Migraine, Tension, or Cervicogenic? How to Tell Your Headache Apart
Most people who tell us they get migraines do not have migraines. Most people who say they just get "stress headaches" have never had the source examined. Getting the type right is the single thing that most changes whether treatment works, because these conditions respond to genuinely different approaches. At Daniels Chiropractic in Racine, WI, identifying the type is the first thing we do. See our headache treatment page for how we approach each one.
Why the Distinction Matters
A cervicogenic headache treated as a migraine gets medication that does not address an irritated joint at the base of the skull. A migraine treated as a muscular problem gets soft tissue work that will not prevent the next attack. And a medication-overuse headache treated with more medication gets worse in a way that is nearly impossible to see from the inside.
Fortunately the three most common types have distinguishing features you can start noticing yourself, before you ever walk into an office.
The Quick Comparison
Tension-Type Headache
- Location: Both sides, often band-like around the head
- Quality: Pressing or tightening, not throbbing
- Intensity: Mild to moderate, draining rather than disabling
- Activity: Walking or climbing stairs does not make it worse
- Other symptoms: No nausea; occasionally mild light or sound sensitivity
- Tell: Tender muscles at the base of the skull and across the shoulders; often builds through the afternoon
Cervicogenic Headache
- Location: One side, and the same side every time; starts at the base of the skull and moves forward
- Quality: Steady ache, sometimes deep and boring behind the eye
- Intensity: Moderate to severe
- Activity: Provoked by neck movement or sustained neck positions
- Other symptoms: Reduced neck rotation; sometimes same-side shoulder or arm discomfort
- Tell: Pressing the right spot at the base of the skull reproduces your familiar headache
Migraine
- Location: Often one side, but it can switch sides between attacks
- Quality: Throbbing or pulsating
- Intensity: Moderate to severe, and frequently disabling
- Activity: Routine activity makes it worse; people want to lie still in the dark
- Other symptoms: Nausea or vomiting, marked light and sound sensitivity, sometimes visual aura beforehand
- Tell: Attacks last four hours to three days and follow a recognizable pattern of triggers
The Three Questions That Sort Most Cases
Does it always stay on the same side? Side-locked headaches point strongly toward cervicogenic. Migraines commonly alternate sides across attacks, and tension headaches are usually bilateral.
Does routine activity make it worse? If climbing a flight of stairs meaningfully worsens the pain, that leans migraine. If you can keep working through it, that leans tension-type.
Can you provoke it with your neck? If turning your head, backing out of a driveway, or an hour at your desk reliably brings it on, the neck is involved regardless of what else is going on.
When to Seek Immediate Medical Attention
None of the above applies to a sudden, severe headache that peaks within seconds. That is an emergency, and so is a headache with fever and stiff neck, or one with confusion, weakness, numbness, slurred speech, or vision changes. Also seek prompt care for a headache after a head injury, a brand-new headache pattern beginning after age 50, or a headache that consistently worsens when you lie down, cough, or strain. Part of any good headache evaluation is confirming that none of these apply.
Two Complications Worth Knowing About
They overlap. Plenty of people have more than one headache type, and having migraines does not protect you from also having a neck-driven headache. In fact, neck involvement is common in migraine sufferers. Many patients discover that treating the cervical component reduces how often the migraines fire, even though the migraine itself is a separate condition.
Medication can become the cause. Taking pain relievers on more than roughly ten to fifteen days a month can produce medication-overuse headache, where headaches grow more frequent as the medication grows less effective. This one hides well, because each individual dose does provide relief. If your headache frequency has climbed alongside your medication use, that is the pattern to look into, and it is worth doing with your physician, since unwinding it should not be attempted abruptly.
Which Ones Respond to What We Do
Cervicogenic headache is the strongest case. Cervical manipulation paired with deep neck flexor training has solid evidence behind it for exactly this condition, and results are often noticeable early.
Tension-type headache also responds well, because the muscular and joint contributors driving it are directly treatable through adjustment, myofascial release, and dry needling of the suboccipital and upper trapezius trigger points.
Migraine is a neurological condition and we do not claim to cure it. What the research does support is that chiropractic care can reduce attack frequency for some patients, and that treating a coexisting neck problem often helps meaningfully. We work alongside your physician rather than in place of them.
Cluster headache needs medical management. If your exam points that direction, we will tell you and refer.
What You Can Do Before Your Appointment
Keep a headache log for two weeks. Note the date, what time it started, how long it lasted, where the pain was, what you were doing beforehand, and anything you took for it. Two weeks of that log is more diagnostically useful than almost anything else you can bring us, because headache patterns are far easier to see on paper than to recall in an exam room. Add a running count of medication days. That number alone occasionally reframes the whole picture.
Frequently Asked Questions
Can you have more than one type of headache?
Yes, and it is common. Tension-type and cervicogenic headaches frequently coexist, and many migraine sufferers also have a neck-driven component. Treating the neck component often reduces overall headache burden even when migraine remains part of the picture.
How do I know if it is a migraine?
The strongest indicators are moderate to severe throbbing pain made worse by routine activity, accompanied by nausea or by pronounced light and sound sensitivity, with attacks lasting from four hours to three days. Visual aura beforehand makes it more likely still. Diagnosis should be confirmed by a physician.
Do I need a scan to find out what kind of headache I have?
Usually not. Headache type is determined primarily by history and physical examination. Imaging becomes appropriate when red flags are present or the examination suggests something structural.
What if my headaches do not match any of these?
Then it is worth being examined rather than guessing. There are less common headache types, and some headaches originate outside the head entirely, and the jaw and the sinuses are two examples. A thorough history sorts most of it out.
Should I see a chiropractor or a neurologist?
It depends on what the pattern suggests. Neck-driven and muscular headaches are squarely in our lane. Migraine, cluster headache, and anything with neurological red flags belong with a physician, and we refer readily. These are not mutually exclusive. Plenty of patients benefit from both, and coordinated care is usually better than choosing sides.
Get Your Headaches Evaluated in Racine
If you have been treating the wrong kind of headache, no amount of persistence will make that treatment work. An examination sorts it out. We serve patients throughout Racine, Mt. Pleasant, and Caledonia, and Dr. Stefany Cruz provides bilingual care. Se habla español. Daniels Chiropractic has taken care of Racine families since 1948, with more than 800 patient reviews and a 5.0 rating on Google. If you are in pain today, we try to get you in the same day. Call or text (262) 638-9999, or schedule online today.