Is It a Migraine or a Headache? Why the Difference Matters More Than You Think

I want to address something that sounds simple but carries real clinical weight: the difference between a headache and a migraine. Because I have met too many women who have been suffering from full neurological migraine events for years — and have been treating them with ibuprofen and rest because they thought they “just got bad headaches.”

Words matter in medicine. Calling a migraine a bad headache is a bit like calling pneumonia a really bad cough. The naming shapes the treatment. And in this case, under-recognition leads to under-treatment.

What Is Actually Happening During a Migraine

A migraine is a neurological event. It involves the trigeminal nerve — the main sensory nerve of the face and head — along with a process called cortical spreading depression, in which a wave of electrical activity moves across the brain’s surface. This is what produces the aura that some migraine sufferers experience before the pain begins.

Blood vessel changes, inflammation of pain-sensitive structures around the brain, and the release of inflammatory neuropeptides like CGRP (calcitonin gene-related peptide) all contribute to the migraine cascade. This is a systemic neurological event, not simply local pain in the head.

Understanding this is important because it explains why migraines produce symptoms beyond head pain: nausea and vomiting, extreme sensitivity to light (photophobia), extreme sensitivity to sound (phonophobia), sensitivity to smell, sometimes visual disturbances, and often significant cognitive impairment — what many people call migraine brain fog.

The Four Phases of a Migraine

Many migraine sufferers do not realize that a migraine has up to four distinct phases, and that paying attention to the earlier phases can help both with management and with root cause tracking.

The prodrome phase can begin hours or even a day or two before the headache itself, and may include subtle symptoms like mood changes, food cravings, neck stiffness, fatigue, or increased urination. Many people recognize these as their “warning signs.” The aura phase, which occurs in approximately 25% of migraine sufferers, involves reversible neurological symptoms — visual disturbances being the most common — that precede the head pain. The headache phase involves the pain itself, typically moderate to severe, often one-sided, often throbbing, and worsened by physical activity. The postdrome phase follows the headache and is characterized by fatigue, cognitive fogginess, and sometimes a feeling of emptiness or exhaustion that can last a day or two.

Why the Distinction Changes Treatment

Treating a migraine like a tension headache — with rest and ibuprofen — is not wrong, but it is often insufficient. Migraine-specific medications like triptans work differently and are far more effective for true migraine events because they specifically target the serotonin receptors and vascular changes involved in the migraine cascade.

More importantly from a root cause perspective, the fact that migraines are neurological events driven by specific physiological mechanisms — inflammation, neurotransmitter dysregulation, hormonal fluctuations, vascular reactivity — means they are addressable at a root level in ways that tension headaches driven simply by muscle tightness are not.

If you have been told you “just get headaches” but they involve nausea, light sensitivity, sound sensitivity, or cognitive impairment, please consider whether you may actually be experiencing migraines. The distinction matters for how you advocate for yourself and what kind of care you pursue.

My free training is a good place to start if you want to understand the root cause approach to migraine specifically. Register at go.theheadachewhisperer.com/root-cause.

🌎 Ready to find your root cause? Join Dr. Myranda’s FREE training at go.theheadachewhisperer.com/root-cause