MIGRAINE OR HEADACHE?

Introduction, the difference between a headache and a migraine, Causes and risk factors for migraine, Prevention, When to call a doctor for migraine

Shreya Dhungana

Published in

Swastha Naari

8 min readJul 11, 2020

Introduction to migraine

Pain can be defined as: ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. A migraine episode is different from a headache and can greatly affect a person’s daily life, including their ability to work or study. In simple words, migraine is a recurring headache that can be either moderate or severe in terms of pain. A migraine can cause pain in a pulsatile manner (beating with strong regular rhythm) usually on one side of the head. It is often accompanied by nausea, vomiting, and hypersensitivity to light and sound. According to WHO, half to three-quarters of adults aged 18–65 years in the world have had headaches in the year 2015 and, among those individuals, 30% or more have reported migraines. Headache on 15 or more days every month affects 1.7–4% of the world’s adult population.

Know the difference between a headache and a migraine

A tension headache gives the patient a feeling that an elastic band is squeezing in his or her head. The headache is caused by the contraction of muscles between the head and neck. The dull pain, experienced across the head, is usually mild to moderate, although it can, in extreme cases, last for days. It more commonly lasts half an hour to a few hours. A migraine, in comparison, tends to range from moderate to very severe pulsating pain at the front or the side of the head, and the pain can be so severe that it interferes with your daily activities. It can be uncompromising and carry on for days and is accompanied by other symptoms sometimes described as the ‘aura’.

Causes and risk factors for migraine

Some common causes of migraine are:

Anxiety and stress as these conditions decrease the chemical called serotonin in the brain ultimately making it the main cause of migraines.
Fluctuation in female hormones like estrogen during menstruation, pregnancy, and menopause may be a cause of migraines in some women.
Bright or flashing lights, strong smells, and loud noises can induce migraine in some people
Medicines like Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
Too much or not enough sleep and sudden changes in weather or environment can also trigger migraine
Overexertion (too much physical activity) can cause migraines more likely during hot, humid weather, or at high altitudes.
Tobacco, which contains nicotine, causes the blood vessels of the brain to narrow ultimately resulting in oxygen deprivation in the brain and pain.
Caffeine or caffeine withdrawal causes migraine in the same way as nicotine.
Skipped meals release hormones in our body signaling the brain that we are hungry. The same hormone causes constriction in blood vessels of the brain causing headaches.
Overuse of medications used in the treatment of migraines can also cause rebound migraines.

Some people have found that certain foods or ingredients can trigger headaches, especially when they are combined with other triggers. These foods and ingredients include:

Alcohol
Chocolate
Aged cheeses
Monosodium glutamate (MSG)
Fermented or pickled goods
Yeast
Cured or processed meats

Several factors may increase the occurrence of migraine in an individual known as risk factors.

Family history: If any person in the family is suffering from migraines, the risk becomes higher.
Age: Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during the 30s, and gradually become less severe and less frequent in the following decades.
Sex: Women are three times more likely to have migraines.
Hormonal changes. For women who have migraines, headaches might begin just before or shortly after the onset of menstruation. They might also change during pregnancy or menopause. Migraines generally improve after menopause.
Other medical conditions: Conditions like depression, anxiety, bipolar disorder, sleep disorders, irritable bowel syndrome, and epilepsy can trigger migraines.

Symptoms of migraine:

Migraines, which often begin in childhood, adolescence, or early adulthood, can progress through four stages: prodrome, aura, attack, and post-drome. Not everyone who has migraines goes through all stages.

Prodrome:

It is the first stage of migraine and usually occurs a few hours or a few days before the pain starts. About 60% of the vulnerable population experience this stage through symptoms such as:

Tiredness
Food craving
Severe thirst
Constipation
Frequent yawning
Mood swings
Bloating
Neck stiffness

2. Aura:

Aura is defined as the disturbances that include flashes of light, blind spots, and other vision changes or tingling in your hand or face. It can occur either before or during the migraine headache. The aura develops gradually and may last for about 20–60 minutes. Symptoms of aura include:

Seeing black dots, wavy lines, flashes of light, or things that aren’t there (hallucinations)
Having tunnel vision
Vision loss
Having tingling or numbness on one side of your body
Difficulty speaking
Having a heavy feeling in your arms and legs
Ringing in your ears
Notice changes in smell, taste, or touch

3. Attack:

Migraine usually starts with mild pain and can last for about 4 to 72 hours if untreated. 80% of people also experience nausea and vomiting during this period.

