Migraine vs Headache: How to Tell Which One You Actually Have

Last updated: August 14, 2026 | Author: Dr. Amanda Myers, DC, MS

People use the words interchangeably. “I get migraines” usually means “my head hurts a lot.” But the migraine vs headache distinction is not semantics — it changes what is driving it, what will help, and whether the thing you have been doing for two years was ever going to work.

What is the difference between a migraine and a headache?

A headache is pain in the head, most often tension-type — both sides, a steady band-like pressure, no nausea, and you can carry on with your day. A migraine is a neurological event — usually one-sided, throbbing, moderate to severe, made worse by movement, and accompanied by nausea or sensitivity to light and sound.

Migraine vs headache: how to tell them apart

	Tension-type headache	Migraine	Cervicogenic (neck-driven)
Where	Both sides, band around the head	Usually one side	Starts at the base of the skull, spreads forward
Feels like	Steady pressure or tightness	Throbbing or pulsing	Dull ache, sometimes behind one eye
Intensity	Mild to moderate	Moderate to severe	Mild to moderate, persistent
Movement	No real change	Clearly worse	Worse with certain neck positions
Nausea, light or sound sensitivity	Rare	Common	Uncommon
Typical length	30 minutes to a few days	4 to 72 hours	Hours to days, often daily
Warning signs before	None	Aura in about a third of cases	Neck stiffness first

The third column is the one most people have never heard of, and it is the one we see most.

Why does location matter so much?

Because where it starts tells you where to look. A headache that reliably begins at the base of your skull and creeps forward over the same eye is not behaving like a migraine, even when it gets severe enough to feel like one.

The upper three cervical segments share nerve pathways with the trigeminal system that supplies your face and head. When those joints lose motion and the muscles around them guard, the brain can misread that input as head pain. It is a real mechanism with a mechanical cause.

This is also why cervicogenic headaches get misdiagnosed as migraine for years. The pain is genuine, the location is convincing, and nobody examined the neck.

What actually triggers each one?

• Migraine: hormonal shifts, disrupted sleep, skipped meals, dehydration, specific foods, weather changes, stress — and often the let-down after stress rather than the stress itself.
• Tension-type: sustained posture, jaw clenching, eye strain, stress, poor sleep.
• Cervicogenic: a specific neck position, a long drive, a night on the wrong pillow, or an old whiplash you had forgotten about.

If your headache diary shows position and posture rather than food and hormones, that is a strong signal about which one you are dealing with.

When should you see a doctor about a headache?

Go to the emergency department immediately for a sudden severe headache that peaks within seconds, a headache with fever and a stiff neck, one following a head injury, or one with confusion, weakness, vision loss or slurred speech.

Get a prompt medical assessment for a headache pattern that has clearly changed, a new headache after age 50, one that is worse lying down or wakes you from sleep, or one accompanied by unexplained weight loss. The National Institute of Neurological Disorders and Stroke lists these among the features that warrant urgent evaluation.

Nothing on this page replaces that assessment.

What can chiropractic care actually help with here?

Honest answer: it depends entirely on which one you have.

Cervicogenic headache is a mechanical problem, and it is the one that responds best. Restoring motion to the upper cervical segments, releasing the suboccipital guarding, and rebuilding deep neck flexor control addresses the actual driver.

Tension-type headache often improves, because sustained posture and jaw and neck tension are usually part of the picture.

Migraine is a neurological condition and we do not claim to treat it. What we can do is remove the cervical contribution, because plenty of people have both — a genuine migraine disorder plus a neck that is generating additional headaches and lowering the threshold for the migraines they do get. Reducing that load is a real gain, not a cure.

That distinction matters. Anyone promising to resolve migraine with adjustments is overselling.

What does an assessment look like in our Lombard office?

We map the pattern first — where it starts, what it feels like, what moves it, what came before. Then we examine the upper cervical spine, the suboccipital tissue, jaw mechanics and thoracic posture, because a neck that cannot move usually has a mid-back that stopped moving first. Your body is compensating.

Where guarding is a major driver we combine massage therapy and chiropractic care, and where pain sensitivity is limiting progress we add acupuncture and chiropractic together. If the pattern points somewhere medical, we refer. If your symptoms recur in a predictable cycle the way back pain keeps coming back, the same root-cause logic applies.

We see patients from Lombard, Glen Ellyn, Wheaton, Villa Park, Elmhurst and across DuPage County.

Migraine vs headache FAQ

How do I know if I have a migraine or just a bad headache?

Three questions separate them most of the time: is it one-sided and throbbing, does routine movement make it clearly worse, and is there nausea or light and sound sensitivity? Two or three yeses point to migraine. Steady pressure on both sides that you can work through points to tension-type.

Can a neck problem cause migraine-like headaches?

Yes. Cervicogenic headache starts at the base of the skull and refers forward, often behind one eye, and can be severe enough to be mistaken for migraine for years. The tell is that neck position changes it.

Can chiropractic care help migraines?

It does not treat migraine itself, which is neurological. It can reduce the cervical contribution when a neck problem is adding headaches or lowering your threshold. Many people have both, and separating them is the point of the assessment.

Why do my headaches always start at the base of my skull?

That is the classic cervicogenic pattern. The upper cervical joints share nerve pathways with the system supplying your face and head, so restricted motion and guarding there can be experienced as head pain.

How long does a migraine last compared to a headache?

An untreated migraine typically runs 4 to 72 hours. Tension-type headaches range from about 30 minutes to several days. Cervicogenic headaches often persist at a lower level for days and can become close to daily.

Should I keep a headache diary?

Yes, and it is the single most useful thing you can bring to an assessment. Log time of day, where it started, what you were doing beforehand, duration, and what helped. Patterns show up in two weeks that no examination reveals in one visit.

Book your New Patient Discovery Assessment

If you have been treating everything as a migraine for years and nothing has moved, the first useful step is working out what you actually have. Book your New Patient Discovery Assessment at True Health Chiropractic and Acupuncture in Lombard.