Headache Types Compared: Migraine, Tension, Cluster, Sinus, and Cervicogenic

The five most common primary and secondary headache types (migraine, tension, cluster, sinus, and cervicogenic) differ sharply in location, duration, accompanying symptoms, and treatment. Migraine is throbbing, one-sided, and disabling. Tension is band-like, mild to moderate, and tied to muscle strain. Cluster is excruciating, around one eye, and brief. Sinus is facial and pressure-like, often with congestion. Cervicogenic starts in the neck and refers up. Treating the wrong type is the most common reason people stay in pain.

People often use "migraine" and "headache" as if they were the same thing. They are not. The wrong label drives the wrong treatment, and the wrong treatment can leave you suffering for years. Here is what each major type actually looks like.

Migraine

• Location: usually one-sided, sometimes shifting sides between attacks
• Quality: throbbing or pulsing
• Duration: 4 to 72 hours untreated
• Severity: moderate to severe, often disabling
• Other symptoms: nausea, vomiting, light and sound sensitivity, smell sensitivity, sometimes aura
• Aggravated by: routine physical activity (walking up stairs makes it worse)
• First-line treatment: triptans, gepants, NSAIDs taken at the earliest sign. Preventives include CGRP monoclonal antibodies, beta blockers, and topiramate.

Migraine is a primary neurological disorder, not a symptom of something else. See our full guide on what does a migraine feel like.

Tension-type headache

• Location: bilateral, often described as a tight band around the head
• Quality: pressing or tightening, never throbbing
• Duration: 30 minutes to 7 days
• Severity: mild to moderate, rarely disabling
• Other symptoms: none of the migraine features. No nausea, no aura, no strong light/sound sensitivity
• Aggravated by: stress, prolonged posture, eye strain. Not worsened by activity.
• First-line treatment: NSAIDs or acetaminophen, posture correction, stretching, magnesium, and stress management. Chronic cases respond to amitriptyline.

Tension-type is the most common headache worldwide. It is real but rarely dangerous. See tension headache vs migraine.

Cluster headache

• Location: strictly one-sided, almost always around or behind one eye
• Quality: stabbing, searing, often described as the worst pain in medicine
• Duration: 15 minutes to 3 hours per attack, multiple attacks per day for weeks
• Severity: extreme. Known as "suicide headache."
• Other symptoms: tearing eye, drooping eyelid, nasal congestion on the same side, restlessness, pacing
• Aggravated by: alcohol during a cluster period
• First-line treatment: high-flow oxygen via non-rebreather mask, subcutaneous sumatriptan, verapamil for prevention, occipital nerve blocks. CGRP antibody galcanezumab is FDA-approved for episodic cluster.

Cluster is dramatically under-recognized in primary care. See cluster headaches explained.

Sinus headache

• Location: forehead, cheeks, bridge of nose, behind the eyes
• Quality: pressure or fullness, worse when bending forward
• Duration: tied to the underlying sinus infection or congestion
• Severity: usually moderate
• Other symptoms: nasal congestion, discolored discharge, fever, reduced sense of smell
• First-line treatment: treat the underlying sinusitis. Decongestants, saline rinses, and (if bacterial) antibiotics.

Most "sinus headaches" are actually migraines. Studies show 88% of self-diagnosed sinus headaches meet full migraine criteria. If your "sinus headache" responds to a triptan, it was a migraine.

Cervicogenic headache

• Location: starts at the base of the skull or neck and radiates up to the forehead or behind one eye
• Quality: dull, steady ache, sometimes sharp on neck movement
• Duration: hours to days, often chronic
• Severity: moderate
• Other symptoms: limited neck range of motion, tender spots in the upper neck, no nausea
• Aggravated by: specific neck positions or movements
• First-line treatment: physical therapy, manual therapy, posture correction, occipital nerve blocks for severe cases

If your headache is reliably reproduced by pressing certain neck spots, suspect cervicogenic and ask for a physical therapy referral.

When to escalate

Any new "thunderclap" headache reaching peak intensity in under a minute, any headache with fever and stiff neck, any sudden severe headache after age 50, or any headache with new neurological deficits is a medical emergency. See migraine red flags.

Sources

• International Headache Society. "International Classification of Headache Disorders, 3rd Edition (ICHD-3)." Cephalalgia, 2018.
• Schreiber CP et al. "Prevalence of Migraine in Patients with a History of Self-Reported or Physician-Diagnosed Sinus Headache." Archives of Internal Medicine, 2004.
• Goadsby PJ et al. "Trigeminal Autonomic Cephalalgias." Continuum, 2012.
• Bogduk N, Govind J. "Cervicogenic Headache: An Assessment of the Evidence." Lancet Neurology, 2009.
• American Headache Society. "Standards of Care for Headache Diagnosis." 2024.