Migraine vs. Headache: What’s The Difference & When To See A Doctor

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Headache and migraines are common pain conditions that most people experience at some point in their life. Headaches can be caused by various factors including stress, allergies and illness. Often, people use “headache” and “migraine” interchangeably to describe their pain, but both do not always refer to the same problem. In this comprehensive guide, we are going to explore the different types of headaches, so you can better describe your problem at your next doctor’s visit. 


Understanding Headaches  

The first and most important thing to discuss is that migraines are a type of headache, and while all migraines are headaches, not all headaches are migraines. 

Broadly speaking, headaches may be classified as Primary Headaches (i.e a headache that arises as a primary condition itself), or Secondary Headaches (i.e a headache that is the result of an underlying medical condition, like an infection or tumour).  

Examples of primary headaches are Tension Headaches, Migraines, and Cluster Headaches. These are by far the most common headache presentations. 


Tension Headaches 

Among the primary headaches, the most common are the tension headaches. It is a mild to moderate pain often described as a tight band around your head. It is often felt circling around the head or at the region of your temples. In some cases, tension headaches can affect your sleep and result in a vague heavy and dizzy sensation 

Common causes of tension headaches include stress, reduced sleep, ongoing illness, warm weather and overall fatigue. 

Thankfully, most of these headaches resolve within a day or so, and rarely require medication beyond standard over-the-counter painkillers like Paracetamol. 

Cluster Headaches 

Cluster headaches are rare but excruciating. It usually involves a sharp, rapidly worsening pain over the front and sides of the head, in the region around the eye on the same side. It will come with excessive tear formation and blurriness in the affected eye. The pain of a cluster headache is one of the most intense of all headaches, and patients often require emergency treatment with high flow oxygen and strong painkillers. 

Fortunately, this condition is rare in our population, and is largely overshadowed by the prevalence of other headaches. 


Migraines are the other commonly seen primary headache in our local population. Classically, it is a one-sided throbbing pain felt on either side of the head, and may progress to involve both sides occasionally. It is often associated with nausea, dizziness, light sensitivity or blurring of vision. Migraines are known to last anywhere from a few hours up to 3-4 days. 

Migraines are also known to follow a few stages of development: 

The 4 Stages of Migraine 

1) Prodromal Phase

The prodromal phase refers to the “warning” symptoms that are familiar to migraine sufferers, that herald the onset of a migraine shortly after. These symptoms include: 

  • Constipation 
  • Mood changes  
  • Food cravings 
  • Neck stiffness 
  • Frequent yawning 

2) Aura Phase

Auras are abnormal changes to the sight/smell/touch sensations that immediately precede a migraine. It is only experienced by some patients but is unmistakable. 

Examples of migraine auras are: 

  • Seeing zig-zag lines, bright spots or flashes of light 
  • Difficulty speaking 
  • Tingling in the face or hands 


3) Attack Phase

During a migraine attack, you may experience moderate to severe pain on one side of the head and is often described as throbbing or pulsating. It usually lasts from 4-72 hours and is often accompanied by symptoms such as nausea, vomiting and hypersensitivity to light or sound. 


4) Postdromal Phase

After the pain of a migraine settles, patients often experience fatigue and poor concentration, which can last up to 1-2 days after the attack. 

The whole course of a migraine often lasts a few days, and frequent episodes can be debilitating for the sufferer, and affect their daily lives heavily. 


Secondary Headaches: When the Pain reflects Something Else 

As opposed to primary headaches, secondary headaches are headaches that arise from an underlying medical condition. Multiple conditions cause headaches, ranging from common issues like uncontrolled high blood pressure and toothaches, to more sinister causes like an intracranial bleed or brain tumour.  

While there are too many causes of secondary headaches to list, here are some more commonly seen ones that are often experienced but wrongly labelled as “migraines”: 

1. Sinus headaches 

Individuals who have allergic rhinitis (colloquially termed “sinus” by locals) would be familiar with the feeling of nasal and cheek congestion that arises during a flare of their condition. Due to chronic inflammation and sensitivity in the nasal airways, sinus pressure builds up in the forehead and cheeks, and sometimes leads to sinus infections and fever. The headache felt from this condition is often accompanied by face and ear pain, along with thick mucus and fever. 

