News: Headaches and Migraine. Don’t Suffer in Silence.

What is the difference between headaches and migraine?

We have all heard of migraines and headaches but many of us may not know the difference between the two, as a “really bad headache” is often confused with a true migraine.

Migraine is often a long term medical condition and people with migraine describe their condition as having ‘attacks’ or ‘episodes’.  A Headache (pain felt around the head region) is a common symptom of migraine, although some people with migraine do not experience a headache when they have an episode. Other common symptoms of migraine include nausea, sensitivity to light or sound and visual changes. Migraines often first occur in the peoples early 20s but sometimes in their teens and 30s.

Both headaches and migraine can be intense and debilitating causing significant suffering, impaired quality of life and disability. Many sufferers often worry about when their next headache or migraine may occur causing much stress and anxiety. These conditions can affect employment, the ability to be involved in (and enjoy!) social or leisure activities and if they are significant, may be associated with a deterioration in mental health.

According to the Lancet, “Globally, the percentage of the adult population with an active headache disorder is 47% for headache in general, 10% for migraine, 38% for tension-type headache, and 3% for chronic headache that lasts for more than 15 days per month.” 4.9 million Australians experience migraine, which costs Australia $35.7 billion per year in direct and indirect costs. 7 million Australians suffer from tension type headaches.

Unfortunately most people with migraine or headaches suffer in silence with the majority of these conditions going undiagnosed and being poorly managed. We often head people say in the clinic, they didn’t know there was anything they could do about it, of was told it was “genetic” and they just had to live with it. We are glad to let you know, there is always something you can do about it, and we are here to help!

The International Classification of Headache Disorders, published by the International Headache Society, has classified more than 150 types of primary and secondary headache disorders. In this article we will discuss a few of the most common types of headache and migraine.

Migraine

There are many different types of migraines.  The vast majority (hence the name) are what is referred to as common migraine, also called migraine without aura. Other types of migraine include migraine with aura, menstrual migraine, vestibular migraine, migraine aura without headache. Migraines usually have different stages which are described in the diagram below.

 

Common Migraine (Migraine without Aura)

• Symptoms: moderate to severe throbbing pain that is often one-sided, which may be accompanied by nausea or vomiting, sensitivity to light, sound or smell.
• Prior to the migraine attack there can often be vague feelings like changes in mood (either depression or feeling super productive), changes in appetite (cravings or loss of appetite) and muscle stiffness.
• Following the migraine there is usually post-migraine fatigue (the postdrome phase, also known as ‘migraine hangover’).

Migraine with Aura

Migraine with Aura is more rare. This type of migraine has all the symptoms of common migraine, with additional strange or unusual symptoms, the most common one is called an aura which can often look like a blurring at the edge of your vision making it look there is an aura or halo. Other visual symptoms can occur such as zig-zags, squiggly lines, sparkles, bright lights, and blind spots.  The aura can also be accompanied by symptoms such as numbness and tingling into one arm, difficulty speaking, swallowing or understanding language, facial parathesia (skin tingling, pricking, chilling, burning, numbness), strange tastes and loss of balance.

All these strange symptoms described should last less than 1 hour.

Note: It is extremely important these symptoms be thoroughly investigated by your doctor as these headaches have a heavy overlap with the symptoms of stroke. The duration of visual disturbances (e.g. a few minutes vs 15 minutes) can be a useful measure to assist your doctor.

Tension Type Headache

The most common headache is a tension type headache.  The pain commonly presents on both sides of the head in a tight band around the temple areas or around the back of the head.  The pain is often moderate but tends to last for longer periods of time than other headaches.  Common complaints are difficulty concentrating, fatigue, dizziness, difficulty sleeping, nausea and generally feeling unwell.  There is also a heavy association with neck and jaw stiffness, restricted movement and tight muscles, as well as depression, anxiety and difficulty concentrating for prolonged periods e.g. when reading/working.

Cervicogenic Headache

This is a headache that is worsened with particular neck/shoulder movements (for example rotating your head to the left) and often has associated tenderness through the upper portion of the neck. The pain is usually on one side and is often accompanied by neck pain and significantly restricted neck movement as well as tight surrounding neck and shoulder muscles.

