A migraine is usually one-sided, throbbing, moderate to severe, made worse by light, sound, and movement, and often comes with nausea. A tension headache is usually both-sided, a steady pressure or tightness rather than a throb, and does not stop you functioning. Both are common and neither is dangerous in itself.
But some headaches are a symptom of something urgent, and those come first.
Red flags: go to an emergency room now
Do not wait for an appointment if a headache is:
- Thunderclap — maximum intensity within a minute, like being struck
- The worst headache of your life, or unlike any you have had
- Accompanied by a fever and a stiff neck, or a rash — possible meningitis
- With weakness, numbness, face drooping, slurred speech, or confusion — treat as a stroke and call 911
- With vision loss, double vision, or a new seizure
- Following a head injury, especially with drowsiness or repeated vomiting
- Worse when lying down, coughing, or straining, or waking you from sleep
- New after age 50
- With jaw pain when chewing and scalp tenderness in an older adult — possible giant cell arteritis, which can threaten sight and needs same-day treatment
- New in pregnancy with swelling or high blood pressure — possible pre-eclampsia
- New in someone with cancer, HIV, or a suppressed immune system
- Progressively worsening over days or weeks
Those are the ones we want to see in the Emergency Room, where a CT scan and laboratory tests are in the building.
Telling the two common types apart
| Tension headache | Migraine | |
|---|---|---|
| Location | Both sides; band around the head | Usually one side, can switch |
| Quality | Steady pressure, tightening | Throbbing, pulsating |
| Severity | Mild to moderate | Moderate to severe |
| Duration | 30 minutes to several hours | 4 hours to 3 days |
| Movement | Not much affected | Clearly worse with movement |
| Light and sound | Sometimes mildly bothersome | Usually intolerable |
| Nausea | Uncommon | Common, sometimes vomiting |
| Warning signs | None | Aura in some people — visual zigzags, blind spots, tingling |
| Able to carry on | Usually yes | Often no |
The migraine pattern
Migraine is a neurological condition, not “a bad headache.” Many people experience it in phases: a vague prodrome of irritability, food cravings, or yawning hours or a day beforehand; sometimes an aura of visual disturbance or tingling for 20 to 60 minutes; the headache itself; then a “hangover” of fatigue and fuzzy thinking for a day after.
Recognising your own prodrome is genuinely useful, because migraine treatment works dramatically better taken early.
Other types worth naming
Cluster headaches — severe, strictly one-sided pain around the eye, with a watering eye, drooping lid, or blocked nostril, in attacks of 15 minutes to 3 hours, often at the same time each day. Distinctive and treatable, but often misdiagnosed for years.
Sinus headaches — facial pressure with congestion and discharge. Frequently over-diagnosed; many “sinus headaches” are actually migraines, which also cause facial pressure and a runny nose.
Medication-overuse headache — the cruel one. Taking pain relief for headaches more than about 10 to 15 days a month can cause a persistent daily headache that only resolves by carefully stopping the medication. If you are taking something most days, come and see us rather than increasing the dose.
The Arizona triggers
Our patients’ headaches have a local flavour, and knowing it helps.
Dehydration is probably the single most common avoidable trigger here. You lose fluid constantly in dry desert air without feeling sweaty, because it evaporates immediately. Many summer headaches in Fountain Hills are simply fluid loss.
Heat itself provokes migraines in a large proportion of people who have them, and bright, high-intensity sunlight is a classic trigger — good sunglasses are genuinely preventive here rather than cosmetic.
Monsoon barometric swings. Rapid pressure changes before a storm are a well-recognised migraine trigger, and our monsoon season delivers them repeatedly from July through September.
Dust and pollen drive sinus congestion and, in turn, headaches. Spring palo verde and olive pollen are notorious in the Valley.
Altitude change. Driving up from Phoenix to the high country, or arriving from sea level for the season, can set off headaches for a few days.
What actually helps
For tension headaches: over-the-counter pain relief used sparingly, hydration, sleep, movement breaks from screens, and attention to neck and shoulder posture. Most respond well.
For migraines: treat at the very first sign. A dark, quiet, cool room. Hydration. Simple analgesia works for milder attacks, but if migraines are disrupting your life you should be on proper migraine-specific treatment — triptans, and in recent years the CGRP-targeted medications, which have changed outcomes substantially for people with frequent attacks. Preventive medication is worth discussing if you have more than about four migraine days a month.
Keep a headache diary for a few weeks before your appointment: date, time, duration, severity, what you had eaten, how you had slept, and what you took. It is the most useful thing you can bring us, and patterns often become obvious on paper that were invisible in memory.
Where to go
Call 911 for a thunderclap headache, a headache with weakness or speech difficulty, a seizure, or a headache after significant head injury.
Come to our Emergency Room — 9700 N. Saguaro Blvd, open 24 hours — for any red flag above. ER: (602) 671-7990.
Book our Medical Clinic for recurring headaches, migraines you are managing badly or not at all, daily pain relief use, or a pattern that has changed. This is treatable, and most people live with far more headache than they need to. Call (602) 671-7981.
Related reading
- High Blood Pressure Emergency: Know the Numbers and Act Fast
- Eye Health in the Desert: What to Check, and What’s an Emergency
- Sudden Fatigue and Weakness: What Your Body Might Be Telling You
Sources
- American Migraine Foundation — Types of headache
- Mayo Clinic — Migraine
- National Institute of Neurological Disorders and Stroke — Headache