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Everyday symptoms

Headaches and migraine – telling them apart

Tension headache, migraine and the headache caused by painkillers themselves need different answers. How to tell which you have.

The common kinds

  • Tension headache — a dull, tight, band-like pressure on both sides, mild to moderate, not made worse by ordinary activity. The most common by far.
  • Migraine — usually one-sided, throbbing, moderate to severe, made worse by movement, and typically with nausea and dislike of light or noise. Some people get a visual aura first — zigzags or blind spots — lasting under an hour.
  • Cluster headache — severe pain around one eye in bouts, with a red or watering eye and a blocked nostril on the same side. Uncommon and distinctive.
  • Medication-overuse headache — a daily or near-daily headache caused by the painkillers taken for headaches. Under-recognised and very common.

Managing migraine

  1. Treat early. Migraine medicine works far better taken at the first sign than once the attack is established.
  2. Lie down somewhere dark and quiet if you can.
  3. Keep a simple diary — date, duration, what preceded it. Triggers are personal and a diary finds them where guessing does not.
  4. Look at the reliable trigger categories: missed meals, dehydration, poor or irregular sleep, alcohol, stress and the let-down after stress, and hormonal changes.
  5. If attacks are frequent, ask about preventive medication taken daily rather than only treating each attack.

Used for migraine in South Africa:

  • Paracetamol — Panado, Painamol, Tylenol, Pacimol

    Mild to moderate pain; fever

  • Ibuprofen — Nurofen, Brufen, Advil, Ibupain

    Mild to moderate pain; inflammation; fever; dysmenorrhoea

  • Sumatriptan — Imigran, Accord Sumatriptan, Migranal, Sumatab

    Acute migraine with or without aura; cluster headache

  • Metoclopramide — Maxolon, Clopamon, Reglan, Primperan

    Nausea and vomiting; GORD; gastroparesis; chemotherapy-induced nausea

  • Propranolol — Inderal, Adco-Propranolol

    Hypertension; angina; essential tremor; anxiety (performance); migraine prophylaxis; thyrotoxicosis symptoms

  • Amitriptyline — Trepiline, Adco-Amitriptyline, Laroxyl, Elavil

    Depression; neuropathic pain; migraine prophylaxis; insomnia (low dose)

Headaches that need urgent assessment

Also worth a non-urgent appointment: a headache that has clearly changed in pattern, one that is worse when lying down, coughing or straining, one that wakes you from sleep, or headaches in someone with HIV or cancer.

Prevention that is not medication

  • Regular meals and regular sleep, including at weekends — irregularity is a stronger trigger than most single foods.
  • Enough water, particularly in South African heat.
  • Caffeine consistency. Both too much and an abrupt drop cause headaches.
  • Physical activity, which reduces both tension headache and migraine frequency.
  • Eye test if headaches come with reading or screen work.
  • Attention to posture and neck tension for tension-type headache.

Common questions

Is a bad headache a sign of high blood pressure?
Usually not. Ordinary high blood pressure causes no symptoms, which is precisely why it goes undetected. Very high readings can cause headache, so a reading is worth taking, but blaming routine headaches on blood pressure often delays finding the real cause.
Do I need a scan for headaches?
Most people do not. Scans are guided by the warning features above and by examination findings rather than by how painful the headaches are. A normal scan also does not treat the headache.
Why do my headaches come on at weekends?
Classic pattern for two things: caffeine withdrawal after a lower weekend intake, and the let-down after a stressful week, which is a well-recognised migraine trigger. Keeping caffeine and sleep consistent across the week helps both.

Sources

Last reviewed 4 August 2026.