Cluster Headaches

Cluster headaches are generally a very rare type of headache. They occur for short periods (generally 15 minutes at a time, although they can last up to 3 hours) but occur in a cluster, often occurring multiple times in a day or week. The pain is usually behind one eye and is often described as ‘knife-like’ 10/10 pain that is fairly consistent for a short period of time. Other common symptoms are watery eyes, dropping of the eyelid, eyelid swelling, runny nose, facial redness and sweating, all on the same side as the pain.  The primary complaint with this type of headache is the excruciating pain.  The good news is that cluster headaches are not usually associated with changes in vision or sound, numbness/tingling or post-headache fatigue and after the cluster ends (the remission period) it often doesn’t re-occur for months or even a year.

Other types of headaches

Other headaches include:

• alcohol, dehydration, exercise or sexual activity related headache
• trigeminal neuralgia
• withdrawal related headaches (including caffeine, opioids and other pain killers, oestrogen)
• sinus or jaw (TMJ) related headaches

Headaches and migraine often have many factors that contribute to their onset; it is important to take a broad approach to your condition. Here are a few factors that have been reported as potential triggers – most of these relate to migraine but they can also trigger other types of headaches:

• Certain foods, including chocolate, cheese, coffee, caffeinated drinks, nuts, citrus fruits, processed meats, additives like nitrates & MSG, salty foods, fatty foods and alcohol (usually red wine and beer)
• Caffeine withdrawal
• Lack of food e.g. fasting or missing meals
• Dehydration
• Visual & auditory triggers e.g. flickering lights or very bright light, loud noises
• Strong smells or tastes e.g. strong perfume or aftershave, paint, smoke
• Menstruation
• Lack of sleep and fatigue
• Stress, depression and anxiety
• Neck or jaw pain and associated tightness/stiffness
• Lack of exercise
• Weather changes e.g. high humidity, or changes in atmospheric pressure
• Certain medications, or withdrawal from medications

At South Eastern Active Health we treat a lot of patients with headaches and migraine.

• Our first step is to take a detailed history and  assess your symptoms so we can identify they type of headache or migraine you may have and if any further investigations are required to rule out any more serious issues.
• Your practitioner will then ask you about triggers and other potentially related lifestyle factors as well as about the pain and other symptoms you have. In many cases there can be musculoskeletal (muscle and joint) factors that contribute to your symptoms. Common factors include neck pain, muscle tightness and stiffness, jaw pain as well as stress. Often treating the neck, upper back and jaw can significantly reduce the frequency and intensity of headaches and migraine.
• We may also discuss changes to other aspects of your lifestyle to help you manage your condition. For example, stress management strategies, sleep, dietary improvements or physical activity, which can all help to improve your physical and mental health.
• In some cases we may ask you to keep a headache diary to help identify potential triggers and other factors involved in the onset of your symptoms.
• We may also refer back to your GP who may help with prescribing some particular medications which can help in conjunction with a good hands on management plan.

 

A question we are commonly asked is “Should I come in for an appointment while I have a headache or migraine or should I wait until it subsides?” Generally our approach is to be gentle during the headache or migraine phase as your body may be very sensitive during this period. In some cases treatment can give the person significant relief, but this may not be the case for everyone. It really depends from person to person and they type of headache/migraine they have. If you are unsure, it may really be worth trialing some treatment during the symptoms as it may really help you.

At South Eastern Active Health we take a proactive approach to migraine and headaches. We use a variety of safe and effecting hands on and rehabilitation techniques to to help people who suffer from these often stressful and debilitating conditions. So please don’t just suffer in silence, let us help you live a happier and healthier life.

Book your appointment

References

Jensen, R. and Stovner, L., 2008. Epidemiology and comorbidity of headache. The Lancet Neurology, 7(4), pp.354-361.

Who.int. 2021. Headache disorders. Available at: https://www.who.int/news-room/fact-sheets/detail/headache-disorders

Migraine Australia. 2021. Migraine Australia. Available at: https://www.migraine.org.au

Headache Australia. 2021. Prevalence and Cost Of Headache – Headache Australia. Available at: https://headacheaustralia.org.au/what-is-headache/prevalence-and-cost-of-headache