Headache Versus Migraine

Question: My doctor just told me that I don’t get migraines; he says that they are just regular headaches. My headaches are very severe, so what is the difference between my headache and a migraine headache?
Author: Scott M. Fishman, MD

Answer:

Most everyone experiences a headache every now and then. A headache, which can simply produce a slight aching sensation in our heads, can also produce such intense pain in some people that it may feel as though their heads are in a tight vice, with throbbing pain and no end in sight. While most of us suffer from mild headaches once in awhile, some people suffer from severe headaches and find their lives significantly disrupted by the pain and other problems that these headaches cause.

The International Headache Society (IHS) has classified different types of headaches into categories, in an effort to better define and understand them all. The IHS classification is known throughout the world and doctors follow these categories and definitions in order to determine if a patient is suffering from a regular headache or a migraine. Regular headaches are much more common than migraines, and it is estimated that approximately 28 million Americans suffer from migraine headaches each year.

Headaches can be very tricky for doctors to diagnose and sometimes equally difficult to treat. They can disguise themselves with many different causes and many different symptoms. It is also common for patients to actually suffer from more than one type of headache. This mixture of different types of headaches is an additional challenge for finding the most effective treatment to stop the underlying pain.

Medical researchers have determined that there are at least twelve major types of headaches and they have also uncovered approximately sixty or more different subtypes that fall into one of these twelve categories. The most common types of headache range from a tension headache, a caffeine withdrawal headache, a hunger headache, a menstrual headache, an alcoholic hangover headache, a headache that is caused by eyestrain, a sinus headache, an “ice cream headache”, or a temporal mandibular headache, also known as a TMJ headache. Many headaches are due to fatigue or lack of sleep. Emotional stress and symptoms of depression can also cause headaches, while even certain types of foods have found to be potential contributing factor. Doctors most often treat patients with tension headaches, rebound headaches, cluster headaches, post-traumatic headaches, or those that are classified by the IHS as migraines.

A headache usually starts with a feeling of gradual pressure or tightness in the head. This dull ache can then increase, and sometimes feels as though there is a tremendous amount of pressure – similar to a pressure cooker. Commonly, headaches are felt on both sides of the head, which is one of the key diagnostic features differentiating a non-migraine headache from a migraine headache -- migraines are usually felt only on one side of the head. Tension headaches can last for several hours or days, can happen every day, or only once per week or less frequently. Migraines also usually range from occurring every few days or as infrequently as once or twice a year. The pain from a migraine may also last for many hours and up to several days at a time. Migraines may start early in the morning, or may even start in the middle of the night, causing the patient to awaken from the excruciating pain.

Nausea, vomiting, and difficulty in being able to think clearly can many times accompany a migraine headache, but these symptoms are rarely associated with the average tension headache. In addition to these symptoms, migraines (and sometimes tension headaches) can also cause a sensitivity to light (which is called photophobia) and/or sensitivity to sounds or loud noises (which is called phonophobia.) Migraines and other types of headaches can also be so bad that just standing up out of a chair and slowly walking across a room can make the throbbing pain much, much worse.

Before their head pain even starts, patients may experience a non-painful sensation, called an aura. This aura can be a visual sensation like forms of lights or colors. Auras don’t always occurs. In fact, migraines without these auras are the most common type that patients experience.

There has been extensive research completed over the past ten years to determine the cause of headaches, and to find better drugs to treat them. While females are found to be three times more likely to have headaches, doctors believe that female hormones may, at times, play a role in their cause. This important finding has helped research direct efforts to drugs that counteract the powerful effects of these hormones. Migraines have also been found to run in families, and researchers are now exploring the possibility of finding the “migraine gene” in hopes or targeting more effective treatments.

Those who have recurrent headaches, or who finds that their headaches prevent them going about their routine daily activities, should seek help from their doctors. Immediate attention from a physician is required if the headache is particularly severe, such as the worst headache of your life, so much pain that you feel physically incapacitated, or stiff neck and/or fever. Also seek help if the headache is associated with any change in your neurological function, such as any paralysis, numbness, slurred speech, or loss of sight. It is important for physicians to determine that the headache is not related to any other type of physical problem that could be causing the pain. But rest assured that while most patients with a severe new headache fear that they might have a brain tumor or other neurological disorder, these serious problems are extremely rare. Your physician can best determine the type of headache you are experiencing and may then be able to prescribe an effective treatment to combat the pain.

June, 2004