Introduction

Headaches are a common and uncomfortable problem for people of all ages. You get different types of headaches, including tension headaches, migraines, and chronic headaches. While some can be traced back to specific medical conditions, others are often due to lifestyle habits. If you are searching for a way to relieve headaches, you should know that there is no one-size-fits-all solution. In this article, we'll look at the differences between headaches and migraines, as well as things you can do to prevent and manage each one.

How do you know the difference between a headache and a migraine?

You can suffer from chronic headaches or migraine headaches and many people do not know the difference. Migraines are more common than headaches and are estimated to affect 20% of the population at some point in their life. They are also more severe and last longer than headaches. Migraines are caused by an abnormal nerve signal in the brain. If you experience pain in your face, head, or neck accompanied by nausea, vomiting, fatigue, or sensitivity to light, sound, or touch, you may be experiencing a migraine.

The first time you experience a headache, you might not realize it is a symptom of a potentially serious illness. But if you experience headaches frequently, or experience more severe symptoms, then it is a good idea to seek medical advice. A variety of different medical conditions can cause headaches, from sinus and thyroid infections to cerebral tumors. If you experience headaches regularly it can be helpful to keep a headache diary, detailing when it happened, type of pain (stinging or throbbing), how long it lasted, location in your head (behind the eyes, back, or top of the head, etc.), and any other symptoms you experienced such as nausea and blurred vision.

How do I know it's a migraine?

Most people think that a migraine is just a severe form of headache. But experiencing headaches is only one of the symptoms of migraines, and they can range in severity and duration.

Migraine symptoms can include, extreme sensitivity to light and sound, coupled with nausea and vomiting are all symptoms of a migraine. It is also associated with severe throbbing or pulsing pain on one side of the head, which can last for hours to days. These throbbing pains can become so uncomfortable that it often interferes with normal daily activities.

What are the four stages of a migraine?

Stage 1: Prodrome

The prodrome or premonitory phase can begin 1 to 3 days before the headache itself.

Symptoms associated with this stage are:

• fatigue
• irritability
• trouble concentrating
• depressed mood
• yawning
• food cravings
• sensitivity to light or sound
• hyperactivity
• neck pain or stiffness

It is important to note however that any one of these conditions does not indicate the beginning of a migraine. We all yawn, get irritable and experience fatigue from time to time. What can indicate the beginning of a migraine is a combination of these symptoms. If you experience a whole range of these symptoms at once then it is recommended to start preventative measures to avoid the worst effects of migraine and to get the right measures to combat it when it occurs (1).

Stage 2: Aura

This stage is not always present during a migraine episode. One out of three migraine episodes normally has an aura stage associated with it.

The aura comprises neurological symptoms such as:

• numbness or tingling in the face or limbs
• weakness in the face or limbs
• partial vision loss
• impairments or disturbances in taste, smell, or touch
• changes in speech

These symptoms occur approximately 10 - 30 minutes before the headache. A cold compress on the forehead can help to alleviate symptoms as well as some prescription medications for migraines (1).

Stage 3: Headache

This is associated with the throbbing part of the migraine and can last a couple of hours to a couple of days. On average, this part lasts 4 hours.

Symptoms include:

• difficulty sleeping
• dizziness
• pulsing or throbbing head or neck pain
• mood changes
• increased sensitivity to light and sound
• nausea and/or vomiting

Treatments work best when the first signs of a headache are noticed. If you know you suffer from migraines then it is advised that you always carry your medication with you (1).

Stage 4: Postdrome

This is known as the migraine hangover. It normally starts after the peak pain of the headache stage has dissipated. Symptoms affect the entire body and can range from mild discomfort to pain within the body. Symptoms can last for 24 to 48 hours but are not always present during every migraine headache. It is also important to note that everybody's symptoms will differ.

Postdrome symptoms are associated with:

• Body aches
• Dehydration
• Fatigue
• Mental “fogginess”
• Trouble concentrating
• Depressed mood
• Euphoric mood (1).

What causes migraines?

Migraines can be caused by a whole host of factors. Most of these factors aren't the sole trigger of a migraine. Normally it is comprised of a combination of these factors. Here are the most common ones to look out for:

Neurological

Neurological factors can include the following:

• The way nerve signals are conveyed between one another
• Balance of chemicals in the brain
• The constriction or dilation of blood vessels on the scalp

Genetic

Genetic features may also play a role, as having a family history of migraines is a common risk factor (2).

Triggers that induce migraines to vary from person to person, but can include:

• Dietary factors, including alcohol, caffeine, chocolate, cheese, citrus fruits, and foods containing the additive tyramine.
• Medications, such as sleeping pills, hormone replacement therapy (HRT), and some birth control pills.
• Hormonal changes, for example, around the time of menstruation.
• Environmental factors, including flickering screens, strong smells, secondhand smoke, loud noises, stuffy rooms, temperature changes, and bright lights.
• Emotional triggers, such as stress, depression, anxiety, and excitement.

Other Triggers

These can include:

• A lack of sleep
• Tiredness
• Jet lag
• Poor posture
• Shoulder and neck tension
• Physical overexertion
• Irregular mealtimes
• Low blood sugar
• Dehydration

Risk factors

So, who runs the highest risk of suffering from migraines? The answer is that anyone can develop a migraine, but there are certain traits and characteristics that can lead to some people getting migraines more frequently.

These characteristics are:

• People suffering from depression and anxiety
• People that have bipolar disorder
• People suffering from obsessive-compulsive disorder (OCD)
• Fibromyalgia
• An overactive bladder
• Irritable bowel syndrome
• Sleep disorders

What is the fastest way to get rid of a migraine?

