Tension Headache, Migraine, or Neck Headache? How to Tell Them Apart
Most headaches fall into a few familiar patterns, and knowing which one you’re dealing with changes what helps. A tension headache, a migraine, and a headache that starts in your neck can all hurt in similar places, but they behave differently. Here’s how to tell them apart, and which signs mean you need medical care right away.
The Short Answer
A tension headache usually feels like a dull, tight band around the head. A migraine usually throbs, often on one side, and comes with light sensitivity or nausea. A cervicogenic headache starts in the neck, usually on one side, and gets worse when you move your neck.
MedlinePlus calls tension headaches the most common type of headache and notes that they can happen alongside migraines. That overlap is why the pattern over several weeks tells you more than any single headache.
Tension Headache: The Tight Band
Tension headaches come from tight, tense muscles in the neck and scalp. MedlinePlus describes the pain as:
- Dull and pressure-like, not throbbing
- A tight band or vise around the head
- All over, rather than in one spot or on one side
- Worse in the scalp, temples, or back of the neck, sometimes into the shoulders
They can last anywhere from 30 minutes to 7 days, and they usually don’t cause nausea or vomiting. Common triggers include stress, fatigue, eye strain, and holding your head in one position for a long time, like typing or other computer work. If a hard week tends to land in your shoulders and neck, it’s a good example of how stress shows up physically.
Migraine: The Throbbing Attack
A migraine throbs instead of pressing. Mayo Clinic describes throbbing or pulsing pain, usually on one side, along with sensitivity to light and sound, and often nausea or vomiting. Some people get an aura first, such as flashes of light or blind spots. Untreated, an attack can last 4 to 72 hours, and many people feel drained for up to a day afterward.
Triggers vary from person to person. The American Migraine Foundation lists stress as a trigger for almost 70% of people with migraine, along with irregular sleep, hormonal changes, caffeine and alcohol, weather changes, and dehydration. That cluster of throbbing pain, sensory sensitivity, and nausea is the hallmark of migraines.
Cervicogenic Headache: It Starts in the Neck
A cervicogenic headache is head pain that comes from a problem in the neck. According to Cleveland Clinic, it’s usually one-sided, starts at the base or back of the head, and can move forward to the area behind the eye. It tends to get worse with certain neck movements or positions, and your neck often won’t turn as far as it used to.
Unlike a migraine, it usually doesn’t bring light or sound sensitivity, nausea, or vomiting, which is one reason it’s often mistaken for a tension headache instead. Common sources include neck strain, arthritis in the neck, long hours of awkward posture, and a past whiplash injury. Because the problem lives in the neck, headaches that start in the neck usually need the neck examined, not just the head treated.
What to Look for in a Provider
If headaches are happening often enough to plan around, a few things are worth asking about before you book.
- An exam before any treatment. A detailed headache history, neck range of motion, and neurologic testing, so care is based on what’s found.
- Honesty about fit. Neck-related headaches are a good fit for a chiropractic exam. Migraines often call for medical care alongside it, and you should hear that plainly.
- A plan for between visits. Posture, sleep, and home exercises matter as much as what happens on the table.
- A willingness to refer. Some headaches need a physician or neurologist first.
- Clear communication. You should understand what care involves and what it costs before you start.
How to Tell Them Apart
Four questions usually sort it out:
- Where: tension headaches feel all over or like a band. Migraines and cervicogenic headaches usually favor one side.
- How it feels: tension is dull pressure. Migraine throbs. Cervicogenic is often a steady ache that starts at the base of the skull.
- Extras: light and sound sensitivity, nausea, or an aura point toward migraine.
- Neck movement: a headache that changes when you turn or tilt your head points toward the neck.
These are tendencies, not rules, and plenty of people have more than one type. Headaches that arrive along with stiffness and neck pain are a good reason to have the neck checked, especially if they keep coming back on the same side.
What a Visit Looks Like at River of Life
Every first visit starts with a detailed history of your headaches, then a hands-on exam: how your neck moves, the muscles and joints at the base of the skull, and neurologic testing. That’s why every visit starts with an exam. If the exam points to the neck, care follows three steps: Prime, guided breathing to help your body settle; Facilitate, a gentle, specific adjustment; and Integrate, the posture, sleep, and home exercises that happen between visits.
It’s worth being honest about the research. The NIH center for integrative health notes that spinal manipulation is often used for headaches but that studies have had mixed results, so tell every provider you see what you’re doing. Our migraine and headache relief care works alongside your doctor, not in place of one.
When a Headache Needs Emergency Care
Most headaches aren’t dangerous, but some need emergency care, not a chiropractic visit.
Call 911 or go to the ER for:
- A sudden, severe headache that feels like the worst of your life
- Headache with fever and a stiff neck
- Headache with confusion, trouble speaking, vision changes, weakness, or numbness on one side. These can be stroke warning signs.
- Headache after a head injury
- A new kind of headache that starts after age 50
Start a Headache Diary
MedlinePlus recommends keeping a headache diary to spot your triggers. For each headache, jot down:
- When it started and how long it lasted
- Where it hurt and what it felt like: band, throb, or ache
- Any extras, like nausea, light sensitivity, or an aura
- What came before it: screen time, short sleep, stress, caffeine, a missed meal
- Whether turning your head made it better or worse
- What helped, even a little
A few weeks of notes usually make the pattern obvious, and they’re the most useful thing you can bring to an exam.
Headaches wearing you down?
We’re glad to answer questions before you book. See what to expect at your first visit, and bring your headache diary if you’ve started one.
Sources
This article is for general education and is not medical advice. For questions about your own health, talk with your doctor or another qualified healthcare provider.
From the team at River of Life Chiropractic, 4519 Mills Park Cir Ste 300, College Station, TX 77845.
About the Author
Dr. Levi Hansen, DC
Founder of River of Life Chiropractic in College Station, TX
Webster Certified (ICPA)B.S. Neuroscience, WSU
Raised in Kenai, Alaska, Dr. Hansen played football at Washington State, earned a B.S. in Neuroscience, then his Doctor of Chiropractic from Parker University. Every visit starts with a real exam, followed by his three-step Prime, Facilitate, Integrate process.
- Every visit starts with a physical exam
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