Headache and migraine: These terms are often used interchangeably, yet they are not synonymous. Among the most common forms of headache are migraine and tension headache. Let’s explore the differences with a neurologist specializing in headaches.
What is Tension Headache, and What are the Symptoms?
The most common form of headache is tension headache, characterized by persistent, constricting pain in the head. The associated pain is often described as a “circle in the head” and can range from mild to moderate intensity.
Typically, the pain is bilateral or located at the back of the head. Duration varies from 30 minutes to a week for sporadic forms and tends to be continuous in chronic cases. Although daily activities are generally unaffected, some individuals may experience associated symptoms such as:
Symptoms of Migraine
Migraine is a different type of headache that is more common in women and tends to start at a younger age. Its attacks involve moderate-to-severe pain affecting both sides of the head.
The duration of a migraine attack can range from a few hours to up to three days.
Phonophobia (sensitivity to noise), photophobia (sensitivity to light), nausea, and vomiting often accompany migraine attacks.
Before an attack, individuals may experience mood and behavior changes and physical symptoms such as increased urination or specific food cravings.
Migraine attacks significantly impact the patient’s quality of life and often require them to cease their daily activities.
Headache and Migraine Triggers
Migraine attacks can be triggered or exacerbated by various factors, including lifestyle choices and certain medications or dietary factors:
- Lifestyle triggers include mental and physical stress, prolonged exposure to light sources, lack of sleep, and poor posture;
- Some foods contain substances that can trigger migraines in susceptible individuals. Examples include aged cheeses, fermented foods, canned foods, shellfish/seafood, citrus fruits, and chocolate;
- In some women, migraines may occur at specific stages of the menstrual cycle, known as catamenial migraines.
Diagnosing Headache or Migraine
The diagnosis of headache or migraine is made by a specialized neurologist who carefully collects the patient’s medical history and conducts a thorough examination.
It is essential to differentiate between primary headaches (migraine and tension headaches) and secondary headaches, which may indicate other underlying conditions.
In some cases, additional investigations, such as neuroimaging (CT or MRI scans), blood tests, or cardiac assessments, may be necessary.
Mixed forms, where migraine and tension headache coexist, can also occur in some patients.
Treating Tension Headache
Tension headaches can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) during an attack to alleviate symptoms. It is crucial to avoid excessive use of painkillers to prevent rebound headaches or overuse symptoms. Other treatments include:
- Muscle relaxants or acupuncture, which may be recommended for individuals experiencing tension and soreness in the head and neck muscles;
- Cognitive-behavioral psychotherapy, biofeedback, relaxation techniques, and physiotherapy, which can also be beneficial for chronic tension headache disorders.
Migraine treatment varies from person to person. Some examples include:
- Nonpharmacological approaches, such as acupuncture, biofeedback, and mindfulness techniques, which can provide relief, sometimes in combination with nutritional supplements like magnesium and riboflavin;
- NSAIDs are commonly used for migraine pain relief, while triptans are more specific for migraine attacks when taken at the onset;
- For frequent and severe migraine attacks, prophylactic therapy may be necessary;
- Medications such as amitriptyline, flunarizine (a calcium antagonist), propranolol (a beta-blocker), and certain antiepileptic drugs;
- New treatments, including botulinum toxin for chronic forms of migraine and drugs that act as CGRP (calcitonin gene-related peptide) antagonists;
- CGRP, which modulates pain stimuli and vasodilation. These drugs are used when NSAIDs have not been effective.
Keeping a record of migraine episodes in a diary can also help optimize treatment and lifestyle adjustments.