Most everyone can recall having head, face, or upper neck pain that is often associated with headaches. The World Health Organization (WHO) reports that nearly 50 to 75% of adults ages 18 to 65 have experienced a headache within the last year globally, and at least 30% of those reported migraines.
Since there are many types of headaches, it is essential to understand the differences between migraines and other headaches and when to seek medical assistance. Furthermore, knowing the root cause of head pain helps determine the treatment course and cope with reoccurring symptoms.
Health professionals suggest keeping a diary to track headaches from onset to treatment to facilitate effective relief methods, which will assist the patient and physician develop a treatment plan. A headache diary tracks characteristics, intensity, length, situational and organic triggers such as food and beverage ingredients, the treatments used, and their level of success.
The National Headache Foundation explains that using a journal will help identify patterns that will help a doctor determine what type of headache a person has and the most useful treatments. There is no need to buy a journal, as the foundation offers a free ready-to-print headache diary page template.
Headaches are the most common nervous system malady. Yet, a healthcare provider does not appropriately diagnose most of these frequently disabling attacks. Neurologists refer to recurrent headaches as primary or secondary headache disorders.
Primary headaches lack a clear underlying causative pathology, trauma, or systemic disease. They tend to be the most life-disrupting and can be disabling, such as migraines, tension-type, and cluster headaches.
Whereas the causes for secondary headache disorders are numerous, their “known causes are as many as there are hairs on the head,” explained Pain Consultants of West Florida. Some illnesses and medical conditions affecting the nervous system can cause a secondary headache: reaction to medication or drugs, environmental pollutants, sleep apnea, head trauma, stroke, brain tumor, leaky spinal fluid, head, neck, spine problems, or the weather.
Medication-Overuse Headache (MOH)
The most commonly identified secondary disorder is medication-overuse headache (MOH), also known as rebound headaches may affect up to 5% of some populations. They are more common in women than in men.
MOHs result from long-term use of headache medications too often or from opiate-based medications, codeine or morphine. These drugs temporarily alleviate symptoms but can trigger MOHs. Additionally, these can make migraines increase in frequency and intensity.
An overuse headache may produce other symptoms such as neck pain, restlessness, a feeling of nasal congestion, reduced sleep quality, and more.
Unfortunately, for some people, taking headache medication even a couple of times a week can be problematic for those experiencing MOHs. “Therefore, it is critically important for individuals who suffer from chronic headaches to rotate therapies so as to not overdo any one of their medications,” according to the Pain Consultants of West Florida blog.
Tension-Type Headaches (TTH)
The most common primary disorder is tension-type headache (TTH). Patients describing these headaches say they “feel like a band of intense pressure around the head,” according to Jamie Eske, reporting for Medical News Today.
Yet, despite their prevalence, tension-type headache causes are not well understood. Causes of TTH may be stress-related or musculoskeletal; additional triggers can include hunger, jaw clenching, depression or anxiety, sleep apnea, arthritis, poor posture, bending or straining the neck, and more.
Tension-type headaches are either considered episodic or chronic. Episodic events occur less than 15 days a month, whereas chronic TTHs happen more than 15 days a month.
- Episodic attacks typically last a few hours. However, they can continue for several days.
- Chronic TTH can be unyielding and more disabling than episodic.
Cluster Headaches (CH)
One of the most severe and relatively uncommon primary headache disorders is cluster headaches. These sudden and excruciating headaches are cyclical and can occur at the same time daily for several weeks.
Episodic attacks typically affect a person daily or near-daily for weeks. These sufferers often find relief during pain-free remissions that can last for months. Whereas chronic bouts, daily or near-daily, last for a year or longer. According to the National Institute of Neurological Disorders and Stroke (NIH), remission for chronic CH patients is only brief.
Like other trigeminal autonomic cephalgia headaches, CH strikes one side of the head, frequently behind or around the eye. Cluster headache attacks may be preceded by a migraine-like aura and nausea, with pain peaking about 5 to 10 minutes after onset. The pain level can continue at the same intensity for as long as three hours.
CH onset is typically seen in people between 20 and 50 but may start at any age. Cluster headaches affect fewer than 1 in 1,000 adults; they occur in men more than women and are more common in smokers than nonsmokers.
For people with migraines, their symptoms significantly dwarf more typical head pain. Even though many people interchangeably use the terms “headache” and “migraine,” not all headaches are migraines, according to Self Magazine.
Simply put, a migraine is a severe headache with other symptoms like nausea and vomiting. Many sufferers also experience fatigue, moodiness, lightheadedness, extreme sensitivity to light (photophobia), odors (hyperosmia), and sound (phonophobia).
However, a migraine is the second most common and multi-faceted primary headache disorder that can last anywhere from 4 to 72 hours without treatment. In addition, migraines tend to fluctuate in occurrence and severity throughout a person’s life. This genetic headache disorder is found in children and adults, but female adults are three times more likely than men to suffer migraines.
Although migraine symptomatology varies from person to person, the pain tends to be distinct. A migraine, which is typically one-sided, can be moderate to severe in intensity. Its characteristics include throbbing pain or pulsating sensation so severe it aggravates routine physical activities. In addition, the simple act of coughing or sneezing can be unbearable.
