Is every excruciating headache a migraine? And what if it is?

We often hear our friends and family members complain that they are having an episode of "migraine"! Do they really have migraine? or is it just a regular headache? I have seen that people who somehow believe that they have "migraine" without ever getting it officially diagnosed, often will get offended that some one has termed their "migraine" just a mere headache! They believe that the other person does not understand the seriousness of their pain and symptoms. And on the other hand migraine is one of the most common under diagnosed condition among people. So what is the real difference between a 'common headache' and a 'migraine'? This is not to just avoid offending people but to really understand the condition. I have myself suffered a lot with the headaches and I made some changes in life stye and my episodes have reduced and I did try migraines meds. a couple of times but honestly I am still unsure if I had migraines or just regular headaches? My symptoms were quite fudged...
So the the most common definition of a headache is a "pain in the head or upper neck area" which sounds really simple? well no.....

Here is some brief basic info on headaches and then I will go back to the real question, whether all headaches are migraines or something else? I have done so much research on this that I can almost write a book on this topic.

There are three major categories of headaches:

1. Primary: Tension headaches, migraines and cluster headaches come in this category.
2. Secondary headaches are caused by some underlying disease in the body.
3. Neuralgia Headaches are caused by a nerve issue probably in the upper neck and head area.

• Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men.
• Migraine headaches are the second most common type of primary headache. An estimated 35 million people in the United States (about 14% of the population) experience a migraine headache. Migraine headaches can affect children as well as adults. 
• Cluster headaches are a rare type of primary headache affecting 0.1% of the population.
• Lets talk about Tension headaches for a little bit, they are the most frequently occurring type of headaches and suprisingly their cause is still not known. They are generally caused by contraction of the muscles over skull area. We feel the muscle spasm and the related pain and the most common areas are the upper neck and area above our eyebrows. They can also cause the related muscles in the upper shoulders to go in spasm. Physical stress like manual labor, sitting at a desk concentrating etc can be factors and so can the be emotional reasons. The end result is the same, tension/spasm of the skull muscles 

Symptoms of tension headaches are........

"The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure.

Often is described as pressure encircling the head with the most intense pressure over the eyebrows.

The pain usually is mild (not disabling) and bilateral (affecting both sides of the head).

The pain is NOT associated with an aura, nausea, vomiting, or sensitivity to light and sound.

The pain occurs sporadically but can occur frequently and even daily in some people.

The pain allows most people to function normally, despite the headache"

The remedy can often be simple and mostly OTC (over the counter) meds like aspirin and other analgesics can help. Often ice or in some cases, even local heat also helps. If you believe that you are overdoing the OTC meds then please get some real medical advice. In my case, I created a monster out of my situation by taking too much Aspirin which caused me to be allergic to aspirin and all the aspirin related products. So almost every episode of my headaches caused me to have some major allergic reactions too. Finally I caught on to it and now I am only take non aspirin pills like Tylenol if needed.
Also chronic headache specially in the same spot in the head can actually be some thing very serious and should NOT be ignored and don't hesitate to seek medical advice. 


Now to understand Migraine in a language as simple as possible.

"The real migraine headache is a form of vascular (blood vessels) headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes the release of chemicals from nerve fibers that coil around the large arteries of the brain. These chemicals cause inflammation, pain, and further enlargement of the artery, causing a vicious circle of awful pain"

Migraine attacks commonly also activates the sympathetic nervous system in our body. The sympathetic nervous system is the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response, this activation itself can cause the increased sympathetic nervous activity in the intestine causing nausea, vomitting, and diarrhea. 


Now this will start making sense to many people! But here is the 'kicker' ..........sympathetic activity also delays emptying of the stomach into the small intestine and thus prevents oral medications from entering the intestine and being absorbed so the common pain meds do not work in this condition. Vasodilation of arteries can also decreases the circulation of blood, and this leads to cold hands and feet and cause light sensitivity and blurred vision.

• Migraine headaches usually are described as an intense, throbbing or pounding pain that involves one temple. (Sometimes the pain is located in the forehead, around the eye, or at the back of the head).
• The pain usually is unilateral (on one side of the head), although about a third of the time the pain is bilateral (on both sides of the head).
• The unilateral headaches typically change sides from one attack to the next. (In fact, unilateral headaches that always occur on the same side should alert the doctor to consider a secondary headache, for example, one caused by a brain tumor).
• A migraine headache usually is aggravated by daily activities such as walking upstairs.
• Nausea, vomiting, diarrhea, facial pallor, cold hands and feet, and sensitivity to light and sound commonly accompany migraine headaches. As a result of this sensitivity to light and sound, migraine sufferers usually prefer to lie in a quiet, dark room during an attack. A typical attack lasts between 4 and 72 hours.

