Tension Headache vs Cervicogenic Headache: Key Signs

Two common headaches can feel alike, but they start in different places. Here is how to tell them apart and what tends to help each one.

Is your headache a tension headache, or is it coming from your neck? A tension headache usually feels like a tight band or pressure on both sides of the head, while a cervicogenic headache usually starts in the neck, sits on one side and gets worse with certain neck movements.

Headache disorders are very common: the World Health Organization estimates they affect about 40% of people worldwide. The two types in this guide can overlap, and even specialists sometimes find them hard to separate. This guide explains the typical signs of each, what causes them, how they are treated, and the warning signs that mean you should get medical help right away.

In this article

• What is the difference between a tension headache and a cervicogenic headache?
• Tension headache vs cervicogenic headache at a glance
• What is a tension headache?
• What is a cervicogenic headache?
• Why the two are easy to confuse
• How each type is treated
• When to see a doctor urgently
• FAQ
• References

What Is the Difference Between a Tension Headache and a Cervicogenic Headache?

The main difference is where the headache comes from. A tension headache is a primary headache, meaning it is not caused by another condition, and it is the most common type of headache. A cervicogenic headache is a secondary headache, caused by a problem in the neck such as the joints, discs or soft tissues of the cervical spine.

That difference shapes the pattern of pain. Tension headaches tend to be on both sides with a pressing quality. Cervicogenic headaches tend to stay on one side, often come with neck pain and stiffness, and can be brought on by moving the head or pressing on certain neck muscles.

Tension Headache vs Cervicogenic Headache at a Glance

These are typical features, not strict rules. Your own symptoms may not fit neatly into one type.

• Where it starts. Tension headache: not caused by another condition; cervicogenic headache: a disorder of the neck (joints, discs or soft tissues).
• Location. Tension headache: usually both sides of the head, a band or pressure feeling; cervicogenic headache: usually one side that stays the same, often spreading from the back of the head to the front.
• Feel. Tension headache: dull, pressing or tightening, mild to moderate; cervicogenic headache: usually comes with neck pain and reduced neck movement.
• What makes it worse. Tension headache: not made worse by routine activity like walking or stairs; cervicogenic headache: neck movements, sustained postures or pressure on neck muscles.
• Common triggers. Tension headache: stress, sleep problems, caffeine; cervicogenic headache: a problem in the neck itself.
• How it changes over time. Tension headache: episodes of 30 minutes to several days; cervicogenic headache: tends to improve as the underlying neck problem improves.

What Is a Tension Headache?

A tension headache, also called a tension-type headache, causes mild to moderate pain that many people describe as a tight band around the head.

Tension headache symptoms

Common signs include:

• Pain on both sides of your head, face or neck
• A feeling of pressure or tightness across the forehead, sides or back of the head
• Tenderness in the scalp, neck and shoulder muscles
• Being able to carry on with daily activities without making the pain worse

Tension headaches do not usually cause nausea or vomiting. You may notice some sensitivity to light or to noise, but not usually both. Episodes last at least 30 minutes and can go on for several days.

Episodic vs chronic tension headaches

Doctors divide tension headaches into episodic and chronic types. Episodic tension headaches happen on fewer than 15 days a month. Chronic tension headaches happen on 15 or more days a month for at least three months, and may feel almost constant.

What causes tension headaches?

The exact cause is not well understood. Experts once thought tight muscles in the head and neck were to blame, but research suggests muscle contraction is not the main cause. The leading theory is that people with tension headaches have a more sensitive pain system, which may also explain the muscle tenderness.

Stress is the most commonly reported trigger. Sleep problems and caffeine are other common culprits. Taking painkillers too often or for too long can also cause headaches, known as medication overuse or rebound headaches.

What Is a Cervicogenic Headache?

A cervicogenic headache is a headache caused by a disorder of the cervical spine, which includes the bones, discs and soft tissues of the neck. It is usually, though not always, accompanied by neck pain.

The pain is felt in the head because nerves from the upper neck and nerves that carry sensation from the head and face meet in the same area of the brainstem. So a problem in the upper neck can be felt as pain in the head.

Cervicogenic headache symptoms

Features that point towards a cervicogenic headache include:

• Pain on one side that does not switch sides
• Headache brought on by neck movement, awkward postures or pressure on neck muscles
• Pain that starts at the back of the head or neck and spreads forward
• Reduced range of movement in the neck
• Neck pain alongside the headache

None of these features is unique to cervicogenic headache, so they suggest the diagnosis rather than prove it.

How common is cervicogenic headache?

Estimates vary widely depending on the criteria used. One review estimated that cervicogenic headache affects about 0.4% to 2.5% of the general population, and as many as 15% to 20% of people with chronic headaches.

How is it diagnosed?

There is no single test. Diagnosis relies on a careful history and examination that link the headache to a neck problem. For example, the headache began around the same time as the neck problem, improves as the neck improves, or is made worse when the neck is moved or pressed. Imaging can help in some cases, but changes in the upper neck are common in people who have no headaches at all, so a scan alone does not confirm the cause.

Not sure which pattern fits your headaches? A physiotherapist can assess your neck, posture and headache history and help you work out a plan.

