs urgent care

Most headaches are harmless. But a small number signal something serious, and these warning signs should never be ignored. A useful checklist is the SNOOP set of red flags:

  • Sudden and severe — a "thunderclap" headache that hits maximum intensity within seconds to minutes. This is a medical emergency and can mean bleeding around the brain.
  • Neurological signs — weakness, numbness, drooping face, slurred speech, confusion, a seizure, or new vision loss. These overlap with stroke warning signs, and stroke is a time-critical emergency.
  • Systemic symptoms — fever, neck stiffness, unexplained weight loss or night sweats alongside the headache.
  • Onset over age 50 — a brand-new headache in later life needs evaluation.
  • Pattern change — your usual headache suddenly becomes more frequent, more severe, or simply different in character.
  • Positional or strain-triggered — headache that clearly worsens on lying down, or that is set off by coughing, exertion or sex.

In pregnancy and the weeks after birth, take headaches especially seriously. A new severe headache, particularly with visual disturbance, swelling or high blood pressure, can be a sign of Preeclampsia in Pregnancy: High BP, Warning Signs and Care, which is an emergency. Read our guides to headaches during pregnancy and the safe management of migraines in pregnancy. Underlying high blood pressure also raises the stakes.

If any red flag is present, seek care the same day, and call 108 (India's emergency ambulance number) for sudden severe or stroke-like symptoms. Doctors may arrange a neurological examination and a CT or MRI scan (in private hospitals, a CT brain costs roughly Rs 2,500-6,500 and an MRI brain Rs 5,000-15,000), and further tests as needed. For an ordinary headache with none of these features, scans are not routinely required.

Treating a migraine attack: painkillers, triptans and anti-sickness medicine

The golden rule of acute migraine treatment is treat early — within the first 30-60 minutes, before the pain peaks — and use a full dose. Waiting often means the medicine works less well.

Treatment is stepped:

  • Mild to moderate attacks: an NSAID such as ibuprofen 400-800mg, naproxen 500mg, or diclofenac, with aspirin 900mg as an alternative. Paracetamol 1000mg helps some people but is generally weaker for migraine. Caffeine combination tablets (Saridon, Anacin) are widely used in India.
  • Moderate to severe, or when NSAIDs fail: triptans, the migraine-specific drugs. Sumatriptan is the most widely available in India (Suminat, Imigran; generics around Rs 30-150 a tablet), with rizatriptan, zolmitriptan, naratriptan and others also on the market. A nasal spray or injection version works faster and is useful if you are vomiting. Take a triptan at the start of the headache (not during the aura); if it helps but the pain returns, a second dose after two hours is allowed.
  • For nausea: anti-sickness tablets such as domperidone (Domstal) or metoclopramide (Perinorm) ease nausea and help the painkillers absorb.

Triptans are not safe for everyone — they should be avoided if you have heart disease, uncontrolled high blood pressure, a history of stroke, or certain rare migraine types, and they are generally avoided in pregnancy. Always check with a doctor or pharmacist first.

A continuous, severe migraine lasting more than 72 hours (status migrainosus) needs hospital treatment with fluids and stronger medication. And whatever you take, the 10-15 day rule holds: using acute medicines on more than 10-15 days a month risks medication overuse headache, where the cure quietly becomes the cause.

Preventing migraine: when daily treatment makes sense

If migraines are frequent (about four or more migraine days a month), very disabling, long-lasting, or not well controlled by acute medicine, preventive treatment is worth discussing. The aim of prevention is to cut attack frequency by at least half. Preventives are taken every day, whether or not you have a headache, and given a fair trial of three to six months before judging them.

First-line options (chosen to match your other health needs) include:

  • Beta-blockers — propranolol or metoprolol. A good choice if you also have anxiety or palpitations.
  • Amitriptyline — a low bedtime dose. Helpful when poor sleep is a trigger, though it can cause drowsiness and weight gain.
  • Topiramate — effective but can cause tingling, word-finding trouble and weight loss.
  • Flunarizine — a calcium-channel blocker popular in India; can cause drowsiness and weight gain.
  • Sodium valproate — effective but avoided in women who could become pregnant because it can harm a developing baby.

