High pressure processing is a promising non-thermal technology for the development of fresh-like, shelf-stable foods. The effect of high pressure on starch has been explored by many researchers using a wide range of techniques. In general, heat and pressure have similar effects: if sufficiently high, they both induce gelatinization of starch in excess water, resulting in a transition of the native granular structure to a starch paste or gel. However, there are significant differences in the structural and rheological properties between heated and pressurized starches. These differences offer benefits with respect to new product development. However, in order to implement high-pressure technology to starch and starch-containing products, a good understanding of the mechanism of pressure-induced gelatinization is necessary. Studies that are published in this area are reviewed, and the similarities and differences between starches gelatinized by pressure and by temperature are summarized.