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Why the Two Are Easy to Confuse

Tension and cervicogenic headaches share many features. Both can come with neck pain, tender muscles and stiffness, and both can be triggered by long hours at a desk or screen.

The international headache classification notes that headaches linked to tender neck muscles are usually classed as tension-type headaches, and that many cases overlap the two categories, which can make diagnosis challenging. People can also have more than one type of headache, including migraine. If you want to understand how migraine fits in, read our guide to migraine vs headache.

Keeping a headache diary can help. Note when each headache starts, where you feel it, how long it lasts, what you were doing and any medicine you took. Bring it to your doctor or physiotherapist.

How Each Type Is Treated

Treatment depends on the type of headache and what is driving it, so getting the right diagnosis matters.

Treating tension headaches

Many tension headaches can be managed at home:

• Over-the-counter painkillers such as paracetamol (acetaminophen), ibuprofen or aspirin, used occasionally and as directed. Ask a pharmacist if you are not sure which is right for you.
• Regular exercise and relaxation, such as yoga, deep breathing or massage
• Better sleep habits if poor sleep is a trigger
• Cutting down on caffeine
• A low, firm pillow and heat or cold packs if you also have neck pain

For frequent headaches, a doctor may suggest stress management techniques such as cognitive behavioural therapy or biofeedback, or a preventive medicine such as low-dose amitriptyline.

Physiotherapy is another option. A 2022 network meta-analysis found that combining hands-on techniques such as joint mobilisation with exercise was among the most effective physiotherapy approaches for reducing tension headache frequency and intensity in the short term. The authors noted that more research is needed on long-term effects.

Treating cervicogenic headaches

Because the source is the neck, treatment usually focuses on the neck. Cervicogenic headache often does not respond well to common headache medicines.

Physiotherapy has some of the strongest evidence. In a randomized controlled trial of 200 people with cervicogenic headache, six weeks of manual therapy, a specific low-load neck exercise program or both reduced headache frequency and intensity, and the benefits lasted at 12-month follow-up. Combining the two was not significantly better than either one alone, though 10% more people gained relief with the combination.

A physiotherapy plan for cervicogenic headache may include:

• Gentle mobilisation of the upper neck joints
• Exercises to strengthen the deep neck flexor muscles and improve control
• Posture and workstation advice
• Strategies to stay active while symptoms settle

If you would like to explore hands-on care for neck-related headaches, learn about our approach to headache relief with physiotherapy.

When to See a Doctor Urgently

Most headaches are not a sign of anything serious, but some need prompt care. Call 911 or go to the nearest emergency department if you have:

• A sudden, very severe headache
• A headache after a head injury, especially if it is getting worse
• A headache with fever, a stiff neck, confusion or a seizure
• A headache with double vision, loss of vision, weakness, numbness or trouble speaking

Book a visit with your doctor if you need headache medicine more than twice a week, you have headaches several times a week, a headache is not getting better with self-care, or your usual headache pattern changes.

FAQ

How do I know if my headache is coming from my neck?

Clues include pain on one side that does not switch sides, neck pain or stiffness, reduced neck movement, and a headache that is triggered by moving your neck or holding a posture. These signs are not unique to cervicogenic headache, so a proper assessment is the best way to know.

Can a tension headache cause neck pain?

Yes. Tension headaches often come with tenderness in the scalp, neck and shoulder muscles. Neck pain on its own does not mean your headache is cervicogenic.

How long does a tension headache last?

A tension headache lasts at least 30 minutes and can last several days. If you have headaches on 15 or more days a month for three months or longer, it is considered chronic.

Can physiotherapy help cervicogenic headaches?

Yes, for many people. A large randomized trial found that manual therapy and specific neck exercises reduced cervicogenic headache frequency and intensity, with benefits lasting a year.

Can poor posture cause headaches?

Bad posture is listed by the NHS as a common cause of headaches. Long periods in one position, such as at a desk or on a phone, can also aggravate a neck problem that drives cervicogenic headache.

Is it safe to keep taking painkillers for headaches?

Occasional use as directed is usually fine, but taking painkillers too often or for too long can cause medication overuse headaches. See your doctor if you need them more than twice a week.

Book a Headache Assessment

If headaches keep coming back, our physiotherapists can assess your neck, posture and headache pattern, explain what is likely driving your symptoms and build a plan to help. We are open 8 am to 8 pm at our clinic near Brentwood in Burnaby.

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References

• Tension headaches. NHS, reviewed 2025.
• Headaches. NHS.
• Tension headache: Symptoms and causes. Mayo Clinic, 2026.
• 2.1 Infrequent episodic tension-type headache. International Classification of Headache Disorders, 3rd edition (ICHD-3), International Headache Society.
• 11.2.1 Cervicogenic headache. ICHD-3, International Headache Society.
• Cervicogenic headaches: a critical review. Haldeman S, Dagenais S. The Spine Journal, 2001.
• A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Jull G, et al. Spine, 2002.
• Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache: a systematic review and network meta-analysis. Cephalalgia, 2022.
• Migraine and other headache disorders. World Health Organization, 2025.