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Headache? Migraine? (There IS a Difference!)
March 29, 2018
If your head hurts, is it a simple headache or is it migraine syndrome? There is a difference, according to Dr. Abigail Chua, a neurologist and headache specialist with the Hartford HealthCare Headache Center.
Q. Explain the difference between a headache and a migraine.
A. While the terms ‘migraine’ and ‘headache’ are often used interchangeably by many people, they are not one in the same. “Headache” is defined as any pain or discomfort in the region of the head. It is a symptom, and not a diagnosis. Migraine, on the other hand, is a neurological disorder that can cause a wide variety of symptoms. While headache is the most common symptom of migraine, not every migraine attack is accompanied by head pain. Some people with migraine experience vertigo (a false sense of movement) with their attacks while others may have visual symptoms without any head pain at all. Migraine is so complex that no two people with migraine experience the attacks the same way.
Q. What is a migraine attack?
A. What most people don’t realize about migraine is that there is more to the migraine than just the ‘attack’. There are actually 4 potential phases of migraine, and symptoms can start before some people are even aware they are in the middle of a migraine cycle. The first phase is the premonitory phase and can precede the migraine attack by up to 3 days. During this phase, individuals can experience symptoms such as fatigue, irritability, nausea, food cravings, and sensitivity to certain stimuli such as light, sound, or smell. For approximately 25% of those with migraine, the premonitory phase is followed by a migraine aura. An aura is a transient, fully reversible neurologic symptom such as changes in vision, sensation or speech. These symptoms usually last 5-60 minutes but can be longer in some people. The actual “migraine attack” is what most people think of when they hear “migraine”. These attacks can last anywhere from 4 hours to several days and it is during this phase that the common symptom of headache begins. These headaches are usually one sided but can involve the whole head as well. They are severe in intensity and usually worsen with routine physical activity such as exercise or housework. The attack phase can also involve nausea, vomiting, and increased sensitivity to light or sound. Lastly, migraine attacks are generally followed by a postdrome phase that may last hours. The symptoms of the postdrome period are similar to those seen in the premonitory phase, and patients usually describe this period as having a “headache hangover”. It is not hard to imagine that these 4 phases, which can take up to a week or more to resolve, can cause significant pain and disability to the individual experiencing them.
Q. What treatment options are available for those dealing with migraine syndrome?
A. Depending on an individual’s migraine frequency, duration or severity, headache management can include preventive treatment strategies, acute treatments, or both. The goal of preventive treatment is a 50% decrease in an individual’s migraine frequency, severity or duration. There are several classes of medications used for migraine prevention, and these include anti-hypertensives (blood pressure medications), anti-seizure medications, anti-depressants or anti-anxiety medications, and nutraceuticals (vitamins and minerals). Acute treatments are meant to be used at the onset of a migraine attack and should be taken no more than a few times per week. Types of acute treatments include non-steroidal anti-inflammatory medications, anti-nausea medications, migraine-specific treatments called triptans, and several others. In addition to medications, migraine treatment can involve procedures such as Botox injections (which are FDA-approved for the preventive treatment of Chronic Migraine) and nerve blocks or trigger point injections (which are commonly used as acute treatment but can work as a preventive treatment strategy in some individuals). There are also several FDA-approved devices for headache treatment and these all fall under the category of “Neuromodulation”. Most importantly, a comprehensive migraine treatment plan should include some form of lifestyle and behavioral intervention, such as stress management techniques, cognitive behavioral therapy, biofeedback, and trigger avoidance.
Q. What is unique about the Hartford HealthCare Headache Center?
A. Our goal at the Hartford Healthcare Headache Center is to provide high-quality, specialized headache care that is specifically tailored to each individual. We have partnered with physicians and specialists across Connecticut that are specialized in Neuroradiology, Integrative Medicine, Sleep Medicine, Women’s Health, ENT, Psychology and Psychiatry, Physical Therapy and several other fields in order to provide comprehensive headache care to our patients. We fully believe in a team-based approach – the entire treatment plan is centered on the patient’s input regarding their goals for their headache care, their feelings towards the types of treatment they want to try, which potential side effects they are most concerned about, and any other concerns they may have regarding their headache treatment. In addition to providing comprehensive headache care to our patients, as an academic headache center, the Hartford Healthcare Headache Center is also actively working to advance the science of headache medicine by conducting several studies and trials right here in Connecticut. These studies will help headache specialists around the world have a better understanding of headache and migraine and will be able to use this information to create more effective treatment plans for their patients.
Looking for help with head pain? Visit the Hartford HealthCare Headache Center here, or call 1.860.696.2925