According to the NIH, the disorder is divided into four phases, all of which may be present during an attack:
- The prodrome, premonitory, or preheadache phase includes symptoms that happen during the 24-48 hours before a migraine develops. These can include light, sound, or smell sensitivity, unexplainable mood changes, neck stiffness, yawning, food cravings, increased urination, and constipation or diarrhea.
- The aura phase refers to electrical activity that moves over the brain and results in visual, speech, sensory, and motor disturbances before or during a migraine attack.
- Visual auras include flashing or bright lights, zig-zagging or wavy lines, blurred vision, or blind spots that expand over time in one or both eyes.
- Sensory auras cause numbness or tingling that begins in the arm and radiates to the face.
- Motor auras affect the migraine sufferer’s ability to communicate and think clearly. Some examples of motor dysfunction include slurred or jumbled speech, difficulty writing, and difficulty understanding others.
- The headache or attack phase: Migraines usually start gradually and build in intensity.
- The postdrome or after-headache phase happens after the headache subsides.
There are at least 10 different types of migraines; however, the first two are most common among sufferers:
- Migraine with aura was previously referred to as classic migraine. People experience visual disturbances and neurological symptoms that arise between 10 minutes and an hour before the onset of the headache. According to the NIH, the aura usually lasts an hour or less, and “the aura may occur without headache pain, which can strike at any time.”
- Migraine without aura. Also called a “common migraine,” this type is the most frequently reported migraine. These headaches are painful and strike without warning. They are usually one-sided, and sufferers experience the typical migraine symptoms.
- Menstrually-related migraine is typically associated with a woman’s period. However, most women with this migraine type also experience symptoms at other times during their menstrual cycle. Menstrual-related migraines may also include migraine without aura symptoms.
- Migraine without headache is illustrated by visual problems or other aura symptoms without head pain.
- Status migrainosus “is a rare and severe type of acute migraine that is rare in which disabling pain and nausea can last 72 hours or longer. The pain and nausea may be so intense that sufferers need to be hospitalized,” according to the NIH.
Other migraine types include abdominal migraine, which primarily affects children; basilar-type migraine mainly affects children and teens; hemiplegic migraine is rare but severe that causes temporary paralysis; ophthalmoplegic migraine is an uncommon type that causes temporary vision problems; and retinal migraine, which is relatively rare and causes partial vision loss or impairment.
Living with Migraine Headache Disorder
Coping with migraine headaches begins with education, observation, learning personal triggers, and making lifestyle changes. When making decisions about handling migraines, it is vital to remember these facts about this second most common primary headache disorder:
- Migraine is an illness.
- Migraine is an inherited and lifelong disorder that is often debilitating.
- Migraine impacts people in the prime of their lives, during their working and parenting years.
- Migraine sufferers frequently report psychiatric disorders like depression and anxiety.
- Migraine is associated with a higher risk of heart attack, stroke, and other vascular disorders.
Trigger factors are events or exposures that increase the likelihood of a migraine attack, and premonitory symptoms are common, but they vary widely among sufferers. For most people, migraine episodes are precipitated by more than one trigger.
According to the NIH, the 10 most frequently reported migraine triggers are stress, not enough or too much sleep, fasting, hormonal changes, alcohol consumption, and weather, as well as auditory, visual, and olfactory triggers. Dietary triggers, which are less frequent, include cheeses, nuts, citrus fruits, chocolate, caffeine, red wine, processed meats, monosodium glutamate, and aspartame.
Standard self-care methods to ease migraine symptoms include reducing irritants such as noise and light. Many sufferers nap or rest in a quiet, darkened room. Some people use a cool cloth or ice pack on their forehead to ease head pain. Furthermore, remaining hydrated is vital, especially during migraine episodes with vomiting. Drink lots of water to replace lost fluids.
When to See a Doctor for a Headache or Migraine
Since headache disorders are common, many people do not give them much thought once the head pain is gone. However, they can impact a person’s ability to function and reduce their quality of life. And, because headaches signal something is amiss with a person’s nervous system, an accurate diagnosis for recurrent headaches or migraines is essential.
Be prepared to answer questions about other family members with headache disorder diagnoses and discuss the headache symptoms, frequency, triggers, and the effectiveness of treatments used.
When a Headache Could Be an Emergency
The following symptoms combined with a headache may be signs of a stroke or other life-threatening problem. If a person has any of them, do not delay calling emergency medical transport services or going to the nearest emergency room, according to Beaumont Health.
- The worst headache of your life.
- Difficulty speaking or understanding what other people are saying.
- Slurred speech or a hoarse voice.
- Numbness or weakness in the face or extremities, particularly if it is on one side.
- Tremors or clumsiness.
- Vision problems, like difficulty seeing or double vision.
Written by Cathy Milne-Ware
(Originally published on Healthopedia)
Medical News Today: Migraine vs. headache; Jamie Eske; Medically reviewed by Nancy Hammond, M.D.
National Institute of Neurological Disorders and Stroke (NIH): Headache: Hope Through Research
Beaumont Health: Headaches and Migraines: When to see a Neurologist
Harvard Health Publishing: A silver lining for migraine sufferers? By Paul Rizzoli, MD
WHO: Headache Disorders
Pain Consultants of West Florida: 13 Common Headache Disorders
National Headache Foundation: Headache Diary: Keeping a Diary Can Help Your Doctor Help You