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What to know about a migraine headache and how to treat migraines.

Girl with migraine headache

Migraines & Headaches

You may have heard someone say, ‘It gives me a migraine’ or ‘Oh! I have a migraine,’ and wondered why they have to name it instead of calling it a headache. In general, migraine is a headache type, but it isn’t like any other headache. Headache is a wide term used to describe a wide variety of nervous system conditions. Headache disorder includes both migraine and other types of headaches

What are the other common types of headaches?

It is not always easy for someone to describe a headache as different types of headaches have different clinical presentations. But, in general, the throbbing, squeezing, either constant or intermittent pain, in one part of the face or skull, or generalized to the whole head, is described as a headache. There are several different types of headaches. Headaches are categorized into primary headaches, secondary headaches, and Cranial neuralgias, facial pain, and other headaches. 

Primary headache

Most common primary headaches include:

Primary headaches also include other common types of headaches, and it affects the quality of life. The symptoms of these headaches are often confused with the symptoms of a stroke, which causes a lot of misperception. It must be noted that the amount of pain caused by a headache does not determine the type of headache. Most people diagnose a headache as a migraine without considering the other types of headaches that show similar symptoms. 

Secondary headache

Secondary headaches are caused by underlying infectious or structural problem in the head or neck. It comprises a broad group of medical conditions that include pain from infected sinus, pain from infected tooth or teeth, or life-threatening brain infections like meningitis. It also includes headaches caused by substance abuse, medication overuse, and headache caused by alcohol and dehydration- called a hangover. 

Cranial neuralgias, facial pain, and other headaches

Neuralgia refers to nerve pain. Cranial neuralgia refers to the inflammation caused by one of the twelve cranial nerves that come from the brain and send sensory signals such as pain from the head and neck. Most commonly recognized neuralgia is a trigeminal neuralgia that presents with severe sharp pain affecting either side of one’s face and worse with chewing, shaving or brushing teeth. 

What is migraine?

Migraine is an extremely painful type of primary headache with not always identifiable etiology. It is often accompanied by nausea, vomiting, sensitivity to light, and sensitivity to sound. Migraine is a headache that affects more women than men and usually starts in young adults. It is not uncommon to have migraine headache in kids that at times can present in kids as young as 4-5 years old. The headache generally lasts between four to seventy-two hours. 

What are the different types of migraine headaches?

Migraine headaches are divided into:

Aura refers to a sensation that a person feels or experiences before the onset of a migraine headache. The sensation can be visual aura or motor aura, and include:

They are just sensations or migraine aura, and not symptoms of a migraine headache

Other rare migraine headaches include:

What is the pathophysiology of a migraine?

Migraine is thought to be a neurovascular pain syndrome with complex mechanism including altered central neuronal processing and involvement of the trigeminovascular system (triggering neuropeptide release, which causes painful inflammation in cranial vessels and connective tissue that surrounds brain) as well as occipital nerves. 

What triggers a migraine headache?

Unfortunately, there is no exact cause of migraine headaches. It is triggered by the following triggers that change from one person to another: 

Phases of migraine headache

There are four distinct phases of migraine headache:

Treatment of migraine headache

Most people make a mistake by self-diagnosing headaches as migraines. There might be other underlying problems that may be causing a headache. Identifying underlying cause is an important task as it guides your healthcare provider with making appropriate treatment options. 

The treatment of migraine is divided into the treatment of individual attacks and the prevention of future attacks. Treatment with dihydroergotamine or triptans is a usual choice for abortive therapy. Some natural remedies like herbal supplements as well as some vitamin supplements can be considered as well. 

Preventive treatments are indicated for individuals with frequent migraine, which is generally agreed to be more than four headache days per month. Many preventive treatment options have been discovered accidentally, and include antihypertensive drugs, anti-epileptic drugs and antidepressants. Botulinum toxin was FDA approved for patients with chronic migraine headaches that were identified as at least fourteen headache days per month with each headache lasting for four or more hours. Recently FDA approved a new class for episodic migraine headache prevention – CGRP inhibitors that include Aimovig, Ajovy and Emgality. They all were approved for a self-administrated subcutaneous shot monthly. 

Besides pills there are more invasive options including occipital nerve block, supra-orbital nerve block and spheno-palatine block that can benefit specific type of patients who are refractory to other options. 

Discussing your options with trained physician is a key. Ignoring headaches unfortunately will not eliminate the problem but instead can lead to more frequent and debilitating headaches.

Image of Dr. Lenny Cohen Dr. Lenny Cohen

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