The pain usually on one side of the head, but often on both sides
Pain in a pulsatile manner
Sensitivity to light, sound, and sometimes even to smell and touch
Nausea and vomiting

4. Post-drome:

This stage can last up to a day after a headache. Symptoms include:

Feeling tired, wiped out, or cranky
Feeling unusually refreshed or happy
Muscle pain or weakness
Food cravings
The sudden head movement might bring on the pain again briefly.

Diagnosis:

There is no ultimate diagnostic tool for migraine. Usually, risk factors associated with migraines are used for analyzing the presence of migraine. However, if the case is unusual or complex, tests such as MRI and CT-scan are conducted to examine the brain image and reach a conclusion.

MRI: An MRI scan uses a powerful magnetic field and radio waves to produce detailed images of the brain and blood vessels. MRI scans help doctors diagnose tumours, strokes, bleeding in the brain, infections, and other brain and nervous system (neurological) conditions.
CT scan: A CT scan uses a series of X-rays to create detailed cross-sectional images of the brain. This helps doctors diagnose tumours, infections, brain damage, bleeding in the brain, and other possible medical problems that may be causing headaches.

Prevention:

According to American Migraine’s society, The ultimate goals of migraine preventive therapy are to:

Reduce frequency, severity, and duration of attacks.
Improve responsiveness to treatment of acute attacks
Reduce the level of disability.
Maintain the cost of care for migraine treatments.
Reduce excessive overuse of acute medications.

According to Healthline, there are 9 ways to prevent the intensity and frequency of migraine headaches. These are:

Avoid loud noises and bright lights:

It may not be totally possible to avoid these in all circumstances but some ways to avoid it may include:

Avoid driving at night.
Avoid being in a movie theatre.
Avoid attending clubs.
Minimize the exposure to bright sun in order to avoid its glare
Take a break from TV, computer screens and mobile from time to time.
Use the screens with low brightness.

2. Food choices:

As mentioned above, some food items might trigger your migraine such as chocolate, red wine, processed meat, sweeteners, cheese, caffeine, etc. The limitation in these items might help in reducing the pain.

3. Keep a headache diary:

Migraine can sometimes come in the pattern. So keeping a track of pain might help you. The diary must include:

What you eat or drink
Your exercise routine
Weather
When you have a strong feeling or emotion
The medication you’re currently using and their side effects
Frequency and severity of your headache.

By keeping a track of these things, you can be able to know what circumstances trigger your migraine.

4. Beware of your hormonal changes:

Hormonal changes can occur during or just before menstruation. It is also the main cause of mood swings and aggressiveness among women during periods. This cannot be avoided but can be reduced by being careful about the diets you take. Taking oral contraceptives and hormonal therapy has shown to increase the frequency and severity of migraines.

5. Take supplements:

Migraine can be treated non pharmacologically. But sometimes, taking dietary supplements might help to reduce its intensity. Studies have shown that magnesium deficiency causes migraines. So magnesium supplements can be taken on a daily basis by consulting your doctor.

6. Weather:

High humidity and high temperature can stimulate migraines. So it’s better to be extra careful these days and focus on preventing measures as well.

7. Eat and sleep on a regular basis:

Food and sleep are the keys to healthy living. However, a routine schedule must be followed for its benefit.

Eat within 3–4 hours.
Drink enough water
Do not skip meals
Sleep for at least 8 hours a day

8. Avoid stress:

Stress has been found to be a major cause of migraine. Performing yoga and meditation might help in reducing stress.

9. Choose a relaxing exercise:

Some light exercises such as deep breathing exercises, walking, aerobics may be performed to avoid migraines. Intense exercises like weight lifting shouldn’t be conducted.

When to call a doctor for migraine:

Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep the record of your attacks and how you treated them. Then make an appointment with the doctor to discuss your headaches. Besides, see the doctor if you have any of the following signs and symptoms:

Have three or more headaches per week
Have headaches that keep getting worse and won’t go away
Need to take a pain reliever every day or almost every day for your headaches
Need more than two to three doses of over-the-counter medications per week to feel better
Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
Have headaches that interfere with your family, work, or social life.

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