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Health education · HeadachesCare and treatments
Migraine and headaches: understanding the differences and treatments
Not all headaches are migraines. Migraine is a neurological disease that can cause painful attacks and disrupt daily activities.1,7
Recognizing the type of headache, how often it happens and how it shows up helps choose the right care.
Warning signs
When should you get urgent help?
Call 911 if a headache is sudden, severe and unusual, or comes with signs of stroke: a drooping face, inability to raise both arms normally, trouble speaking or sudden loss of vision.6
Go to the hospital without waiting if the headache comes with, among other things:2
- fever or a stiff neck;
- confusion, agitation, excessive drowsiness or seizures;
- loss of balance, numbness in a limb or the face, or difficulty speaking or understanding;
- a red, painful eye or difficulty seeing clearly;
- vomiting that won’t stop;
- blood pressure of 180/120 or higher;
- pain that started after physical exertion or sexual activity, or that wakes you at night;
- pain in the temple or jaw when chewing;
- a new, persistent headache after 20 weeks of pregnancy or within 6 weeks after giving birth.
A first-time aura, an unusual aura or one lasting more than 60 minutes also calls for care without waiting.2 A new neurological symptom should not automatically be put down to an aura.
For guidance based on your symptoms, call Info-Santé at 811, option 1, any time.2
Without warning signs, a headache is not always urgent, but some situations call for a consultation.
According to Santé Québec, see a professional in particular if:2
- the headache doesn’t improve or gets worse after 24 hours despite home care;
- it is different from your usual headaches or keeps you from your activities;
- headaches become stronger or more frequent;
- a new headache appears after age 50, or in someone with a history of cancer or a weakened immune system.
Types of headache
What is a headache disorder?
Doctors call a headache a cephalalgia. Common forms include migraine and so-called tension-type headache. The same person can have both, at different times.
| Feature | Migraine | Tension-type headache |
|---|---|---|
| Usual sensation | Pulsating pain, like throbbing.4,5 | Pressing or tightening.4,5 |
| Location | Often one side, but both sides can be affected.4 | Both sides.4,5 |
| Intensity | Moderate to severe.4,5 | Mild to moderate.4,5 |
| Routine physical activity | Makes the pain worse or leads you to avoid activity.4,5 | Does not make it worse.4,5 |
| Other symptoms | Nausea or vomiting, sensitivity to light and noise.4,5 | No nausea.5 |
These guideposts help guide the assessment; they do not replace a diagnosis.
The attack
How can you recognize a migraine attack?
In adults, an untreated or poorly relieved attack lasts 4 to 72 hours. In 12- to 17-year-olds, it can be shorter: 1 to 72 hours.4,5
Presentations vary: a migraine is not always limited to one side of the head, and not everyone with migraine has an aura.4
Aura
What is an aura?
An aura is a set of fully reversible neurological symptoms that can come with some migraines.4,5
A typical aura develops gradually, over at least 5 minutes. Each symptom usually lasts 5 to 60 minutes.4,5
A typical aura can show up as:4
- flickering lights or zigzag lines in the field of vision;
- an area of blurred vision;
- tingling or numbness;
- difficulty with speech.
A first aura, an aura that differs from usual episodes or symptoms lasting more than 60 minutes need assessment without waiting.2 Sudden signs of stroke call for 911, even in someone who already knows their migraine.6
Triggers
Why do attacks happen?
Migraine is a neurological disease. The predisposition to migraine is genetic and comes from a combination of genes.7 Some factors, called triggers, can make an attack more likely:8
Meals and hydration
Skipped meals or a late breakfast, fasting and dehydration.8
Stress
Negative stress, but also positive stress, such as planning a big event.8
Hormones
Hormonal changes, for example around menstruation1 or in perimenopause.8
Alcohol and caffeine
Alcohol, or missing your coffee when you usually drink it.8
Environment
Bright light, loud noises, certain smells, heat, humidity or changes in air pressure.8
A trigger can make an attack more likely, but it is not the cause of the disease. Triggers vary from person to person and can add up, and some attacks happen with no obvious trigger.8
Diagnosis
How is migraine diagnosed?
Migraine is diagnosed using clinical criteria: how long attacks last, what the pain is like and the symptoms that come with it.5
Is a CT scan or MRI needed?
