How To Differentiate Between A Headache And A Migraine

Headache

Headache is among the most common reasons patients seek medical attention. The patient who presents with new-onset, severe headache has quite different causes than the headache which is recurrent and occurring for many years.  In new-onset - severe headache, the underlying cause may be serious or even life-threatening. Whereas recurrent chronic headaches are usually not life-threatening but maybe quite disabling, affecting day to day functioning and may hamper the quality of life. 

Migraine

Migraine is a very common disorder in which patient is having an episodic, recurrent and usually unilateral headache, often a pulsatile character may be associated with nausea and vomiting. It may begin in childhood but usually begins in adolescence or early adult life in 80% of the patients. Its frequency decrease with advancing age but it may worsen in some postmenopausal women. Activation of the trigeminovascular system, leading to an inflammatory response that is generated by local neural mechanisms has been assigned a role in migraine headache. In migraine patients, it has been found in PET scan that there is activation of an area in pons during the attack. 

Mainly migraine is of two types-

1. Migraine with aura (classic migraine): Patients may have an aura before the onset of headache. An aura may be in the form of visual disturbances with flashes of light or zigzag lines or other neurologic symptoms. Migraine with aura, frequently occur after awakening but may occur at any time of the day
2. Migraine without aura (common migraine): In these patients, there’s no aura prior to the onset of headache. It is five times more common than the classic Migraine

Common Features of Classic & Common Migraine

• Either type of migraine may be preceded by vague premonitory changes in mood and appetite
• Sensitivity to bright light, loud sounds or smell and headache increases with head movement, are seen in both types of migraine
• Family history is seen more commonly in classic migraine than common migraine
• One-third of migraine patients have more than three attacks in a month if untreated the frequency increases so need medicines

There are several migraine triggers, including:

• Hormonal changes in women - Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women
• Drinks - alcohol, especially wine, and too much of coffee
• Stress - at work or home can cause migraines
• Sensory stimuli - Bright lights and sun glare, loud sounds. Strong smells - perfume, paint thinner
• Sleep changes - Lack of sleep, jet lag can trigger migraines in some people
• Weather changes - Change of weather or barometric pressure can prompt a migraine
• Foods - Cheeses, chocolates and coffee might trigger migraines. So might skipping meals or fasting
• Food additive- sweetener and the preservative

Difference between Migraine & Normal Headache

1. In migraine, headache is usually episodic, starts with half of the head, throbbing type of headache and associated with nausea and vomiting. Whereas common headache is generally because of stress & it affects both sides of the head and it is usually dull, stretching type of headache. This is not associated with nausea /vomiting/ photophobic/ Sensitive to light and sound
2. A family history of migraine is the most potent and consistent risk factor for migraine, with a two-to-three-fold greater chances of migraine among relatives of people with migraine whereas in common headache family history is not relevant
3. In some of the patient’s migraine is activated by specific triggers whereas in common headache there’s no such trigger
4. Migraine needs specific treatment and management whereas in common headache may be managed by lifestyle modifications & some painkillers

Dr Jaideep Bansal

Guest Author Dr Jaideep Bansal, Director, Dept of Neurology, Fortis Hospital, Shalimar Bagh.