Oftentimes, prevention is better than the cure. So if you know that you are prone to severe headaches and migraines then try some of these preventive treatments.

• Wear polarised sunglasses if you experience sensitivity to light
• Set a sleep schedule and stick to it.
• Try to manage your stress levels. Ways to do this are meditation, exercise, and to get some sunlight.
• Avoid strong scents such as perfumes. These can trigger migraines. If you feel your sense of smell being overwhelmed, try sniffing on some coffee beans or mint. The soothing smell can help prevent migraines from developing.
• Aromatherapy has been found to alleviate stress, such as lavender, and soothe pain, such as peppermint.
• Heat can help relax muscles that can cause migraines. Try a warm bath, hot shower, or warm compress.
• If the heat doesn't help then try something cold against the base of the head.
• Blue light from screens has also been found to cause migraines in some people. Try to avoid it past a certain time in the day, and put a blue light filter on devices such as smartphones and laptops.
• Roll a tennis ball underneath your bare feet. The massaging action can increase blood circulation and relax some nerves in the feet.
• Breath mindfully like you would during meditation. Do this in a quiet spot for 10 minutes every day. Some apps can help to guide you through this practice.
• Avoid noisy places. Noise can also be a trigger for migraines in some people. Try making your environment as quiet as possible or get a pair of comfortable earplugs. You can even have ones custom-made at some ear specialists. They take a mold of the inside of your ear and then design a pair of unique earplugs that fits very comfortably. These can also be fitted with filters that block certain sounds, but let others through. This way you can still hear people speak, but loud noises such as sirens, horns, and heavy machinery get dulled.
• Drink mint tea or eat saltines to settle your stomach. If migraines cause you to feel nauseous, then try to settle your stomach to ward off any queasiness.

Best medication for migraines

Sometimes, all the preventative measures still don't help. In these scenarios, the best method to beat a migraine is through medication. Some over-the-counter pain relievers can work as well as some nasal sprays. Let's take a look at the ones proven to work. Most of these medications are prescription-only, so talk to your doctor to find out what the best solution to your migraine problem is.

Medication to treat an attack

Ergot alkaloids

When taken early enough drugs like Cafergot or Migril might help. However, their efficacy is negated once the migraine headache is established. These medications can also exacerbate the headache if taken too late. Ergotamine has a number of side effects. So it is important not to exceed the recommended dose (3)(4).

Triptan drugs

These are often a better alternative to ergot alkaloids since they can be taken during any stage of the migraine. You will need a prescription for these drugs and it is effective for roughly 80% of people suffering from migraines. Maxalt are the drugs found in this category.

Get Maxalt here

All these drugs have the same mode of action, namely that they constrict the painfully dilated and stretched arteries in the scalp. If you take these drugs and it's effective then it indicates that the pain originated in the scalp arteries. In people suffering from chronic bouts of these types of migraine, surgical treatment of these scalp arteries is a permanent solution to the problem.

It is also important to note that people often tend to overuse these "rescue" medications which can result in medication overuse headaches (MOH). In these cases, the drugs cause the headaches to come more frequently, and with more severity. The patient then falls into a cycle of using more and more medication which further exacerbates the problem. In these instances, the preferred method to combat the headache is the non-drug approach (3)(4).

Medication to prevent an attack

If you experience migraines more than 3 times per month, then the recommended way to combat migraines is to try and prevent them. Your doctor will prescribe medication that prevents migraines.

These are as follows:

• Beta-blockers, such as propranolol (i.e. Inderal). – which will reduce blood vessel dilatation
• Anti-epileptic drugs
• Pizotifen (Sandomigran) – unfortunately often associated with weight gain
• Anti-depressants, such as amitriptyline
• Flunarizine (Sibelium) methysergide
• Clonidine – which inhibits blood vessel contraction and dilatation
• Cyproheptadine (Periactin) (3)(4).

Non-drug migraine treatment

Given the option, most patients opt for non-drug treatment.

The first step is to diagnose where the pain originates. In Migraine, these origins are identified in two anatomical structures.

These are:

• The muscles of the jaw and neck
• The arteries of the scalp (not from inside the brain)

The muscles of the jaw and neck

The treatment that has had the most success for the muscle component of migraine pain is by means of a plate worn in the palate, called a Posture Modifying Appliance or PMA.

Wearing the PMA causes the jaw and neck muscles to relax, and is effective in many migraine sufferers. In five out of every six cases, this was all the intervention that was necessary. These migraines are often classified as tension headaches.

Other treatments such as physiotherapy, exercise, traction, Botox, and minimally invasive bloodless surgery are also used for the muscle tension component.

The arteries of the scalp

It is interesting to note that in many patients with artery pain, by relaxing the muscles by means of a PMA, the artery pain also subsided. Treatment via surgery is normally recommended for those patients where the pain doesn’t improve with the use of a PMA. This is a permanent solution for most people suffering from this form of migraine.

References

(1) Ward, TN. 2012. Migraine diagnosis and pathophysiology.Continuum (Minneap Minn).18: 753–763.PMID: 22868539

(2) Lateef, T. M., Cui, L., Nakamura, E., Dozier, J., & Merikangas, K. (2015). Accuracy of family history reports of migraine in a community-based family study of migraine.Headache,55(3), 407–412. https://doi.org/10.1111/head.12501

(3)Dr. Andrew Rose-Innes, MD, Department of Neurology, Yale University School of Medicine, New Haven

(4)Dr. E. Shevel, BDS, Dip MFOS, MB, BCh, Maxillo-facial and Oral Surgeon,Medical Director,The Headache Clinic, Johannesburg, Durban, Cape Town, August 2011