Tension Headaches vs. Migraines: How to Tell the Difference (Matthews NC)
Written by Dr. Trenton McDaniel, D.C. (Pierce Results System Certified) — MCH Chiropractic and Nutrition, Matthews, NC
Medically reviewed by Dr. Paola Vinas Joy, D.C. (Webster Certified)
Last updated: September 2026
Not all headaches are the same — and treating them like they are is why so many people stay stuck.
Two of the most common types, tension headaches and migraines, feel different, behave differently, and respond to different things. Here’s how to tell them apart, and where the neck and nervous system fit in.
Tension Headaches
Tension-type headaches are the most common kind. They usually feel like:
A dull, tight, band-like pressure around the head
Pain on both sides, not throbbing
Tightness in the neck, shoulders, and the base of the skull
Triggered or worsened by stress, posture, and long hours at a screen
Tension headaches are closely tied to muscle tension and how well your neck is functioning — which is exactly why they’re often connected to what’s happening in your spine.
Migraines
Migraines are a neurological condition — not just a “bad headache.” They often involve:
Throbbing or pulsing pain, frequently on one side
Nausea or vomiting
Sensitivity to light and sound
Sometimes visual changes or “aura” beforehand
Pain severe enough to interrupt normal activity
Migraines need a proper medical diagnosis. We do not diagnose or treat migraines as a condition — but many migraine sufferers also carry neck dysfunction, and we work alongside their medical team, not instead of it.
The Overlap Most People Miss
Here’s what makes this tricky: the two can overlap. Neck tension can trigger or worsen headaches in people who also get migraines, and the upper neck plays a role in both.
That’s why we don’t just ask “which headache is this?” — we ask “is your neck and nervous system part of the problem?” Because if it is, that’s something we can objectively measure and address.
Red Flags: When to Seek Medical Care First
See a physician or go to the emergency room if a headache is sudden and severe, comes with fever and a stiff neck, follows a head injury, brings weakness, numbness, vision loss, trouble speaking, or a drooping face, or is a brand-new headache pattern after age 50. These need medical evaluation before anything else.
How We Evaluate Headaches at MCH
For the common, mechanical headaches tied to the neck, we look for the root cause instead of guessing:
A thorough history and exam of how your neck moves and functions
A Tytron thermography scan — objective measurement of nervous system stress along the spine
Digital Motion X-Rays (DDR) if needed — your neck in motion, showing stuck or unstable segments
A clear report of findings, in plain English
Most chiropractors near Charlotte don’t use both thermography and motion X-rays. We do — because “your neck looks fine” on a still image misses how it’s actually moving.
What the Research Suggests
Research and clinical guidelines suggest spinal manipulation and specific neck-focused care may help reduce how often and how intensely tension-type and neck-related headaches occur for many people. Results vary, and no honest provider promises an outcome. What we promise is an objective look at whether your neck is part of the problem.
Common Questions
Can chiropractic care help migraines?
We don’t treat migraines as a condition — that’s a medical diagnosis. But many migraine patients also have neck dysfunction that may contribute to their symptoms, and addressing it can be part of a broader plan coordinated with their medical team. Results vary.
How do I know if my neck is causing my headaches?
Neck-related headaches often start at the base of the skull, worsen with certain postures, and come with neck stiffness. Our exam, thermography scan, and motion X-rays give objective findings rather than a guess.
Get a Straight Answer About Your Headaches
Our $89 Find-Out Visit includes a full consultation, nervous system evaluation, Tytron thermography scan, motion X-rays if needed, and a clear report of findings.
Schedule your Find-Out Visit here: https://www.mchchiropracticnutrition.com/new-patient-chiropractor-matthews
Or call us at (704) 727-6131.
MCH Chiropractic and Nutrition — 7800 Stevens Mill Rd Ste F, Matthews, NC 28104. Serving Matthews, Indian Trail, Mint Hill, Stallings, Ballantyne, and South Charlotte.
— Dr. Trenton McDaniel, D.C.
