Everyone's response to pain is so different so it's really difficult to categorize "real" vs. "bh" based on your pain level (or even where the pain is located).
My opinion is: if they prevent you from doing other things, they're real. That is, if you can't sleep and walking/talking while having one is difficult (or impossible), they're more likely "real". Another sign that they're "real" is that they won't go away, no matter what you do. If you change position, walk, take a shower, drive, etc, they'll keep coming!