Migraine vs. Headache: Understanding the Difference

The misconception that migraine is “just a headache” can add layers of frustration to your reality. Stigma can shape your daily experiences, and sometimes, that misunderstanding can lead to hesitation in seeking help, potentially turning episodic pain into a chronic state.

What Are Headaches and Migraine Attacks?

Headache Definition

Headaches are a common physical complaint characterized by pain in the head, scalp, or neck. They can vary significantly in frequency, duration, and intensity and can be a symptom of numerous conditions or a condition in and of itself.

Headache Disorders

Headache disorders encompass a range of neurological conditions defined primarily by recurrent headaches as a significant symptom. These disorders are categorized as follows:

Primary headache disorders: These are not symptoms of another condition but are the main clinical issue. They include migraine, tension-type headaches, cluster headaches, and other trigeminal autonomic cephalalgias. These types of headaches are disorders in their own right because they have a recurring pattern, can have identifiable triggers, and may have specific treatments.

Secondary headache disorders: These are headaches that occur due to another medical condition, such as a head injury, hypertension, sinus infection, or cervical artery dissection. The headache is a symptom of the underlying issue, and its resolution often depends on treating the primary ailment.

Other headache disorders: This category includes headaches that do not fit neatly into the primary or secondary groups, such as cranial neuralgias, where nerves in the head and neck and central causes of facial pain cause the pain.

Migraine Definition

Migraine is a chronic neurological disease with varying symptoms, including episodes known as migraine attacks. These episodes can manifest as a throbbing or pulsing pain, typically on one side of the head. Unlike general headaches, migraine attacks can cause significant pain for hours to days and can be so severe that the pain is disabling.

Migraine attacks present with other symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. You may experience warning symptoms, known as aura, before the onset of the migraine attack, including visual disturbances or other neurological signs.

Hallmarks of Migraine Attacks

• Aura: A variety of sensory disturbances that precede the migraine attack, affecting many people who live with migraine.
• Throbbing pain: A pulsating sensation typically on one side of the head.
• Light sensitivity (photophobia): A common symptom during a migraine attack.
• Sound sensitivity (phonophobia): Heightened sensitivity to sound, which can exacerbate the pain.
• Nausea and vomiting: Often accompany the pain and can be as debilitating as the pain itself.
• Prodrome phase: Subtle changes one or two days before a migraine attack, including mood changes, food cravings, neck stiffness, increased thirst and urination, and frequent yawning.
• Postdrome phase: After a migraine attack, you may feel drained, confused, or washed out for up to a day.

Migraine vs. Headache: Identifying the Differences

Feature	Headache	Migraine
Definition	Pain in any region of the head.	A neurological disease with symptoms that may include headaches.
Types	A symptom that can occur due to several underlying factors, including but not limited to, headache disorders.	Migraine with aura, migraine without aura, chronic migraine.
Symptoms	Dull, aching pain.	Throbbing or pulsing pain, often on one side of the head.
	Pressure or tightness across the forehead or back of the head and neck.	Nausea or vomiting, light and sound sensitivity.
Duration	From 30 minutes to a week.	From 4 hours to 72 hours, if untreated.
Location	Often occurs around the forehead, temples, or back of the neck.	Typically affects one side of the head but can be bilateral.
Triggers	Stress, poor posture, skipped meals, dehydration.	Hormonal changes, certain foods and drinks, stress, sensory stimuli, and changes in sleep pattern.
Aura	No aura phase.	Aura symptoms may occur before the headache phase.
Associated Features	Typically does not include symptoms other than head pain.	May include prodrome and postdrome phases, with symptoms like mood changes, fatigue, neck stiffness, and post-attack malaise.
Impact on Daily Activities	Generally mild to moderate, it does not significantly interfere with daily activities for most people.	Can be debilitating and significantly impair one’s ability to perform daily activities.
Treatment	Over-the-counter painkillers, rest, hydration.	Prescription medications, preventative treatments, lifestyle modifications.
Neurological Symptoms	Rarely includes neurological symptoms beyond pain.	Can include visual disturbances, sensory changes, speech difficulties.

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Impact on Quality of Life and Daily Activities

Migraine and headaches significantly differ in their impact on your quality of life and ability to manage daily activities.

Migraine:

• Work and productivity: Migraine attacks can cause you to miss work or perform poorly, often referred to as “presenteeism.” Pain and other symptoms like light sensitivity can be so severe that concentration and even basic tasks become overwhelming.
• Social life: The unpredictability of migraine episodes can lead to canceling social engagements at the last minute, affecting relationships and social life.
• Personal well-being: Chronic migraine can lead to hypervigilance, constantly worrying about the next attack, which can contribute to anxiety and depression. The fear of potential triggers may cause you to avoid activities you enjoy.
• Chronicity and comorbidities: For those with chronic migraine, the consistent presence of symptoms can exacerbate or be associated with other conditions such as sleep disorders, fatigue, and mood disturbances.