Imaging is not routine. It is not recommended for migraine or tension-type headache solely for reassurance.4
It may be indicated with warning signs, an abnormal neurological exam or a substantial change in headaches.4 A CT scan or MRI cannot, on its own, confirm migraine: the diagnosis is clinical.5
Treatments
Which treatments can be offered?
In adults, there are two complementary approaches.1
| Approach | Goal |
|---|---|
| Acute treatment | Relieve pain and associated symptoms within 2 hours, lasting at least 24 hours, without intolerable side effects.1 |
| Preventive treatment | Cut the number of migraine days per month by at least half, and improve quality of life and functioning.1 |
Acute treatment is taken as soon as the headache starts. Depending on the situation, it may be an anti-inflammatory, a triptan or another migraine-specific medication, sometimes with an anti-nausea medication. Opioids should not be prescribed to treat attacks.1
Preventive treatment may be offered, for example, when migraine days are frequent despite acute treatment, when migraine has a major impact, when acute treatment does not work or has to be taken often. Its effect is assessed after at least 2 to 3 months at the target dose, and longer for some injectable treatments.1
The choice depends on medical history, how well past treatments worked and the impact of migraine. Non-drug measures are also favoured: adjusting workload, managing stress, rest, nutrition and adequate hydration.1
What to do during a known attack?
Follow the plan agreed with your professional, including when to take the treatment.1
Lie down in a quiet, dark room, and wear sunglasses if light bothers you. A cold pack on the forehead, 20 minutes at a time, up to every 2 hours, can help; put a cloth between the skin and the cold. Avoid alcohol.2
Medication overuse
Can medications keep headaches going?
Yes. Taken too often, some acute treatments can lead to medication-overuse headache and make it easier for migraine to become chronic.1
The risk depends mainly on the number of days per month you take a medication, more than on the number of pills.3
Guideposts to discuss with a professional
If you take medication often or it works less well, a reassessment can help adjust treatment and consider prevention. Any withdrawal is planned with a health professional.3
Count headache days, not just attacks.1
Day to day
How can you reduce the impact on daily life?
Regular habits can support care:1
- keep sleep hours as regular as possible;1
- eat regularly;1,8
- drink enough;1
- do physical activity suited to your abilities;1
- watch for changes in caffeine;8
- build ways to manage stress.1
The goal is a realistic routine that suits you. Attacks can still happen despite these habits.8
Frequent headaches
What if headaches become very frequent?
Migraine is considered chronic when headaches occur on at least 15 days per month, including at least 8 migraine days, for more than three months. Below that, it is called episodic migraine.1
You don’t need to reach this threshold to ask for help. Less frequent attacks can also have major effects on work, family and quality of life.
When to consult at the Clinique IPS du Palais?
A consultation with a nurse practitioner makes it possible to assess your headaches, clarify the diagnosis, offer acute or preventive treatment when relevant and refer you to a specialist if needed. Bring your headache diary and the list of medications you have tried.
If you have a sudden, severe headache or signs of stroke, call 911 without waiting.
Sources
- Institut national d’excellence en santé et en services sociaux (INESSS). Traitement de la migraine chez l’adulte (clinical tool, in French). September 2025, revised January 29, 2026, accessed October 29, 2026. inesss.qc.ca
- Santé Québec. Mal de tête ou migraine (health advice, in French). Updated September 29, 2026, accessed October 29, 2026. sante.quebec
- Migraine Canada. Medication Overuse (information sheet). 2025, accessed October 29, 2026. migrainecanada.org
- National Institute for Health and Care Excellence (NICE, United Kingdom). Headaches in over 12s: diagnosis and management (CG150). Published September 19, 2012, updated June 3, 2025, accessed October 29, 2026. nice.org.uk
- Institut national de santé publique du Québec (INSPQ). Les céphalées, Appendix VIII of the Québec contraception protocol (in French). 2024, accessed October 29, 2026. inspq.qc.ca
- Government of Québec. Information sur l’accident vasculaire cérébral (AVC) (in French). Updated May 15, 2025, accessed October 29, 2026. quebec.ca
- Migraine Canada. Top Ten Facts on Migraine for Beginners. June 27, 2024, modified August 17, 2026, accessed October 29, 2026. migrainecanada.org
- Migraine Canada. What are the triggers of migraine? Date not stated, accessed October 29, 2026. migrainecanada.org
This sheet provides general information and does not replace an assessment by a health professional. Published October 29, 2026.