Treatment includes intranasal steroids and decongestants, antibiotics and good chronic control of the underlying allergic rhinitis. 

2. Hypertension-related headaches/ Hypertensive emergencies 

Hypertension is nicknamed “The Silent Killer”, and for good reason. It usually has no symptoms and remains hidden unless screened for and treated. Over time, high blood pressure causes changes in the blood vessels that eventually lead to strokes, heart disease and kidney failure. 

In some cases, hypertension does shed its silent moniker and manifest in symptoms. Uncontrolled episodes of elevated blood pressure, usually in the ranges of >170mmHg systolic BP, would lead to altered blood flow in the brain and cause headaches. This condition is termed as Hypertensive Urgency/Emergency, depending on its severity. 

It warrants immediate treatment due to a risk of stroke or intracranial bleeding. 

3. Cervicogenic headaches and neck strains 

A common mechanical strain type of headache is felt in the posterior region, radiating towards the front and sides. This is often accompanied or caused by a neck ache. While it can happen to anyone who develops neck strains, it is commonly seen in individuals who have cervical spine degeneration and arthritis, termed spondylosis. 

Frequent episodes of such pain would warrant X-Ray imaging of the neck and further evaluation. Treatment would be aimed at pain management and physiotherapy to mitigate symptoms related to the degenerative changes. 

Recognising When to Seek Medical Attention 

While most headaches can be managed with over-the-counter medications and lifestyle modifications, certain red flags warrant will require urgent medical evaluation: 

  • Sudden and Severe Headache: A sudden and severe headache, especially if it’s different from your usual headaches, could indicate a medical emergency such as an intracranial hemorrhage or tumour. 
  • Worsening Symptoms: If your headaches or migraines become more frequent, severe, or prolonged over time, or if they significantly impact your daily activities. 
  • Neurological Symptoms: Symptoms such as confusion, difficulty speaking or understanding speech, weakness or numbness in one side of the body, or loss of consciousness require immediate medical attention and may indicate a more serious underlying condition. 
  • Headaches with Other Health Conditions: If your headaches are accompanied by symptoms of another health condition, such as fever, rash, or neurological deficits, it’s essential to consult a doctor to rule out underlying causes and ensure appropriate management. 


Primary Care Clinics: DR+ Medical & Paincare 

Family Physicians at your GP clinics would be the best starting point for you to evaluate and treat your headaches. It is important to obtain an accurate diagnosis and treatment plan, as the various conditions that cause headaches are managed differently. 

At DR+ Medical & Paincare clinics, we go beyond standard pain relief medications, and seek to treat the heart of the condition. Specialised treatments include Coreflex injections and nerve blocks for migraines and chronic headaches, coupled with targeted pain medications to allow sustained pain control. 



Understanding the differences between various headache types are essential for effective management. While headaches are common and often manageable with self-care measures, migraines and other complex headaches require a more comprehensive approach due to their debilitating nature and associated symptoms. With greater clarity on their condition and partnership with their regular family doctors, individuals can take proactive steps to effectively manage their condition and improve their quality of life. 


DR+ Medical & Paincare Alexandra 

Led by Dr Caleb Seet Yu Shiang, DR+ Medical & Paincare Alexandra Clinic is a GP clinic that provides a full suite of family medicine services, medical examinations (work permits/insurance/student pass), minor surgical procedures, health screenings & corporate healthcare. Trained by Singapore Paincare Academy, Dr Seet treats a wide variety of chronic pain conditions through the use of Minimally Invasive Procedures (MIPs) to patients, as an alternative to open surgery. In addition, Dr Seet is also trained in Sports Medicine and manages various pain-related conditions and sports injuries. 

Address: 321 Alexandra Road #01-05 Alexandra Central Mall Singapore 159971  

Contact number: +65 6322 7350