An estimated 40%-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include:

• sleepiness,
• irritability,
• fatigue,
• depression or euphoria,
• yawning, and
• cravings for sweet or salty foods.

One of most common symptom described by almost 30 to 40 % of patients is the "Aura"

1. flashing, brightly colored lights in a zigzag pattern and usually starting in the middle of the visual field and progressing outward.
2. a hole in the visual field, also known as a blind spot.

A less common aura consists of pins-and-needles sensations in the hand and the arm on one side of the body or pins-and-needles sensations around the mouth and the nose on the same side. Other auras include auditory (hearing) hallucinations and abnormal tastes and smells. It may also cause to have dizziness fainting and in some extreme cases even have symptoms which can mimic one sided stroke.

For approximately 24 hours after a migraine attack, the migraine sufferer may feel drained of energy and may experience a low-grade headache along with sensitivity to light and sound. Unfortunately, some sufferers may have recurrences of the headache during this period.

So what do we do if our headache is really a big stinking migraine with all or most of the above mentioned bells and whistles and the not the common garden variety headache? Well see a well qualified medical practitioner right away. Till you can see a doctor, you can try to sleep if you can and use ice or other relaxation techniques like deep breathing as in yoga. You can also work to proactively work to reduce the so called 'trigger factors' to minimize the chances of migraine such as avoiding foods like strong cheese, nuts, pressed meats and chocolate. Avoid smoking, caffeine and alcohol too. Avoid episodes of long duration between the meals. Also try to stay away from bright flickering lights and try for sound sleep. So better avoid going to the '60's and 70's night' at the dance club.

As I mentioned you can try OTC analgesics but they might not be as effective due to the sympathetic nervous system response. For some women, the decline in the blood level of estrogen during the onset of menstruation is a trigger for migraine headaches too. Try to exercise regularly and avoid what ever might have known to 'trigger' these headaches spells. That may not completely avoid a major episode but surely can reduce the frequencies. In some cases that itself can be a big step in improving the quality of life.

For the most effective treatment see a doctor and the migraine can be effectively diagnosed by physical exam, MRI, CT scan and spinal tap. The doctors may prescribe you meds like the abortive medications for moderate or severe migraine headaches that are different than OTC analgesics. 
Instead of relieving pain, they abort headaches by counteracting the cause of the headache, dilation of the temporal arteries. In fact, they cause narrowing of the arteries. Examples of migraine-specific abortive medications are the triptans, ergot preparations and midrils. More commonly known as 

Beta blockers such as propranolol (Inderal), atenolol(Tenormin), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol(Corgard), and timolol (Blocadren). 

Tricyclic anti depressants (TCAs) such as amitriptyline(Elavil, Endep), nortriptyline (Pamelor, Aventyl), doxepin (Sinequan),imipramine (Tofranil), and protriptyline

Anti serotonin meds like Methysergide (Sansert) and calcium channel blockers such as diltiazem (Cardizem, Dilacor, Tiazac), verapamil (Calan, Verelan, Isoptin), and nimodipine.

Side Effects: While all of these meds might not work for all the patient strata but you can be assured of one common factor amongst them that almost all of these meds can have some serious side effects. Some of the common to really serious side effects are.....drowsiness, diarrhea, constipation, fatigue, decrease in endurance, insomnia, nausea, depression, memory loss, impotence, fast heart rate, blurred vision, difficulty urinating, dry mouth, constipation, weight gain or loss, low BP when standing, scarring around the lungs that can lead to chest pain, shortness of breath, as well as scarring of the heart valves, and serious toxicity. 

In the end all I can say is that use your common sense and try to prevent the migraine spells as much you can. The hardcore migraine suffers mostly know in advance that a spell is coming or at least know what causes it. Regular exercises, deep breathing, good healthy diet and de-stressers are the key elements of a proactive approach. I personally have done some key changes in lifestyle and don't take any more meds for it. If I have that feeling of a headache, I simply take some OTC anti allergic like Children's Benadryl, vapor steam and rest. I might have to take an occasional OTC tylenol but that's about it. The OTC anti allergy meds helps to prevent any allergic issues as I have come to a conclusion that at least my headaches were allergen related and once the sinuses are inflamed, it triggered my headaches. So write your issues down and try to narrow the possible causes to the simplest headaches and you may avoid a major spell?

~Dr. V  

REFERENCES:

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Roger Cady, MD, David W. Dodick, MD. Diagnosis and Treatment of Migraine. Mayo Clin Proc. 2002;77:255-261.

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Previous contributing author and editor: Dennis Lee, MD and Harley I. Kornblum, MD, PhD

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