What Kind of Headache Do You Actually Have? A Chiropractor's Guide to Tension, Cervicogenic, and Migraine Patterns
In 40 years of treating headaches, the most useful thing I have learned is that "I have a headache" tells me almost nothing. Where it hurts, when it comes, what makes it worse, and what comes along with it tell me a great deal. Two people can describe the same pain and need completely different care.
Most patients who walk in have been calling their headaches "migraines" or "sinus headaches" for years. Sometimes that label is right. Often it is not, and the wrong label means the wrong treatment. This guide walks through the three patterns I see most, how to tell them apart, and what to do about each one.
Why the Type of Headache Matters
Medication works on the pain. It does not tell you where the pain is coming from. If your headache starts in a stiff upper neck, a pill can quiet it for a few hours, but the neck is still stiff tomorrow. If your headache is a true migraine, adjusting your neck will not replace medical care for it.
Getting the type right is the first step toward getting better, and it is why I do an exam before I recommend anything. You can learn a lot on your own, though, so here is what I look for.
Tension-Type Headaches
This is the most common headache there is, and it is the one people most often misdiagnose as something worse.
What it feels like
A steady pressure or tightness, often described as a band around the head
Pain on both sides, usually across the forehead, temples, or the back of the head
Mild to moderate intensity, not the kind that sends you to a dark room
No nausea, and no real sensitivity to light or sound
Tight, sore muscles in the neck, upper back, or shoulders
What is usually behind it
Tight muscles and trigger points in the neck and shoulders, often made worse by long hours at a screen and a head that sits forward of where it should. If that sounds like your workday, these tech neck exercises are a good place to start.
How chiropractic fits
Tension-type headaches respond well to hands-on care for the neck joints and the muscles around them. The goal is fewer headaches and milder ones, not just a faster exit from the one you have today.
Cervicogenic Headaches
This is the headache that gets overlooked the most, and it is the one I see most often in patients who tell me nothing has worked.
What it feels like
Pain that starts at the base of the skull or in the upper neck and travels forward
Often on one side, and usually the same side every time
Pain toward the temple, forehead, or behind one eye
A stiff neck, or noticeably less turning range than you used to have
Headaches that flare with certain neck movements or after holding one position for a long time
What is usually behind it
The joints, muscles, and nerves in the upper neck can send pain signals into the head. The head hurts, but the problem is in the neck. Old injuries are a common source. A car accident or a fall from years ago can leave an upper neck problem that quietly produces headaches long after you stopped thinking about the original injury. If your headaches started after a collision, see my post on headaches after a car accident, and for the injury behind many of them, whiplash.
How chiropractic fits
This is where chiropractic has the strongest case. When the exam confirms the neck is the source, treating the neck is treating the cause. Depending on the findings, that may mean adjustments, low-force techniques for patients who prefer them, traction, or soft tissue work and therapies to calm irritated tissue.
Migraines
Migraines are a neurological condition, and real ones deserve real medical care. They are also one of the most over-applied labels in headache medicine.
What it feels like
Moderate to severe pain, often throbbing or pulsing
Frequently one-sided, though it can switch or affect both sides
Nausea or vomiting
Sensitivity to light, sound, or smells
Pain that gets worse with activity, so you want to lie still
Episodes that last hours to a few days
For some people, an aura beforehand, such as flashing lights or blind spots
Where the neck comes in
Many people with migraines also have a neck problem that adds to them. Stiff upper neck joints, tight muscles, and old injuries can make migraines more frequent, more intense, or harder to shake. That neck component can be found on exam and treated, and for many patients it makes a real difference.
If your headaches are primarily migraine and need medical management, I will tell you that plainly and work alongside your physician. I would rather send you to the right place than keep you here for the wrong reasons.
Two Others Worth Knowing About
"Sinus" headaches
A lot of headaches that people blame on their sinuses are actually migraine or tension-type headaches. True sinus headaches come with other sinus signs, such as thick colored discharge, fever, and congestion that lasts more than a few days. If you get pressure around your forehead and cheeks without those signs, it is worth having the diagnosis checked.
Cluster headaches
These are rare but unmistakable: severe, stabbing pain around one eye, often with a red or tearing eye and a runny nostril on the same side, arriving in cycles. They need medical care. If this describes you, see your physician.
When You Have More Than One Type
This is more common than most people expect. A patient can have tension-type headaches from a stiff neck and migraines on top of it. A patient with a cervicogenic headache can develop tension in the muscles around it. Part of the exam is sorting out which pattern is doing what, because the plan depends on it.
A Simple Way to Sort Out Your Own Pattern
If you have been guessing, keep a headache diary for two to three weeks. It does not need to be fancy. Note:
The date and time the headache started
Where it hurt, and whether it was one side or both
What the pain felt like: pressure, throbbing, stabbing
What you were doing before it started, including long stretches at a desk or driving
Whether turning your head made it better or worse
Anything that came along with it: nausea, light sensitivity, a stiff neck
What you took for it and how long it helped
Bring it with you. It saves time and often points straight at the answer.
A Word About Pain Medication
If you are taking over-the-counter pain relievers on most days of the week, tell your doctor. Frequent use can cause its own pattern of headaches, and it can hide the pattern of the original problem. Do not stop prescribed medication without talking to the physician who prescribed it.
When a Headache Is an Emergency
Most headaches are not dangerous, but some need a hospital, not a chiropractor. Go to the emergency room right away if you have:
A sudden, severe headache unlike any you have had before
A headache with fever, a stiff neck, or confusion
Vision changes, weakness, trouble speaking, or facial drooping
A headache after a blow to the head
What Happens at Your First Visit
I start with your history: where the pain is, how often it comes, how long it lasts, what triggers it, and what comes with it. Then I examine your neck, posture, and range of motion and perform a neurological screening. If the findings call for it, I take high-frequency digital x-rays on site.
By the end of the visit you will know whether your headaches have a neck or soft tissue component, whether I can help, and what a realistic plan looks like. The consultation and exam are free, with no obligation. There are no prepaid packages and no pressure. If your headaches turn out to be something I should not be treating, I will tell you.
For the full picture of how we evaluate and treat headaches here, see our headache chiropractor page. If you are not sure what to look for in a provider, my posts on how to choose a chiropractor and the red flags to watch for are worth a read.
To schedule, call (864) 271-0001 or book online. Early morning hours are available, and we see patients from Greenville, Greer, Taylors, Simpsonville, and Travelers Rest.
Dr. Jeff W. Brown, D.C.
Brown Chiropractic Center, Greenville, SC
