Headaches and Migraines

Your headache could be a tension, cluster, sinus, or rebound headache–or even a migraine. The more you know, the easier it is to stop or prevent headache pain.

Headaches and migraines are two separate conditions, but they both can be unbearable and affect your ability to work and enjoy life.

A headache means you have pain in some part of your head or face. A migraine, however, comes with symptoms in addition to head pain, such as nausea, fatigue, and sensitivity to light and sound. While most people experience headaches from time-to-time, 39 million people suffer from migraines. In the U.S. 18% of women and 6% of men report having migraines.

Headaches can be a condition on its own—called a primary headache disorder. Or, they can be a symptom of another health problem, such as allergies, a sinus infection, or vascular disease. Tension, migraine, and cluster headaches are considered primary headache disorders. 

Tension Headache

Stress and tension can trigger a mild-to-moderate headache. Tension-type pain often feels like pressure, tightness, or a band squeezing your head, and typically affects both sides. Tension, also called tension-type headache (TTH), is the most common type of headache. 

Migraine

A migraine is a moderate-to-severe headache that's often one-sided (though it can be present on both sides), throbs and pulses, and is accompanied by other symptoms, such as nausea or sensitivity to light and sound.

Some migraineurs have an aura, which are neurological symptoms that strike before the headache. For example: You may see dots or zig-zag lines or feel numbness or weakness on one side of the body. Within the umbrella of migraine, there are several different types of migraines, such as chronic migraines, retinal migraines, hemiplegic migraines, among others. Sinus headaches are often misdiagnosed; a majority of these are actually migraines.

Cluster Headache

Unlike tension headaches and migraine, cluster headaches are more likely to affect men, and are uncommon. You may experience a series of severe headaches behind one eye throughout the day. Other symptoms include redness and tearing and lid droopiness in the affected eye, along with a runny nose.

It's not just head pain that you'll feel. Headaches and migraines come with a slew of uncomfortable symptoms that can completely derail your day. It's why the conditions are a leading cause of disability and missed workdays.

Everyone has different symptoms, and a lot depends on what type of headache you have and what triggered the attack:

• Head pain that's dull, aching, throbbing, pulsating, or stabbing. May be located on one or both sides of the head, behind one eye, or in the back or front of the head.
• Nausea and vomiting.
• Sensitivity to light, sound, or smells.
• Visual disturbances, such as zig zag lines, black spots, or flashes.
• Dizziness and vertigo.
• Stroke-like symptoms, such as weakness, numbness, or paralysis on one side of the body, as well as balance, confusion, and problems with speech. If this is your first time experiencing these symptoms, get medical attention immediately.
• Nasal congestion and watery eyes (in the case of an allergy-related migraine).
• Nasal pain and pressure (if caused by a sinus infection).
• Eye redness and tearing.
• Nasal congestion.
• Facial flushing.
• No head pain. Some people with migraine have an aura only during an attack.

When it comes to migraine, the disorder is believed to be hereditary and affects three times more women than men. Depression and anxiety often accompany migraine, but it's not clear if one causes the other.  

Certain lifestyle habits and environmental changes can lead to an attack in both tension headaches and migraines, which are called triggers. These are some common triggers:

• Stress.
• Hormonal changes.
• Irregular sleeping habits (e.g., too much or too little sleep, going to bed or waking up at inconsistent times).
• Skipping meals.
• Caffeine.
• Weather changes.
• Smoke exposure.
• Strong odors.
• Allergies.

Taking over-the-counter medications, like NSAIDs, to treat headaches too often can also lead to what's called a medication overuse headache, where the medication actually triggers another attack. This can happen in both tension and migraine type headaches.

Talk to your PCP if you experience frequent headaches or have symptoms of migraine. If you are not feeling better, consider seeing a neurologist who specializes in headaches and migraines.

When being evaluated for headache or migraine, you'll first start off your appointment by getting your vital signs measured. Next, your provider will talk to you about your symptoms, when they occur, as well as their intensity and how long they last. They may also conduct a neurological exam to check reflexes, motor movement, and vision.

Depending on your symptoms, you may also be evaluated for another health condition that could be causing the headaches. If suspected, an imaging scan, like an MRI, may be ordered to rule out certain problems, like an aneurysm or tumor.

The goal with treatment is to relieve the pain so you can function and feel well and return to your daily activities. Finding the right treatment for your headache or migraine can be challenging, but there are so many options. There are two main categories of medication that your doctor will discuss with you.

Acute Medication

These are taken to stop migraines when an attack starts. You can take OTC medication, like ibuprofen or acetaminophen, for both migraine and tension headache. If you have migraines, your doctor may prescribe a different type of drug called a triptan. Do not take either type of medication more than eight times per month, or they can cause a rebound headache. If you get more than four migraines per month, you're a candidate for one of the preventative medications.

Preventative Medication

This is both a prevention and treatment for migraines. Preventatives include beta blockers and calcium channel blockers, anticonvulsants, certain antidepressants, and onabotulinumtoxinA (Botox). These medications are especially important in treating chronic migraines, which is defined as having 15 or more headache days per month.

The first step is to assess and avoid your headache and migraine triggers. If you're not sure what sets off an attack, keep a headache diary. In it, record your headache and migraine, as well as anything else unique about the day. Was it a stressful day? Was it raining? Did you go somewhere that was really noisy? Were you sitting on a beach on a sunny, hot day? Did you drink an extra cup of coffee? Keep this log over a couple months. Together with your provider, you can go over the information and begin to make connections between your habits and other outside factors that trigger your head pain.

From there, come up with a realistic plan to avoid those triggers. For example, stress is a big one for many people who have both tension headaches and migraines. While it's unlikely you can leave stress behind, what can you do to manage it? That might be through exercise, journaling, or talk therapy. Other habits, like getting enough sleep, eating regularly, and keeping a consistent schedule can also help reduce the number of headaches you have.

Lastly, occasional headaches and migraines can become chronic, which makes them more difficult to treat. Working to steer clear of potential triggers and avoiding medication overuse can also help prevent future attacks.

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