Tension Headaches vs. Migraines: How to Tell Them Apart and What May Help

You feel a headache coming on and immediately start doing the mental checklist.

Did I drink enough water? Is it because I've been staring at my laptop all day? Am I stressed? Is this a migraine?

Sometimes you know exactly what kind of day you're in for.

Other times, it's genuinely hard to tell.

Tension-type headaches and migraines can share some symptoms, and it's even possible for the same person to experience both. But there are a few differences that can help you start recognizing your own pattern.

And that's really the goal here.

Not diagnosing your headache from a blog post, but helping you understand what your body has been telling you.

First, what does a tension-type headache usually feel like?

Think more pressure or squeezing than pounding.

Maybe it feels like there's a band around your head. Maybe you notice pressure on both sides, or your head just feels heavy after a long day.

The International Headache Society describes tension-type headaches as typically mild to moderate, pressing or tightening rather than pulsating, and commonly affecting both sides of the head. Everyday activity, like walking or taking the stairs, doesn't usually make the headache significantly worse.

You might also notice tenderness around your head or neck.

And despite the name, having a tension-type headache doesn't necessarily mean you were simply "too tense" or stressed.

That's an easy assumption to make, but tension-type headache is an actual headache disorder. Stress or muscular tension may be part of someone's experience, but the name doesn't give us one simple cause.

How does a migraine tend to feel different?

This is where people sometimes say, "Oh, I don't get migraines. My headaches aren't that bad."

But migraine isn't defined simply by having an extremely painful headache.

Migraine is a neurological disorder with a particular pattern of symptoms.

According to the International Headache Society, a typical migraine without aura can last anywhere from 4 to 72 hours when untreated or unsuccessfully treated. The pain is often moderate to severe and may be pulsating or throbbing. It's also commonly one-sided, although that isn't a requirement every single time.

Then there are the symptoms that come along for the ride.

Nausea or vomiting can happen.

Light might suddenly feel way too bright.

Sounds that normally wouldn't bother you can become incredibly annoying.

And something as ordinary as walking up the stairs may make the headache feel worse.

That last part can actually be a useful clue.

With a tension-type headache, you may still be able to carry on with your day even though you'd rather not have the headache.

With migraine, normal activity may make you want to stop what you're doing altogether.

What about that weird visual stuff some people get?

That's called an aura, and some people with migraine experience one.

You may have heard someone describe seeing flashing lights, zigzags, blind spots, or other visual changes before a migraine.

Aura can also involve other temporary neurological symptoms, and it typically develops before or around the headache.

But here's an important distinction:

You do not need to experience aura to have migraine.

Migraine without aura is its own recognized diagnosis.

So if you've always assumed, "I don't see flashing lights, so it can't be migraine," that isn't necessarily true.

A quick way to think about the difference

Rather than focusing on one symptom, look at the whole experience.

A tension-type headache more commonly sounds like:

"My head feels tight and achy, but I can still get through my day."

Migraine may sound more like:

"My head is throbbing, the lights are bothering me, I feel nauseous, and moving around makes everything worse."

Of course, real life doesn't always fit neatly into those two sentences.

Tension-type headaches and migraines can overlap, and the International Headache Society specifically notes that people can experience both headache disorders.

That's why one symptom by itself isn't enough to diagnose what's happening.

"But my neck hurts when I get a migraine too"

This is an important one.

If your neck gets sore around the same time as your headache, it's tempting to assume:

My neck must be causing the migraine.

Not necessarily.

Neck pain and stiffness can actually be part of the migraine experience. The International Headache Society includes neck stiffness and/or pain among symptoms that can occur before or after a migraine attack.

So neck pain during migraine doesn't automatically tell us where the migraine "came from."

At the same time, there are other headache disorders that can be related to structures in the neck.

This is exactly why recurring headaches deserve a little more curiosity than simply assuming every headache that comes with a sore neck is a "tension headache."

Keeping a headache diary can tell you a lot

You don't need anything fancy.

The notes app on your phone works perfectly well.

When you get a headache, jot down a few things:

• When did it start?

• How long did it last?

• Was it on one side or both?

• Was it pressure-like or throbbing?

• Did movement make it worse?

• Did you feel nauseous?

• Did light or sound bother you?

• Did you notice neck discomfort?

• What helped?

You may start seeing patterns that are hard to notice when you're just trying to get through the headache.

The International Headache Society actually recommends headache diaries when tension-type headache and migraine may coexist because distinguishing between them can matter for choosing appropriate treatment.

Can massage help with tension-type headaches?

This is one of those questions where the most accurate answer is: maybe for some people, but the research isn't strong enough to promise it.

If your headaches happen alongside neck or shoulder soreness, massage may feel good and help you relax.

But that isn't the same thing as saying massage treats the underlying headache disorder.

Research on manual therapies for headache has produced mixed results, and study quality varies. So we'd rather be transparent about that than tell you massage will "release the tension causing your headaches."

At Hidden Valley Health Centre, massage therapy is tailored to the individual after an initial consultation, which can be useful if neck or shoulder discomfort is part of what you've been experiencing.

Sometimes feeling more comfortable is a worthwhile goal on its own.

Where might chiropractic care fit?

This depends on the type of headache you're experiencing.

If your headaches happen alongside neck pain, stiffness, or difficulty moving comfortably, a chiropractor can assess the musculoskeletal side of the picture and determine whether conservative care is appropriate.

That does not mean every headache is coming from your neck.

And it doesn't mean a chiropractic adjustment is a treatment for every migraine.

That's an important distinction.

At Hidden Valley Health Centre, chiropractic is one of the musculoskeletal services offered alongside physiotherapy and massage therapy.

If the pattern sounds more like migraine, particularly if you're having frequent or disabling attacks, speaking with a physician or nurse practitioner is also important. Migraine has evidence-based medical treatment options, and you shouldn't have to simply keep pushing through attacks.

When should a headache get medical attention?

Most headaches aren't emergencies.

But a headache that is sudden and extremely severe, especially one that reaches maximum intensity very quickly, deserves urgent medical assessment.

The same goes for a new headache accompanied by symptoms such as confusion, fainting, fever with significant neck stiffness, new weakness or numbness, difficulty speaking, or significant changes in vision.

A new or unusual headache following a significant head injury also deserves medical attention.

And even when nothing feels urgent, headaches that are becoming more frequent, changing significantly from your usual pattern, or regularly interfering with work, sleep, school, or everyday life are worth discussing with a healthcare professional.

You don't need to wait until they're unbearable.

Start by noticing the pattern

If you've been calling every headache a "tension headache" because your neck feels tight, it may be worth looking a little closer.

Does the pain press or throb?

Does moving make it worse?

Does light suddenly become your enemy?

Do you feel nauseous?

How long does it last?

And is every headache actually the same?

Sometimes the biggest clue isn't where your head hurts.

It's everything else that happens along with it.

The more you understand that pattern, the easier it becomes to have a useful conversation with the right healthcare provider about what may help next.