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How to tell the difference between a headache and a migraine attack

An aching head is something that many people will experience occasionally. There are no clear boundaries that can distinguish between a transient headache that has minimal clinical importance, and that will clear up without radical treatment in a reasonable timeframe and a migraine attack that may be totally debilitating, and may be repetitive and worsening over time.

It makes it even harder to distinguish between headaches and migraine attacks because when they are present, it’s difficult for someone suffering the pain to think clearly and to measure the degree or length of the attack. Aches like this push people to seek immediate relief and so trying to observe the signs and symptoms is less important than taking steps to minimize their discomfort.

Overall, headaches may be affecting nearly half of the total adult population, and of them, about a quarter will be experiencing the more severe forms, which could be classified as migraine attacks.

What are the main differences between headaches and migraine attacks?

The main differences appear to be in the precursors of the headache, the severity of the pain, and the duration of the attack.

Probably the main way to distinguish a headache from a migraine is by its degree of severity. Headaches usually range from a dull ache to more acute pain, but there is no particular focus in the skull, and it is accompanied by throbbing. The primary feeling is one of discomfort. 

Migraines are more debilitating – with specific signs that have been aggregated into the acronym POUND, used by doctors to help identify the key migraine signs and symptoms.

What are the features of POUND migraine attacks?

  • Photophobia & Phonophobia – while experiencing a migraine attack, bright light and loud noise may produce sharp spikes in pain. One study has reported that even without a current migraine attack, the intensity of photophobia and phonophobia is greater during normal daily activities in migraine individuals, especially those with aura and chronic migraine, than for control groups. Also, levels of both photophobia and phonophobia were correlated to migraine intensity, migraine frequency, and frequency of aura
  • Ongoing duration of a severe attack – tension headaches normally last for three to four hours, and will usually clear up in under a day, often relieved by simple OTC medications, changes in position, and sleep. Migraines, especially in people with aura and chronic migraine, may last from 12 to 72 hours without remission and are not relieved in the same way as tension headaches
  • Unilateral focus of the pain – normal headaches usually are experienced is a band of pressure across the top of the head, or radiating down into the face and neck. Migraines are usually felt more intensely on one side of the head 
  • Nausea and vomiting – people experiencing chronic migraine attacks may also feel other discomforts, such as nausea. In some cases, this can be so severe as to induce vomiting.
  • Disabling intensity, which stops people from normal activity due to the intensity of the pain and discomfort.

Common treatment for Migraines

There are several prescription medications that can help to relieve the intensity of migraine attacks, and shorten the duration of the attack. There are no cures for migraines.

 

Drug Effects

Relpax

Relpax/Relert (eletriptan) 

Triptans are a group of medications that work by narrowing blood vessels and counteracting substances that can trigger nausea, sensitivity to light and sound, and other migraine symptoms.  They work by stimulating serotonin (or 5HT) receptors in the brain. They mimic the action of serotonin on these receptors to narrow blood vessels and so relieve the pain of migraine attacks.

Amerge

Amerge/Naramig (naratriptan) is a triptan that works in the same way as Relpax and Maxalt and others

Imitrex , Imigran

Imitrex / Imigran (sumatriptan) is a triptan that works in the same way as Relpax, Amerge and others

Maxalt

Maxalt (rizatriptan) is a triptan that works the same way as Imitrex / Imigran, Zomig and others

Naprosyn

Naprosyn (naproxen) is a COX inhibitor. It works by blocking the production of prostaglandins which can cause pain, swelling and inflammation. Naprosyn is effective in reducing inflammation and pain that may trigger a migraine attack

Methergine

Methergine (methylergometrine) is a smooth muscle constrictor that can be used for both prevention and treatment of acute migraines

Zomig

Zomig (zolmitriptan) is a triptan that works the same way as Imitrex, Maxalt and others

 

FAQ

What happens during a migraine attack?

A typical migraine attack has four distinct phases with different symptoms, although not all people experience these phases in exactly the same way: 

  • Prodrome phase, also known as the onset phase. Beginning a few hours and up to one or two days before the actual attack, people experience symptoms of mood changes such as depression, repetitive yawning and stiffness in the neck. Some unusual body functions like constipation, fluid retention and increased urination may occur
  • Aura phase (not experienced by all people). People experience sensations such as vision loss or blurring, flashes of light and other visual disturbances. Bodily sensations like numbness or pins-and-needles in arms or legs, difficulty speaking and weakness on one side of the face. This phase may last for several hours and precedes the migraine attack
  • Attack phase with the typical symptoms of a migraine attack – throbbing or pulsing pain on one side of the head, sensitivity to bright light and loud noise (photophobia and phonophobia), nausea and vomiting. This phase may last for several hours or even a few days
  • Postdrome phase occurs once the attack has subsided and may continue for a day. It is usually a feeling of being totally drained and washed out, along with confusion and tiredness.

What are the main types of headaches?

A headache is a pain located mainly in the head, sometimes throbbing in response to heart rhythm. The different types of headaches are:

  • Tension headache – may be chronic and is the most common. It can affect the entire head, usually starting at the back and spreading forward as it progresses. The most common causes are jaw clenching, eyestrain, stress and hunger 
  • Sinus headaches are created by some conditions that result in congestion in the nasal passages. The headache is often worse when waking up in the morning
  • Cluster headaches are less common, and can be mistaken for migraines because they have the same degree of intensity. They may occur several times each day and repeatedly throughout the month. Dilation of blood vessels in the brain caused by release of hormones such as serotonin and melatonin could be the triggers.

What are the main types of migraines?

Although the main symptom in all migraines is the same, being intense pain, there are a few additional symptoms that distinguish between how patients report their symptoms. These are:

  • Migraine with aura for up to one third of people experiencing migraine attacks, the onset of the attack is preceded by a sensation of an aura, but not all people experiencing migraine episodes will experience an aura every time. 
  • Migraine without aura – the aura phase is not always a sign of a migraine attack. Some people never experience the aura and go directly into the attack phase, other people may experience an aura but it is not always followed by a migraine
  • When the intense, throbbing headaches are felt on one side of the head, it may last from 4 hours to three days.
  • Abdominal migraines have also been reported, mainly in children between the ages of 3 and 10. They cause abdominal pain, nausea, and vomiting but this is accompanied by a mild headache or no pain at all.
  • Hemiplegic migraine is relatively rare, and presents as a temporary paralysis on one side of the body before or during the migraine attack, along with vertigo, difficulty speaking or swallowing.

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