Migraine or Headache? How to Tell the Difference
A Michigan Medicine neurologist explains the causes and symptoms of migraine, how it differs from a typical headache, and what to do when one hits.
A migraine can happen to anyone at any time.
And they’re relatively common: The severe headaches have affected 20 percent of women — and nearly 10 percent of men — within the last three months, federal data show.
The debilitating pain may last for hours or even days.
“It’s the sixth-highest cause of disability for working people in the entire world,” says Michigan Medicine headache neurologist Wade Cooper, D.O., “so thinking that migraine isn’t a big deal or isn’t something that’s a real disease is a missight for our patients, their family and the people they work with.”
Many, however, might not know they’re having one.
Cooper, the director of Michigan Medicine’s Headache and Neuropathic Pain Clinic, explains how a headache differs from migraine, what symptoms to look for and why we shouldn’t understate its impact.
Key facts to know about migraine
What is a migraine and what are the symptoms?
Cooper: A migraine is a reflex in our nervous system that we all have, and we understand the biology now better than we ever did. We know the immune system gets activated, the nervous system gets activated, and there’s a consequence of a hypersensitized brain with light and sound sensitivity and pain.
Everyone in the world can have a migraine. Those who say they’ve never had a migraine but have had a hangover headache have probably had a migraine that was induced by alcohol.
For someone who has severe migraine, they can’t just be fine in an hour or two when it occurs. They expand to having severe light and sound sensitivity or severe nausea — sometimes having to throw up, lie down and actually sleep or rest for a day or two at a time.
They have no way to predict when that’s going to happen. It may occur while a person is at work or maybe while they have something important going on, such as a wedding. There’s really no way to control that.
What causes migraine?
Cooper: Anything that irritates that nervous system experience can cause migraine. For some people, that’s not getting enough sleep. For others, it’s because they’ve been under undue amounts of stress.
Our sympathetic nervous system is activated when our nervous system is under stress. It makes our heart beat a bit faster, our blood pressure go up and our blood vessels constrict. All of these things irritate the nervous system and can bring out migraine.
We also know there are certain foods that trigger migraine relatively quickly. The biggest culprits are artificial sweeteners, such as the ones you’d find in diet soda pop or zero-calorie yogurt. We know aged cheeses have a protein that is built up in them that can stimulate and bring out migraine, as well as processed lunch foods that contain nitrate.
Red wine can also bring out migraine, as can eating foods high in sugars and overusing caffeine.
How do I know if I have a headache or a migraine?
Cooper: By and large, the most common type of headache is a tension-type headache, which is a low-pressure squeezing sensation of the forehead and temples. By definition, that can only be of moderate intensity or less. But as soon as it becomes severe, you can’t call it a tension headache anymore — and that’s almost always going to be migraine in that situation.
Migraine is the one that people go to their physicians the most for, and migraine are episodes that occur between four hours, lasting up to 72 hours.
People have not only a throbbing headache but also have light and sound sensitivity or nausea. That helps us diagnose migraine compared to other headache syndromes.
What about a sinus headache?
Cooper: Sometimes we hear about sinus headaches — when people are at home thinking they have a sinus infection because they have an eye that waters or nose that runs as well as a throbbing headache.
Many times, it’s actually migraine that looks just like sinus headache because it activates those same symptoms people attribute to a sinus infection.
What are common treatment options for migraine?
Cooper: People who are prone to have migraine should try to avoid stressors, keep a normal sleep and wake cycle, avoid skipping meals, and eat a rotation diet, meaning not the same food every day.
If someone does have a migraine, I do encourage them to get care from their physician, because they might be able to get treatments that are very effective and very quick.
There are some over-the-counter medicines that can be quite effective, such as anti-inflammatory medicines like naproxen. It works really well in the right situation. Naproxen comes in a liquid-gel formulation that’s faster than a regular tablet, so if someone’s going to use an over-the-counter medicine, we typically recommend that.
There are some combination medicines that include caffeine and acetaminophen, like Excedrin, and those are also really effective for rare episodes of migraine.
Can those medications be problematic?
Cooper: If someone starts having frequent headaches, meaning more than two headaches in a week, you really should see a physician because those same medicines, if taken too often, actually irritate headache pattern and make you have more frequent and more intense headache.
That’s something we call medication overuse headache, or rebound headache.
People get into that trap because they’re uncomfortable. They have to use these medicines because they make them feel better within about an hour or so, but if they have recurrent headache and they keep taking those medicines, it irritates the nervous system — making the next headache more severe and more likely to happen with little stimulus.