Migraine vs. Headache: How to Tell the Difference

Man in front of computer with headache

Most of us are familiar with the throbbing ache in your temples. Just another headache, right? Not so fast.

"Migraines impact over 37 million men, women and children in the United States, but fewer than 5 percent of those affected have been accurately diagnosed and received appropriate care," says Brandeis Brockman, CRNP, BSN, MSN, nurse practitioner at Delancey Internal Medicine.

Before you write your pain off as just another headache, learn the distinctions between headaches and migraines. Knowing their key differences could bring you long-awaited relief.

Types and Causes of Common Headaches

There are many different types of headaches, so identifying the location and nature of your pain can help determine the cause.

Some of the most common types include:

  • Tension headaches: The pain from tension headaches tends to spread across both sides of the head, often starting at the back and creeping forward. This is the most common form of headache pain. Eyestrain, stress and hunger are frequently causes of tension headaches, and they can be chronic.
  • Sinus headaches: These headaches often strike when you’re sick or feeling congested. They’re caused by swelling in the sinus passages, resulting in pain behind the cheeks, nose and eyes. The pain is often as its worst when you wake up on the morning and when you bend forward.
  • Cluster headaches: These headaches are usually very painful and occur in “clusters,” meaning they happen daily (usually at the same time), sometimes up to several times per day for months. They are a result of dilation in the blood vessels of the brain due to a release of serotonin and histamines. They can be caused by physical exertion, bright lights or even altitude.

Migraines: More Than Just a Headache

When most people hear the term migraine, they often think of a severe headache. But headaches are only one symptom of migraines, and they can range in severity and length.

"Migraines are a neurological disease that involve nerve pathways and chemicals," explains Brockman.

The changes in brain activity affect blood in the brain and surrounding tissues, causing a range of symptoms. In addition to severe head pain, migraine sufferers may experience some or all of the following symptoms:

  • Nausea
  • Increased sensitivity to light, sound or smells
  • Dizziness
  • Extreme fatigue

A migraine episode may occur in four different phases, though not everyone experiences every phase. The phases include:

  • Prodrome phase: Sometimes called the pre-headache phase, this stage features painless symptoms that occur hours or days before the migraine arrives. These include mood swings, food cravings and stiffness of the neck.
  • Aura phase: Auras refer to sensory disturbances that occur before or during a migraine. Auras can affect a person’s vision, touch or speech, though not everyone who suffers from migraines experiences auras. Examples of auras include blurred visions, blind spots that expand over time, numbness in the arm, and slurred or jumbled speech.
  • Headache phase: This is when the pain usually hits, and it may range from mild to debilitating. Physical activity and exposure to light, sound and smells may worsen the pain. However, some people can have a migraine without developing a headache.
  • Postdromal phase: The final phase is when the pain has subsided. People may feel exhausted, confused or generally unwell during this phase.

Causes of Migraines

While headaches usually have easily traceable causes, migraines have common triggers but no one cause. If you suffer from migraines, you may find that certain factors trigger their onset.

Triggers vary from person to person and can include:

  • Gender and hormonal shifts: Women are three times more likely to suffer from migraines than men. Brockman says menstrual cycles and changes in hormones are a factor in migraines in women.
  • Allergies: Also called allergic rhinitis, allergies cause irritation and inflammation in the body. Because migraines are associated with inflammation of the blood vessels, allergies are a known trigger for some people.
  • Family history and genetics: People with family members suffering from migraines are more likely to develop migraines themselves. Scientists have discovered a genetic mutation that is common in those with the most typical type of migraine.
  • Environmental: This category includes a wide range of triggers, like changes in weather, stress, food, smells and lack of sleep.

Treatment for Migraines and Headaches

While there is no specific cure for headaches and migraines, medication and lifestyle changes can help treat your symptoms and prevent future episodes.

Over-the-Counter Medicines

"Over-the-counter (OTC) pain medicines like acetaminophen, ibuprofen and aspirin can be helpful for headaches or mild migraines," says Brockman. "Excedrin® Migraine is another great OTC option that works well for my patients, as well as caffeine." 

A 2017 study also found that melatonin may help prevent migraines and cluster headaches. Since the right dose varies according to each condition and person, speak to your physician about using this treatment.

Prescription Medications

If you experience moderate to severe migraines on a regular basis, OTC treatments might not be enough to manage your symptoms. Prescription medication may help reduce the severity of your migraines and prevent future occurrences. Medication may include:

  • Blood pressure medicines, such as beta blockers
  • Antidepressants
  • Anti-seizure medicines
  • Botulinum toxin A (Botox) injections

Lifestyle Changes

Adopting lifestyle changes may also help prevent some types of headaches and migraines. These include:

  • Exercising regularly
  • Making dietary changes to avoid trigger foods
  • Improving sleep habits
  • Practicing relaxation techniques, like yoga and meditation

"Keeping a migraine or headache journal can also help you to track patterns and identify triggers," adds Brockman. Note things like the day and time your headache or migraine began, your surroundings and activity before symptoms started, and how long the pain lasted.

This information can help you and your physician create a plan to avoid your triggers and reduce the frequency of your migraines or headaches.

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