Headaches:

• Daily interruption: While headaches can be painful and unpleasant, they typically don’t cause the same disruption as migraine episodes. Most people with headaches can continue with their daily tasks.
• Lower psychological impact: Generally, headaches have a lesser psychological impact compared to migraine. The pain, while potentially severe, is usually not accompanied by the additional, more debilitating symptoms of migraine.
• Effect on lifestyle: Headaches may prompt lifestyle changes, such as improved posture or better hydration. However, these adjustments are often less significant than the changes people with migraine may need to make.

Both conditions can have a pronounced impact on life, but migraine, in particular, can lead to a significant reduction in life quality.

Diagnosis and When to See a Doctor

Your primary care physician or neurologist will review your symptoms and family history and use the International Classification of Headache Disorders (ICHD-3) criteria for diagnosis. Sometimes, they may order further diagnostic tests to rule out other causes.

Diagnostic Criteria for Migraine

To be diagnosed with migraine, you typically need to have experienced at least five attacks that meet the following criteria:

• Untreated or unsuccessfully treated attacks lasting four to 72 hours.

The experience should have at least two of the following characteristics:

• It’s on one side of the head.
• It has a pulsating or throbbing quality.
• It’s moderate to severe in pain intensity.
• It’s aggravated by or causes avoidance of routine physical activities.

During the headache, you must experience at least one of the following:

• Nausea and/or vomiting
• Sensitivity to light (photophobia) and sound (phonophobia).

In addition, these symptoms cannot be attributed to another medical condition.

When to See a Doctor

• See a doctor if your symptoms are disrupting your life, impacting your ability to function.
• Consult a doctor if you notice new or unusual symptoms alongside your headaches, like vision changes, numbness, or coordination issues.
• Regular headaches that require pain medication more than twice a week should be evaluated.

Red Flags and Emergency Symptoms

Immediate medical attention is crucial if you experience:

• Sudden, severe headache pain.
• Headache with stiff neck, fever, or neurological symptoms.
• Headache after a head injury.

Treatment Options and Prevention Strategies

Migraine treatment, just like the disease, can be highly individualized. What works for one person may not work for another. There are various strategies to help manage migraine attacks.

Medication and Medical Interventions

Acute treatments: These are taken at the onset of an attack to reduce symptoms. They include:

• NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin or ibuprofen
• Triptans, which specifically target migraine pain pathways.
• Antiemetics for nausea may also have pain-relieving properties.
• Gepants and ditans are newer classes of medication that have been developed for the acute treatment of migraine attacks.

Preventive treatments: If you have frequent or severe attacks, these medications can reduce the frequency and severity of migraine episodes:

• Blood pressure medications like beta-blockers.
• Antidepressants can influence serotonin levels, affecting migraine pathways.
• Anticonvulsants, which may calm hyperactive brain cells.
• CGRP (calcitonin gene-related peptide) inhibitors are a newer class of preventive medication.
• Gepants help with prevention as well.

Other medical interventions for chronic migraine include:

• Botox injections can prevent migraine attacks for up to three months.
• Neuromodulation devices which disrupt pain signals during a migraine attack.

Lifestyle Changes and Home Remedies

• Recognize and manage triggers: Common triggers include stress, certain foods, alcohol, hormonal changes, and sleep disturbances. Keeping a diary can help you identify personal triggers to avoid.
• Maintain a routine: Regular sleep patterns and eating schedules can help.
• Stress management: Meditation, mindfulness, deep breathing, or yoga can reduce stress-related triggers. Therapy can also help.
• Hydration and diet: Staying hydrated and eating a balanced diet can help prevent attacks. Some people find relief by avoiding foods with MSG, caffeine, or artificial sweeteners.
• Exercise: In many cases, physical activity can reduce the frequency and severity of attacks. However, physical exertion can also be a trigger.

Alternative Therapies

• Acupuncture/Acupressure/Physiotherapy: Some find that alternative treatments like these help reduce migraine frequency.
• Biofeedback: This technique trains you to control certain body responses to reduce pain.
• Supplements: Magnesium, riboflavin (vitamin B2), and coenzyme Q10 effectively reduce migraine frequency for some people.

Recognizing the differences between headache disorders and migraine is crucial, as is the acknowledgment of the full breadth of migraine’s impact on your life.

Your experiences are valid, and your challenges are real.