“Is this a headache or a migraine?” It’s one of the most common questions we hear from patients in our Tampa clinic — and the answer matters, because the two conditions respond differently to treatment. Understanding which type you’re dealing with is the first step toward real relief.
The Key Differences
Tension Headaches
- Dull, pressure-like pain — often described as a “tight band” around the head
- Usually affects both sides of the head
- Mild to moderate intensity
- Often linked to neck and shoulder tension, stress, or poor posture
- Doesn’t typically cause nausea or light sensitivity
Migraines
- Throbbing or pulsing pain, often on one side of the head
- Moderate to severe intensity — frequently disabling
- Often accompanied by nausea, vomiting, or sensitivity to light and sound
- May be preceded by an “aura” (visual disturbances, tingling, etc.)
- Can last anywhere from 4 hours to several days
Cervicogenic Headaches (Often Mistaken for Migraines)
- Pain starts at the base of the skull or neck and radiates forward, often to one side
- Worsens with certain neck movements or positions
- Frequently accompanied by neck stiffness
- Can mimic migraine symptoms closely, which is why proper evaluation matters
Why the Distinction Matters for Treatment
Tension headaches and cervicogenic headaches are largely mechanical — driven by muscle tightness, joint restriction, and posture — which makes them highly responsive to physical therapy techniques like manual therapy, postural correction, and targeted strengthening.
True migraines have a stronger neurological and vascular component. While physical therapy alone won’t eliminate migraines, addressing neck tension and posture can reduce how often they’re triggered and how intense they feel, especially for patients whose migraines are worsened by cervical dysfunction.
How We Evaluate Which Type You Have
During your evaluation, we assess:
- Neck range of motion and whether it reproduces your headache pain
- Palpation of neck and shoulder muscles to check for trigger points and tightness
- Postural patterns that may be contributing to muscle overload
- Headache pattern and triggers — timing, location, associated symptoms
- Response to specific movement tests that help distinguish cervicogenic pain from vascular/neurological headache types
This assessment helps us determine whether physical therapy alone is likely to resolve your symptoms, or whether we should coordinate care with a physician or neurologist for a comprehensive migraine management plan.
Frequently Asked Questions
Can a physical therapist diagnose migraines? Physical therapists don’t diagnose migraines in the medical sense, but we’re trained to identify cervicogenic and tension-type headache patterns and can help determine whether your symptoms are likely coming from the neck versus a primary headache disorder like migraine.
Can physical therapy make migraines less frequent? For many patients, yes — especially when neck tension and posture are contributing triggers. Reducing that mechanical load can lower migraine frequency and severity, even though PT doesn’t treat the underlying neurological cause directly.
What’s a cervicogenic headache exactly? It’s a headache caused by a problem in the neck — typically the upper cervical joints, discs, or surrounding soft tissue — that refers pain up into the head. It’s one of the most treatable headache types with physical therapy.
Should I see a physical therapist or a neurologist first? If your headaches are clearly linked to neck stiffness, posture, or started after an injury, physical therapy is a great first step. If you’re experiencing classic migraine symptoms (aura, severe nausea, light sensitivity) that significantly disrupt your life, a combined approach with your physician is often best.
Find Out What’s Really Causing Your Headaches
Our Tampa physical therapy team can help you pinpoint exactly what type of headache you’re dealing with — and build a treatment plan around it. Schedule your evaluation today.
