Headache or migraine? How to tell the difference

People use "headache" and "migraine" interchangeably, and they are not the same thing. They differ in mechanism, in how they feel, and in what helps. Sorting out which you're dealing with is the first useful step — and for a meaningful number of people, the answer turns out to involve the neck.

Tension-type headache

The most common kind by a wide margin. It usually presents as a dull, pressing tightness on both sides — often described as a band around the head. It doesn't typically throb, isn't usually made dramatically worse by moving around, and rarely comes with nausea. Stress, poor sleep, sustained desk posture, and jaw clenching are frequent contributors.

Migraine

A neurological condition, not simply a severe headache. Migraine is more often one-sided, throbbing or pulsing, moderate to severe, and made worse by ordinary activity. It commonly brings light and sound sensitivity, nausea, and for some people an aura beforehand — visual disturbance, tingling, or difficulty finding words. Attacks can last from a few hours to several days.

A rough guide

• Both sides, pressing, no nausea — more likely tension-type
• One side, throbbing, light and sound sensitivity — more likely migraine
• Starts in the neck, worse with certain movements or positions — possibly cervicogenic
• Preceded by visual changes or tingling — migraine with aura

The third category people miss

Cervicogenic headache originates in the neck and refers pain up into the head. It's typically one-sided, often starts at the base of the skull and spreads forward, and is provoked by neck movement or by holding a position for a long time. It can look convincingly like migraine — which is why it's often treated as one for years without much success.

This is the category where hands-on care tends to help most directly, because the source is mechanical. Restoring movement in the upper cervical joints and releasing the surrounding muscle often reduces both frequency and intensity.

What helps, by type

Tension-type and cervicogenic headaches respond well to manual therapy, posture and workstation changes, and targeted strengthening. Migraine is managed differently — trigger identification, sleep and routine consistency, and medical care — though people with migraine frequently have neck involvement layered on top, and treating that layer can reduce the overall burden.

When a headache needs urgent attention

Most headaches are benign. Some are not. Seek immediate medical care for a sudden severe headache that peaks within seconds, a headache with fever and a stiff neck, one following a head injury, or any headache with confusion, weakness, vision loss, or difficulty speaking.