Newer CGRP monoclonal antibody injections (erenumab, fremanezumab, galcanezumab) are highly effective but expensive (roughly Rs 25,000-50,000 per dose) and available mainly through specialist centres in India. Botox injections every 12 weeks are an option for chronic migraine.

Medicine works best alongside steady habits: a regular sleep schedule of 7-9 hours, regular meals, good hydration, stress management and regular exercise. Some supplements have reasonable evidence in prevention, including magnesium (around 400-600mg daily), riboflavin (vitamin B2) 400mg daily and CoQ10. Many women find managing the broader picture — for example treating overlapping PMS symptoms or the headaches of Perimenopause in Indian Women: Symptoms, Timing and Treatment — reduces attacks too. If menopause is the driver, weigh up hormone replacement therapy options and costs in India with your doctor.

Cluster headache and other less common headaches

Not every severe one-sided headache is migraine. Cluster headache is rarer (affecting fewer than 1 in 200 adults) and, unusually, affects men more than women. It is one of the most painful conditions known, and recognising it matters because the treatment is specific.

A cluster attack brings:

  • Excruciating one-sided pain around or behind one eye or temple
  • Short attacks of 15-180 minutes, often striking at the same time each day or waking you at night
  • Autonomic signs on the same side — a red, watering eye, drooping eyelid, blocked or runny nostril
  • Restlessness — unlike migraine, sufferers pace and cannot keep still

Attacks come in "clusters" lasting weeks to months, then disappear for long stretches. Acute treatment is high-flow oxygen through a mask and injectable sumatriptan, with verapamil used to prevent attacks during a cluster. Cluster headache needs a neurologist.

Other less common headaches include hemicrania continua (a continuous one-sided headache that responds remarkably to one specific drug, indomethacin), new daily persistent headache (a headache that starts one identifiable day and simply never stops), and the "alarm-clock" hypnic headache that wakes older adults from sleep. These are uncommon and usually need a neurologist to diagnose. If a headache does not fit the familiar migraine or tension pattern, that is itself a reason to get it assessed.

Myths vs facts

Frequently asked questions

How do I know if I have a migraine or just a headache?

A tension headache is usually a steady, band-like pressure on both sides of the head that lets you carry on with your day. A migraine is more often a throbbing pain on one side, moderate to severe, made worse by movement, and comes with nausea or sensitivity to light and sound. If two of these apply — disabling pain, nausea, light bothering you — it is most likely migraine.

Why do I get a headache or migraine before my period?

The sharp drop in oestrogen in the days before your period is a powerful migraine trigger. This is called menstrual migraine, and these attacks tend to be longer and more stubborn than usual. Treating them early with an NSAID or triptan, or starting a short preventive course before the period is due, can help.

Can I take painkillers for every headache?

Occasional use is fine, but taking acute painkillers — including paracetamol, ibuprofen and combination tablets like Saridon — on more than 10-15 days a month can cause medication overuse headache, where the medicine itself drives more headaches. If you need painkillers that often, see a doctor about preventive treatment instead.

Is migraine dangerous?

Migraine itself is not dangerous, but it is disabling and deserves proper treatment. Certain warning signs need urgent care: a sudden thunderclap headache, headache with weakness, slurred speech or vision loss, a new severe headache in pregnancy, or any headache that feels very different from your usual pattern. For these, seek care the same day or call 108.

Are contraceptive pills safe if I have migraines?

It depends on the type of migraine. Combined oestrogen-containing pills are not recommended for women who have migraine with aura, because they raise stroke risk. Progestin-only methods — the mini-pill, implant or hormonal IUD — are usually safe and often preferred. Discuss your migraine type with your doctor before choosing.

Does pregnancy make migraines better or worse?

For most women migraine improves during pregnancy, usually after the first trimester, because oestrogen stays high and steady. However, a new or severe headache in pregnancy should always be checked, as it can be a sign of preeclampsia or other conditions that need prompt care.

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