Tension Headache or Migraine? How to Tell the Difference and When Bodywork Helps

I have had migraines since I was a teenager. I also spent years assuming every bad headache was a migraine, because that was the only word I had for it. It was not until I understood the difference between a tension headache and a migraine that I understood why some of my headaches responded to one thing and some responded to another. That distinction is not academic. It changes what actually helps.

People use the two words interchangeably, but they are different conditions with different mechanisms. Knowing which one you are dealing with tells you a great deal about what kind of help to look for, including whether bodywork is likely to do anything for you.

What a tension headache actually is

A tension-type headache is the most common kind of headache there is. It usually shows up on both sides of the head. It feels like pressure or tightening, a band around the head or a vise, rather than a pounding. It is usually mild to moderate. It does not typically get worse when you move around, and it does not usually come with nausea. What it does come with, very often, is tenderness and tightness in the muscles of the neck, shoulders, jaw, and the base of the skull.

That last part is the key, because it tells you where a tension headache comes from. The muscular and myofascial tissue of the head and neck is doing too much, for too long, and the headache is the result. Stress, posture, screen time, clenching, and jaw tension all feed it.

What a migraine actually is

A migraine is a neurological event, not a muscle problem. It tends to be moderate to severe. It is often, though not always, on one side. It frequently pulses or throbs rather than pressing. It usually gets worse with physical activity, which is why people want to lie still in a dark room. It often comes with nausea, sensitivity to light, and sensitivity to sound. Some people get aura, the visual or sensory disturbance that can precede the pain.

A migraine involves the nervous system and the vascular system in ways researchers are still mapping. It is not simply a worse version of a tension headache. It is a different thing happening in the body, which is why it does not respond to the same interventions in the same way.

Why the difference matters for whether bodywork helps

Here is the part that matters for what I do. Tension headaches are, at their root, a soft tissue problem. When the muscles of the neck, shoulders, jaw, and occiput are chronically tight, releasing that tension addresses the actual cause. This is the kind of headache where skilled bodywork can do a great deal, because it is working directly on the tissue generating the pain.

Migraines are more complicated. Bodywork does not treat the underlying neurological mechanism of a migraine, and I will not tell you that it does. What it can do is address the things that trigger or worsen migraines in people who are already prone to them. Neck and jaw tension are common migraine triggers. Nervous system overload is a common migraine trigger. For many of my clients who get migraines, reducing the muscular and nervous system load lowers how often the migraines come, even though the work is not touching the migraine mechanism itself. I have written in much more detail about whether MLD can help migraine, including the newer research on cervical lymphatics and the glymphatic system.

The honest framing is this: for tension headaches, bodywork can work on the cause. For migraines, bodywork can work on the triggers. Both are worth doing. They are just different claims, and I think you deserve to know which one you are getting.

The overlap nobody tells you about

Most people do not fit neatly into one box. You can have both. Frequent tension headaches can trigger migraines in people who are prone to them, and the muscular tension that drives a tension headache can sit right alongside a migraine disorder. Jaw tension and TMJ dysfunction feed both. This is why I do so much work at the intersection of the jaw and the head, and why buccal massage for TMJ comes up so often when people come to me for headaches.

When a client comes to me with headaches, I am not trying to diagnose which kind they have. That is not my job. What I am doing is feeling for the tissue that is contributing, the tight cervical muscles, the locked-up jaw, the shoulders that have been up around the ears for a decade, and working on what I can actually affect. My post on why jaw tension causes headaches goes deeper on that mechanism.

When a headache needs a doctor, not a massage

Some headaches are signals, not just pain. A headache that is the worst of your life and came on suddenly, a headache with fever and a stiff neck, a headache after a head injury, a headache with confusion, weakness, vision loss, or difficulty speaking, or a brand new headache pattern in someone over fifty all need medical evaluation, not a massage appointment. If your headaches are new, changing, or escalating, see a doctor first. Bodywork is for the chronic, muscular, stress-driven headaches that you and your doctor already understand.

Where I fit

I work on tissue, fluid, and the nervous system. For tension headaches, that means releasing the muscular and myofascial tension generating the pain. For migraines, that means lowering the muscular and nervous system load that can trigger them, and supporting the lymphatic and parasympathetic systems that help your body settle. I am not a neurologist and I do not replace one. What I am is a skilled set of hands for the part of the headache picture that is actually about tissue and tension.

If you live with headaches and are not sure what kind they are or what might help, you are welcome to book a session or reach out. I serve Morris County and northern New Jersey.

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Morgan Larson, LMT, CMLDT

Owner, Firm and Flourish Lymphatic Therapies

Kinnelon, NJ | Serving Morris County