Tension Headaches and Migraines: How to Tell Them Apart, What Helps and When to Get Checked
It starts as a dull squeeze around your forehead by mid-afternoon. Or it’s a throbbing pain behind one eye that sends you looking for a dark, quiet room. Headaches are very common, and knowing which kind you have is the first step toward finding what helps.
Tension headache, migraine or neck headache?
There are many types of headache. Three of the most common are tension-type headaches, migraines and cervicogenic headaches (headaches that start in the neck). Here’s a rough guide to how they often feel:
| Type | How it often feels | Common clues |
|---|---|---|
| Tension-type | A dull, pressing band or tight cap around the head, usually on both sides | Tight neck and shoulders, stress, long days at a screen. Usually mild to moderate. |
| Migraine | Throbbing or pulsing pain, often on one side, lasting hours to a few days | Nausea, sensitivity to light or sound, worse with activity. Some people see visual changes (an “aura”) beforehand. |
| Cervicogenic (neck-related) | Pain that starts at the base of the skull and spreads forward, usually on one side | Neck stiffness, pain that changes with neck movement or certain positions |
This is a starting point, not a way to diagnose yourself.
Why do headaches happen?
Tension-type and neck-related headaches are often linked to how our muscles and joints are coping. Tight muscles in the neck, shoulders, jaw and scalp can refer pain into the head. Stiff joints in the upper neck can do the same. Long hours at a desk, clenching your jaw, poor sleep and stress all tend to stack up.
Migraine is different. It’s a neurological condition, and it often runs in families. Attacks can be set off by triggers such as missed meals, dehydration, changes in sleep, hormonal changes, bright light, strong smells, alcohol or stress. Our older post on what triggers your migraine covers several common ones.
What can I do at home?
- Keep a headache diary. Jot down when each headache starts, how it feels, what you were doing, what you ate and how you slept. After a few weeks, patterns often show up.
- Keep the basics steady. Regular meals, plenty of water and a consistent sleep schedule (even on weekends) can make a real difference, especially for migraine.
- Take screen breaks. Every 30 minutes, look away from the screen, roll your shoulders and gently turn your head side to side. Raise your monitor so you aren’t looking down all day.
- Relax your jaw. Notice if you clench while you concentrate. Lips together, teeth apart, tongue resting on the roof of your mouth.
- Try heat or cold. A warm pack on the neck and shoulders may ease a tension headache. Some people with migraine prefer a cool cloth on the forehead or neck.
- Use pain medication wisely. Using pain relievers on many days each month can lead to “rebound” headaches. If you’re reaching for them often, talk to your doctor or pharmacist.
When should I get it checked?
Book an assessment if your headaches are frequent, are getting worse, keep you from work or sleep, or come with neck pain and stiffness. If you think you have migraines, see your family doctor as well. Migraine has specific medical treatments, and a diagnosis helps everyone on your care team.
Get medical care right away (see your doctor, or go to emergency) if you have:
- A sudden, severe headache that peaks within a minute, or the “worst headache of your life”
- A headache with fever, a stiff neck, rash or confusion
- A headache after a fall, blow to the head or car accident
- Weakness, numbness, trouble speaking, drooping of the face, loss of balance or vision changes
- A new headache pattern after age 50, or a headache that keeps getting worse over days or weeks
- A headache that wakes you from sleep and comes with vomiting
How we help with headaches
Our team looks for what may be feeding your headaches, especially the neck, shoulders and jaw. We’ll work alongside your family doctor when that’s the right fit. You can learn more on our neck pain and headaches page.
Chiropractic
Our chiropractors assess the joints and muscles of your neck and upper back, which can play a part in tension-type and neck-related headaches. Care may include spinal manipulation or gentler low-force options, soft tissue work, exercises and posture advice. Dr. Tessa Bryan, DC uses soft tissue therapies, instrument-assisted and manual techniques, cupping and therapeutic exercise. Dr. Alexia Grelson, DC has additional training in cranial techniques and is especially interested in helping patients shift out of tension and into ease. Dr. Matthew Bryan, DC takes a collaborative, multidisciplinary approach. Dr. Krisjan Gustavson, DC has been in practice since 1986.
Registered Massage Therapy
Massage therapy can ease tight neck, shoulder, jaw and scalp muscles and may help reduce tension headaches. Craig Lawrence, RMT has practised since 2006 and focuses on trigger point release, often for working professionals dealing with desk-bound aches and tension headaches. Braedan Pearce, RMT uses myofascial release, trigger point release and stretching, with a calming pace that supports stress relief. Alex Baan-Meiklejohn, RMT trained in trigger point therapy and stretching,. Morag Hart, RMT and McKenzie Connell, RMT tailor each treatment to your needs.
Acupuncture
Acupuncture is another option that may help with headaches, muscle tension and the stress that often comes with them. Lauren Ching, R.Ac supports people with pain and stress management, sleep and emotional regulation, using techniques including scalp acupuncture and cupping. Rebecca Thompson, R.Ac, R.TCM.P includes chronic pain, insomnia and mental and emotional health among her clinical focuses. Annie Wang, R.Ac, R.TCM.P works with myofascial tension, postural pain and stress-related concerns. Jun Liu, R.Ac works with musculoskeletal pain, postural concerns and insomnia, and provides care in English, Mandarin and French.
Book an appointment
If headaches are getting in the way of your work, sleep or weekends, we’d be glad to help you sort out what’s going on. We bill most insurance plans directly, so you can focus on feeling better.
Book online or call us at 250-382-0018. You’ll find us at 1063 Fort Street in downtown Victoria.
This article is general information and isn’t a substitute for an assessment by a qualified health professional.
