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Headaches vs. Migraines. What’s the Difference?

If you’ve ever been sidelined by throbbing head pain, you may have wondered at what point your tension headache was actually a full-blown migraine. Migraine headaches are relatively common: They affect about 10 percent of people worldwide. Women are almost three times more likely to experience them than men. 

But how can you tell the difference between a migraine and a garden-variety headache? Which doctor should you seek for help? And what are your treatment options? We talked with experts to learn how patients can distinguish between migraines and tension headaches.


Migraines

Causes

Despite their prevalence, researchers aren’t quite sure what physiological responses cause people to develop migraines. One theory is that “migraine headaches originate via a complex interaction between the nerve that supplies sensation to the head and face, blood vessels in the brain and the meninges, a protective membrane around the brain,” says Dr. Kapil Sachdeva, a neurologist at Northwestern Medicine Central DuPage Hospital in Illinois.

Despite uncertainty about the exact cause, experts do know that a migraine “generates an enhanced nervous system experience, meaning every one of our sensory systems is in overdrive,” says Dr. Wade Cooper, a neurologist at University of Michigan Health. That’s why migraine headaches can also include symptoms like light and sound sensitivity.

Triggers

Hormonal fluctuations, sleep dysfunction and certain foods, “including red wine, artificial sweeteners and a bunch of other less common food additives, like MSG or certain food dyes,” can trigger migraines, Cooper says. 

Many women who suffer from migraines experience worse symptoms around menstruation; changes in barometric pressure and humidity can also trigger migraine headaches.

Severity 

Migraines are debilitating. If you’ve never experienced one, Cooper likens the headache pain to a bad hangover.

“You can envision someone with a hangover wearing sunglasses the next morning, wanting everyone to be quiet around them,” he says. Light and sound sensitivity are also common symptoms of a migraine, along with nausea and vomiting.

Other symptoms

Some migraine sufferers experience a visual aura that impacts their vision: “An electrical wave on the back of the brain kind of makes you hallucinate, with spots and sparkles in your vision,” Cooper says.

Migraines can also occur on either side of the head or both sides.

“Contrary to popular belief, a migraine does not have to be located on one side of the head, and, like tension headaches, can be located on both sides,” Sachdeva says.

Diagnosis

The first stop for treating headache pain is your primary care doctor.

“Typically, migraines are initially managed by a primary care physician, particularly if the headaches are infrequent and respond well to initial management,” Sachdeva says.

Doctors generally diagnose migraines based on a patient’s symptoms without any extra testing. But your provider might order brain imaging or a blood test to rule out other causes if you present with red flags like loss of vision or movement, facial droop, history of cancer or headaches occurring for the first time after age 50.

If you’re not getting relief after seeing a primary care provider, your headaches get worse or you experience unusual symptoms like loss of vision, it might be time to see a neurologist for more specialized treatment.

Treatment

There is no cure for migraines. “But with treatment, most patients can have a good quality of life,” Sachdeva says.

Treatment options are plentiful, including over-the-counter painkillers, prescription devices and lifestyle changes. Some ways to treat and manage migraines include:

  • Over-the-counter medications. NSAIDs like Tylenol and Advil are the first line of defense for many migraine sufferers; Cooper suggests ibuprofen gel caps, which work faster than tablets. Some people find relief from Excedrin, which is a combination of acetaminophen, aspirin and caffeine. 
  • Prescription drugs. For years, doctors have prescribed triptans to decrease migraine sensitivity. “These are very safe and effective, but not everyone responds to them,” Cooper says. Other people do better with newer classes of medication like ditans and gepants, two other oral medications that can treat acute migraines, or the Cefaly, a prescription device that stimulates a specific nerve to treat acute migraine attacks.
  • Lifestyle changes. Some people find relief by changing their habits. “It comes down to the same thing you always hear: get good sleep, eat healthy, exercise,” Cooper says.  “Exercises like yoga influence a mindfulness concept, which can be helpful in reducing migraine susceptibility.” says. Plus, he adds, “when you exercise, your body releases hormones that lower your body’s ability to trigger or bring out a migraine attack.”
  • Cutting caffeine. If you have a serious coffee habit, reducing your caffeine intake can help with managing migraines. This might seem counterintuitive, since caffeine is an active ingredient in OTC migraine medications like Excedrin; Cooper says caffeine works well in small doses to treat migraines, but overdoing it can ultimately agitate your headaches

If you suffer from chronic migraines, occurring at least 15 days per month, you might consider preventive treatments, including:

  • Botox. Patients receive Botox injections in the scalp every three months to reduce migraine frequency. “It takes about two to three months to kick in [after the first treatment], but once it kicks in, it’s quite effective in reducing the frequency and severity of migraine attacks,” Cooper says.
  • Supplements. Your doctor might recommend a vitamin supplement, like magnesium or vitamin B2 (riboflavin), to keep migraines at bay.

Tension headaches

Causes

Tension headaches — the most common type of headache — are “typically caused by factors extrinsic to the brain itself, such as stress, muscle tightness or stiffness or an increased sensitivity to pain around the head and neck,” Sachdeva says.

Triggers

Anything from stress to jaw-clenching can trigger a tension headache. Other headache triggers include alcohol use, caffeine overuse or withdrawal and the common cold.

Severity

Tension headaches are a pain, but they’re mild compared to a migraine; the Mayo Clinic likens the feeling to a tight band around the head.

If the pain is more intense, you might be dealing with a migraine.

“By definition, a tension headache cannot be severe and cannot pick up the cardinal features of migraine,” Cooper says. “If someone gets both light and sound sensitivity, or if someone gets nausea or throws up, we call that a migraine.”

Diagnosis

Like migraines, most tension headaches are diagnosed based on a patient’s description of their symptoms. Some neurologists perform a physical exam to feel the muscles on the side of the head and identify tightness and irritation, Cooper says.

Treatment


Other types of headaches

Tension headaches and migraines are the most common headaches, but they’re not the only types that are extant. Sinus headaches (a byproduct of a sinus infection that causes pain in the sinus cavities) and cluster headaches (characterized by a sharp stabbing pain) are two other culprits. 

Researchers aren’t entirely sure what causes cluster headaches, but they suspect it’s related to a sudden release of histamine or serotonin in the body. Although cluster headache pain can be intense, it’s not the same as migraine pain, Cooper says.

“People with migraine headaches want to sit as still as possible,” he says. “Cluster headache is a very brief, short-lived, incredibly intense headache associated with an inability to sit still.”

Many patients also mistake migraines for sinus headaches, Cooper says, but sinus headaches are relatively uncommon. If you’re unsure what kind of headache you’re experiencing, a doctor can identify the cause.

Other types of headaches that occur under very particular circumstances, like only at night or in a certain region of the head, could warrant a visit to a neurologist.


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About The Paper Gown

The Paper Gown, a Zocdoc-powered blog, strives to tell stories that help patients feel informed, empowered and understood. Views and opinions expressed on The Paper Gown do not necessarily reflect those of Zocdoc, Inc.

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