Migraine or headache, how do we know?

Headache is a very common yet unpleasant term we come across in our day today conversations. The severity of it might not keep us away from our daily lifestyle. Yet some headaches can be really torturing and could make us remain in bed, doing nothing.  

When suffering from these headaches, have you ever thought whether it could be something to do with ‘Migraine’- a very common term we hear at present. Is this probably due to rapid advancements of diagnosis and patient knowledge in various clinical conditions? Yes, your headache can of course be a migraine, but it is always necessary to think of all the other types of headaches and their natures, before coming in to the exact diagnosis of Migraine. Through this article we are going to discuss what a headache and migraine are and how they differ from one another. Knowing this difference is highly important in deciding the modality of treatment required.  

What is a headache?
A headache is an unpleasant sensation in your head which can present either as pressure or an ache. The severity of it can depend on the way you can bear up pain (pain threshold) and vary from mild to severe. Commonest places for headache include, forehead, temples and back of the neck. Headaches can occur as a symptom of an underlying pathology so persistent headaches, or ones which cause a negative impact on day to day activities, should be taken in to consideration immediately and medical advice should be sought.  

There are various types of headaches, based on the underlying etiology. They are as follows-  
Primary

• Tension headache- This is a type of headache which gives a similar sensation of an elastic band, squeezing around your head. Caused by the contraction of muscles between your head and neck, this dull pain is usually experienced across the head and can be mild to moderate in severity. An attack usually lasts for half an hour to few hours, but in severe cases this can last long for days.  
• Cluster headaches-Severe and painful headaches, which usually occur in one side of the head (unilateral). Painful attacks, experienced here are usually of clusters and will be accompanied by head ache free episodes.  
• Migraine headaches- A moderate to severe pain, throbbing in nature on a side of the head or in the front area. Can be associated with nausea, vomiting and blurred vision.  

Secondary
These headaches usually occur as a part of an underlying illness or an injury.   

• Sinus headache- This is the commonest type of secondary headache which can arise due to an underlying infection or increased pressure in sinuses.  
• Medication over use headache-Long term use of certain drugs can trigger persistent headaches. These sort of headaches will usually resolve when drugs are stopped and alternatives are used.  A patient presenting with an acute or chronic headache should be assessed carefully in order to establish an accurate diagnosis. In such cases, special attention should be given to numerous signs and symptoms associated such as nausea, vomiting, blurring of vision, aura, neck stiffness, fever, ear discharge etc. 

 
Corner stone of management

-Over the counter drugs

• Acetaminophen  
• Ibuprofen  
• Aspirin  

-Relaxation techniques

• Heat therapy  
• Physiotherapy  
• Massages  
• Neck exercises with stretching  

What is Migraine?
Migraine is a throbbing pain usually arising in one side of the head (unilateral), triggered by specific things or situations. Accounting for a significant female predominance (75%), Migraine itself is known to make a huge negative impact on the manpower in the community.  

Commonest triggering factors for migraine include,  

• Food such as caffeine, cheese and chocolate  
• Stress  
• Hormones  
• Cold climates  
• Waking up in the morning  
• Long journeys of flights  

There are two main categories of Migraine based on the presence of Aura- A vivid visual sensation experienced by individuals, 10-30 minutes before a migraine attack.  

• Migraine with aura   
• Migraine without aura   
• Migraine with aura are usually associated with,  
• Disturbed thinking  
• Visual disturbances such as flashing lights or vivid lines  
• A tingling or numb sensation in hands or face  
• Sensory disturbances of smell, taste or touch  

Other signs and symptoms associated with migraine include,  

• Yawning  
• Irritability  
• Constipation  
• Stiffness in the neck   
• Unusual food cravings  

How do you treat Migraine?  

• Prevention and staying away from triggering factors play a major role in the treatment.   
• Other interventions include,  
• Pharmacotherapy and medication such as-Anti emetics, Non-steroidal anti-inflammatory drugs and Triptans.  

How can you differentiate a headache from migraine?
Migraine is a type of headache which usually occurs due to various triggering agents such as environment, stress, hormones, food etc. Most migraines are moderate to severe in nature when compared to headaches, where the severity would depend on the underlying cause and may vary from mild to moderate to severe.   Migraine typically affects only one side of the head (unilateral), where some patients might rarely present with bilateral aches.   

As far as the quality of pain is concerned, headaches are usually intense and achy whereas migraine can be throbbing and dull, making daily activities quite difficult or impossible.