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Headache vs. migraine: How to tell the difference

A man massaging his temples to relieve his headache

Headaches happen, and they’re usually nothing to worry about. Migraines are an entirely different medical problem. Here’s how to tell what’s causing your pain and finally feel better.

At some point in your life, you’ve probably had a headache. Hunger, eyestrain and stress are common causes. These headaches aren’t exactly comfortable. But they’re usually no big deal. But some types of head pain are more serious than others. If your headaches make it hard or impossible to get through the day, there’s a chance you’re dealing with migraines.

About 15% of people are affected by them. That’s more than 1 billion people worldwide.1

Many people have these severe headaches for years without ever seeing a doctor, says Gary Keilson, MD. He’s the chief of neurology at Reliant Medical Group, part of Optum, in Worcester, Massachusetts.

“These headaches affect people’s quality of life,” Dr. Keilson says. “But we have a lot of treatments for migraines that work well.”

Migraines and headaches do have some overlapping symptoms. But the two conditions aren’t the same. Telling them apart is key to feeling better. Here’s everything you need to know to identify and care for your headaches, whatever their cause.

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What is a headache?

A headache is, quite simply, an ache in your head. Headache pain is often described as throbbing or stabbing. There are a few types of headaches, all of which have different causes and treatments.2

Tension-type headache.2 This is the most common type of headache. These headaches might feel as if a belt is being tightened around your head. Tension-type headaches can be caused by:

  • Stress
  • Missed meals
  • Dehydration
  • Depression
  • Not enough sleep

Trigeminal autonomic cephalgias (TACs).2 This type of headache causes severe pain in or around your eye on one side of your face. TACs also cause reactions on the same side of your face. This could include a drooping eyelid or a runny nose.

Cluster headaches are the most severe form of TACs. These are headaches that happen in “clusters” on one side of the head. You’ll usually feel them behind or around your eye. They typically happen at the same time of day for many weeks in a row.

Miscellaneous primary headache.2 These types of headaches aren’t linked to other disorders. The causes of many of these headaches are unknown.

Secondary headache disorders.2 These headaches are symptoms of a related health problem. For example, a brain tumor, a stroke or head injury. Most people who have headaches don’t have brain tumors.

How do you care for a headache?

Treatment options for headaches vary depending on which type of headache you have.

Tension-type headaches usually go away once you take care of the underlying cause. Try ibuprofen (Advil®) or naproxen (Aleve®) to ease the pain from tension-type headaches.2

You can care for TACs such as cluster headaches with a special device. The device stimulates the vagus nerve with electrical currents. This is one of the longest nerves in your body. There are branches on each side of the neck. When the nerve is stimulated, pain signals can be blocked.2, 3

You can also ease pain and cut back the number of attacks with calcium-channel blockers. (These are medicines used to lower your blood pressure.)

Miscellaneous primary headaches are often treated with acetaminophen or indomethacin. Corticosteroids and certain antidepressants and anticonvulsants might also help.2

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What is a migraine?

Migraines are severe throbbing headaches on one side of the head. But sometimes, the pain affects the whole head, says Dr. Keilson. These headaches happen most often as soon as you wake up. The pain can last anywhere from four to 72 hours.2

Episodic migraines are when you have 14 or fewer headache days a month. If you have 15 or more, you’re dealing with chronic migraines.1 Read more about chronic pain.

There are two major types of migraines: migraines with aura and migraines without aura.2

Migraine with aura. About one out of three people with migraines have symptoms before the pain starts.1 Aura symptoms include:2

  • Visual disturbances, such as flashing lights or what looks like heat waves
  • Partial or total loss of your vision
  • Neurological symptoms, such as trouble speaking
  • Nausea
  • Increased sensitivity to light, sound or noise

Migraine without aura. This is extreme headache pain without warning, usually on one side of the head. You can also have:2

  • Nausea
  • Confusion
  • Blurred vision
  • Mood changes
  • Increased sensitivity to light, sound or noise

Migraines generally have four distinct phases:

Prodrome. These symptoms arise up to 24 hours before a migraine. They can include:

  • Food cravings
  • Mood swings
  • Yawning
  • Fluid retention

Aura. Some people go through this phase about 10 to 60 minutes before the headache. Or they skip right to the headache.

Severe head pain. Headaches are common with migraines, but they’re only one symptom. It’s possible to have a migraine without a headache. These are called “migraine aura without headache.” People may have aura symptoms but no pain after. The aura symptoms can still make it hard to do daily tasks, though.

Postdrome. You may feel tired or confused for up to a day after the headache.

What causes a migraine?

Migraines are a brain disorder. They typically start between the ages of 25 and 40. Migraines can affect anyone. But they affect women three times as much as men.2 This could be due to changes in hormones during women’s menstrual cycles.2, 4 The headaches might start at the first menstrual cycle or during pregnancy.2

Migraines are genetic, so it’s important to learn if they run in your family.

Some common migraine triggers are:2

  • Stress
  • Poor sleep
  • Reactions to certain foods or ingredients
  • Changes in weather
  • Alcohol
  • Bright lights
  • Exercise

How do you care for a migraine?

If you’re diagnosed with migraines, know there are treatment options. The first step is finding a way to ease the pain.1,4 Your doctor will likely suggest over-the-counter (OTC) pain medication such as:

If OTC medications don’t work for you, there are many migraine-specific medications. If you have migraines once in a while, you may use medication only when pain occurs. If you have chronic migraines, your doctor may suggest taking a daily medication to prevent pain from starting.1

Preventive migraine medications include:

Botox® (botulinum toxin type A) injections can help care for chronic migraines.4 There are also other ways to care for migraine without using medicines. Acupuncture is one example.1,4

Examples of as-needed migraine medications include:

What can I do to lessen the effects of a migraine?

If you think a migraine is coming on:

  • Nap or rest your eyes in a quiet, dark room
  • Put a cool cloth or ice pack on your forehead
  • Hydrate
  • Drink small amounts of caffeine during the early stages of a migraine2

If you have medication, take it at the first sign of pain or as told by your doctor.

“Migraines are underdiagnosed and undertreated,” Dr. Keilson says. “People are suffering because they’re afraid to call in sick and say, ‘Oh, I have a migraine.’ Because if the boss doesn’t suffer from migraines, they have no understanding of what it’s like.”

Can you prevent migraines?

Staying on top of healthy habits may also help you stay ahead of migraine pain. Ask your doctor about how these might help you:2

  • Take over-the-counter vitamins.
  • Exercise regularly (unless it triggers migraines for you).
  • Stay away from foods or beverages that cause headaches.
  • Stay hydrated.
  • Keep the same sleep schedule.

Sources

  1. Nature Reviews Neurology. Diagnosis and management of migraine in ten steps. Published June 18, 2021. Accessed July 11, 2022.
  2. National Institute of Neurological Disorders and Stroke. Headache: Hope through research. Last reviewed April 18, 2022. Accessed July 11, 2022.
  3. PLOS One. Noninvasive vagus nerve stimulation alters neural response and physiological autonomic tone to noxious thermal challenge. Published February 13, 2019. Accessed August 10, 2022.
  4. American Academy of Neurology (AAN) Brain & Life. Migraine. Accessed July 11, 2022.

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