The Difference Between A Really Bad Headache and A Migraine?

Q: What’s the difference between a really bad headache and a migraine?

A: A migraine headache is a headache that tends to recur in an individual and is moderate to severe if left untreated. It can be one sided, throbbing and aggravated by routine physical activity. It can be associated with light, sound and smell sensitivity and many patients will become nauseated with it. In a minority of patients there can be visual or sensory changes before, during or after the headache, known as auras. Each migraine typically lasts from four hours to three days, but can last more than a week.

The National Headache Foundation estimates that nearly 30 million Americans, or approximately 12 percent of the population, suffer from migraines. Migraines occur about three times more frequently in women than in men.

The exact causes of migraines are unknown, although they are related to changes in the brain as well as to genetic causes. People with migraines may inherit the tendency to be affected by certain migraine triggers such as fatigue, skipping meals, certain foods, bright lights and weather changes.

For many years, scientists believed that migraines were linked to the expanding (dilation) and constriction (narrowing) of blood vessels on the brain’s surface. However, it is now believed that a migraine is caused by inherited abnormalities in certain areas of the brain. There is a migraine “pain center” or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels leading to the dilation of these vessels and the release of prostaglandins and other inflammatory substances that cause the pulsation to be painful.

Katharina Truelove

Katharina Truelove, M.D., is a Marshall Medical Center Provider

Sometimes it is difficult to differentiate a migraine from other serious causes of headaches. Red flags (reasons to get evaluated urgently) are a headache subsequent to head trauma, a headache with a sudden onset (“thunderclap” headache), a headache with signs of systemic illness (fever, stiff neck and/or rash), a headache beginning after 50 years of age (because migraines will typically start under age 50, and over age 50 is more likely to be temporal arteritis—which needs urgent treatment to prevent vision loss—or a mass lesion/brain cancer), headaches increasing in frequency and severity, a headache with focal neurologic signs or symptoms of disease (other than one’s typical aura), or a new-onset headache in a patient with risk factors for HIV infection or cancer.

Krystal Morrison

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