Not every headache is the same headache.
Migraine, tension headache, and headaches coming from the neck can feel similar — but they respond to very different treatments. Knowing which one you have is where relief begins.
Migraine, tension headache, and headaches coming from the neck can feel similar — but they respond to very different treatments. Knowing which one you have is where relief begins.
Is this your headache?
Most patients we see have already tried something — and it worked partly, or stopped working. These are the patterns we hear most often.
Several days every month
Headaches frequent enough that you plan around them — work, family, travel
Starts in the neck
Tightness at the base of the skull that climbs up and settles behind the eyes
Light and sound become too much
Needing a dark, quiet room — sometimes with nausea or visual changes beforehand
The medication stopped working
Relief that used to last now fades quickly, and headaches come more often than they used to
Often tension-type headache — steady, tightening, usually without nausea
Often migraine — pulsing, worse with activity, sensitive to light and sound
Often cervicogenic — the pain is felt in the head but originates in the neck
Can suggest occipital neuralgia or nerve-driven pain rather than a primary headache
What could be causing it
Two people with identical symptoms can have entirely different underlying mechanisms. Identifying yours is what makes treatment work.
A neurological condition, not simply a bad headache. Involves changes in nerve and blood vessel activity, often with light sensitivity, nausea, and warning symptoms beforehand.
Steady, band-like pressure on both sides, often linked to sustained muscle tension in the scalp, jaw, neck, and shoulders. The most common headache type overall.
Pain referred into the head from the upper cervical joints or nerves. Frequently misdiagnosed as migraine — and it responds to treating the neck, not the head.
Irritation of the occipital nerves at the back of the head produces sharp, shooting, or electric pain that travels up the scalp, sometimes behind one eye.
Frequent use of acute pain relievers can gradually make headaches more frequent and harder to treat. It's common, often unrecognized, and reversible with a plan.
When headaches persist for years, the nervous system can become increasingly reactive — amplifying pain signals and lowering the threshold for what triggers an attack.
Most headaches are not dangerous. A small number are. Please seek emergency care — not a scheduled appointment — if any of the following apply:
How we evaluate it
There is no single scan that identifies migraine or tension headache. What identifies them is a careful history — which takes time, and which we take.
How often, how long, where it sits, what it feels like, what comes before it, and what you've already tried.
Neurological exam, cervical spine mobility, tenderness over the occipital nerves and muscles — findings that separate one headache type from another.
Prior imaging, medication history, and previous treatments — including what worked briefly and then stopped.
Determine the headache type — or types, since many patients have more than one — and whether medication overuse is part of the picture.
A plan that addresses both the attacks you have now and the frequency going forward, explained clearly before anything begins.
What treatment may look like
Treating the attack matters. Reducing how often attacks happen matters more. We work on both.
Sleep, hydration, caffeine, stress load, and posture all shape headache frequency. Understanding your own pattern is a treatment in itself.
Cervical mobility, postural strengthening, and jaw and shoulder tension work — particularly effective for tension-type and cervicogenic headache.
Separating rescue medication from preventive medication — and, where needed, carefully unwinding medication overuse.
A newer class of preventive treatment developed specifically for migraine. CGRP is a protein involved in setting off an attack, and these medications block its effect. For many patients they reduce how often attacks happen, and they tend to be better tolerated than older preventives that were borrowed from other conditions.
A brief in-office injection near the occipital nerves. Used both to confirm the pain source and to interrupt a persistent headache cycle.
For headaches driven by tight, tender bands in the neck and shoulder muscles that reliably reproduce your headache.
When headaches are confirmed to arise from upper cervical joints, targeted injections and radiofrequency ablation can offer longer-lasting relief.
Common questions
Thousand Oaks, CA
Board-certified in Pain Medicine. Neuroscience-trained. Conservative approach first.
(805) 557-7050Mon–Fri · 8:00 AM – 5:30 PM
558 St. Charles Drive, Suite 110, Thousand Oaks
Frequent migraine?
CGRP Preventive Medication
A preventive class developed specifically for migraine rather than borrowed from another condition — and generally better tolerated because of it.
Learn more →
Related condition
Neck Pain
If your headaches begin at the base of the skull, the cervical spine may be the source. Neck and headache evaluation often go together.
Learn about neck pain →
Treatments for this condition
