- Tension headaches feel like steady, pressing pain on both sides of the head, often tied to neck and shoulder tightness.
- Migraines are usually one-sided and throbbing, and come with nausea, light or sound sensitivity, or visual aura.
- Duration: tension headaches usually clear in a few hours. Migraine attacks can last 4 to 72 hours.
- What helps most: tension-type headaches respond well to chiropractic care, posture work, and targeted neck stretches. Migraine usually needs a medical workup and, often, prescription care.
- Red flag: a sudden severe headache, or any headache that feels like the worst of your life, is an emergency. Call 911, not your chiropractor.
Tension headaches and migraines feel different because they come from different mechanisms. Tension-type headache is mostly muscular and postural. Migraine is a neurological condition with vascular and inflammatory features. Telling them apart matters because each one responds to a different first-line treatment.
What does a tension headache feel like?
A tension headache feels like steady, mild-to-moderate pressure on both sides of the head, often described as a tight band or a heavy weight at the base of the skull. The pain stays consistent rather than throbbing. Bright light and sound usually do not make it worse. Most attacks last 30 minutes to a few hours.
Tension-type headache is the most common primary headache in adults, according to the Cleveland Clinic. Triggers tend to be physical and behavioral. Long stretches at a desk, jaw clenching, poor sleep, dehydration, and holding the head forward over a phone are the common patterns we see in the exam room.
A patient comes in after a fourteen-hour workday with tightness running from the base of the skull through the upper trapezius. Pressing on the suboccipital muscles reproduces the headache exactly. That tells us we are dealing with a cervicogenic component, not a primary migraine, and the treatment plan shifts accordingly.
What does a migraine feel like?
A migraine is a moderate-to-severe throbbing headache, usually on one side of the head, that gets worse with movement, light, or sound. Many people feel nauseated or vomit. About a third of people with migraine experience an aura, which can be visual zigzags, blind spots, or tingling. Attacks last 4 to 72 hours without treatment.
Migraine is common, and women are about three times more likely than men to be diagnosed, according to the Mayo Clinic. Common triggers include hormonal shifts, certain foods (aged cheese, red wine, processed meats, artificial sweeteners), skipped meals, weather changes, and disrupted sleep.
Migraines often move through phases: prodrome with mood changes or food cravings, then aura for some people, then headache, then postdrome where you feel foggy and drained for up to a day. Recognizing these phases helps separate a true migraine from a severe tension headache and gives a doctor real data to work with.
How can I tell the difference at home?
Use four cues: location, quality, duration, and triggers. Tension headaches usually sit on both sides as steady pressure, last a few hours, and follow posture or stress. Migraines are usually one-sided and throbbing, last much longer, and follow neurological triggers. Nausea, aura, or strong sensitivity to light points toward migraine.
- Pressing band on both sides: tension-type
- Throbbing on one side: migraine
- Nausea or vomiting: migraine
- Visual changes or aura: migraine
- Worse with bright light or sound: migraine
- Triggered or worsened by neck movement: tension-type or cervicogenic
- Reproducible by pressing on the upper neck muscles: cervicogenic component
Many patients have both. A neck-driven tension headache can also set off a migraine in someone who is prone to migraine. Sorting that out is the first step in treatment, because each pattern needs a different approach.
Can a chiropractor help with headaches?
For tension-type and cervicogenic headaches, the evidence is solid. A systematic review indexed on PubMed found that cervical spinal manipulation reduces frequency and intensity of these headache types. For true migraine, manual therapy can lower attack frequency in some patients, but prescription medication is still the first-line treatment.
A focused chiropractic headache exam looks at the following:
- Cervical and upper thoracic range of motion
- Suboccipital, trapezius, and levator scapulae tenderness
- Posture during work, driving, and sleep
- Jaw and TMJ function
- Eye strain, screen distance, and reading glasses fit
Treatment usually combines cervical and thoracic adjustments, soft tissue work on the upper neck and shoulders, and specific stretches the patient takes home. Most patients with chronic tension headaches see meaningful change within 4 to 6 visits when they also adjust their desk setup.
When should I see a chiropractor for headaches?
See a chiropractor if your headaches feel like neck-driven pressure and happen two or more days a week. They often get worse after long desk hours or ease when you stretch the neck. These signs point to a tension-type or cervicogenic pattern, which responds well to manual care.
Also consider chiropractic if over-the-counter medication is working less well over time, or if your headache pattern changed after a car accident, a fall, or a sports impact. Post-traumatic headaches often have a cervical driver that does not show up on the initial ER scan.
When does a headache need urgent medical care?
Some headaches are emergencies. Go to the ER or call 911 if your headache is the worst of your life, comes on like a thunderclap in under a minute, follows a head injury, comes with fever and a stiff neck, or comes with confusion, slurred speech, weakness, or vision loss.
- Sudden severe headache reaching peak intensity within seconds to minutes
- Headache with fever above 101°F and a stiff neck
- A new headache pattern starting after age 50
- Headache that wakes you from sleep with vomiting
- Headache with new neurological symptoms such as weakness, numbness, slurred speech, or vision change
- Headache during pregnancy with high blood pressure or vision changes
- Any headache after a head injury, especially with confusion or repeated vomiting
These can signal stroke, meningitis, aneurysm, or severe hypertension. Chiropractic care is not appropriate for any of those. Get medical evaluation first, then circle back for follow-up care if the source turns out to be muscular.
What helps a tension headache right now?
For an active tension headache, drink water and step away from the screen, then apply heat to the upper neck and shoulders for 10 to 15 minutes. Slow chin tucks and gentle neck rotations release suboccipital tension. Caffeine in moderation helps some people. Daily over-caffeination causes rebound headaches, so do not overdo it.
A simple desk reset most patients can run in five minutes:
- Stand up and walk for two minutes.
- Roll the shoulders backward 10 times.
- Hold a doorway chest stretch for 30 seconds per side.
- Do 10 slow chin tucks.
- Drink 12 to 16 ounces of water.
If you are running this routine more than twice a week without relief, the pattern is bigger than a single bad day and deserves a real exam.
What helps a migraine right now?
Move to a dark, quiet room. Put a cold compress on the forehead or the back of the neck. Hydrate. Take any prescribed abortive medication as early in the attack as possible. Sleep if you can. Triptans like sumatriptan tend to work best when taken within the first hour of migraine onset.
If you do not have a migraine diagnosis or prescription, schedule with primary care or a neurologist. Track each attack for two weeks: time of day, food, sleep, stress, weather. Real data turns a vague "bad headache" into a treatable pattern, and helps your care team rule out a cervicogenic driver.