The Doctor Is In

Q:All my life, I have been a person who gets headaches but I am starting to think they might be migraines … What are the differences between headaches and migraines? Do they need or require different treatment?

“Not tonight honey. I have a headache.”

Although this statement is well known, it is unclear what type of headache is being described here. In fact, there are over 150 types of headaches, and migraine headaches are a common variety of headache—although not the most common. The most frequent type of headache is the tension headache.

My patients will often describe a tension headache as a tight band around their head. There is frequently tenderness in the scalp, neck and shoulder muscles, and it is often characterized as a dull aching head pain. These headaches can often improve with over-the-counter pain relievers, massage, rest and heat, and stretching of the neck and shoulder muscles.

Migraine headaches, on the other hand, are often one-sided, throbbing and more severe. They are frequently associated with nausea as well as sensitivity to both light and noise.

There are certain migraine sufferers who get an “aura” before the headache where they can often see flashing lights and other visual disturbances. Migraines are much more common in females, and can often be triggered by certain foods, alcohol, change in barometric pressure, as well as stress and hormonal changes.

There are a variety of over-the-counter and prescription options that can treat migraine headaches, so it is important to discuss your symptoms with your medical provider.

Other headaches that I see frequently are sinus headaches and caffeine withdrawal headaches for those frequent coffee drinkers who decide to abruptly stop drinking their morning caffeinated beverage.

In addition, cluster headaches are very painful and are often described as “an ice pick behind my eye!” They are one-sided, cause redness and tearing in the eye, as well as nasal congestion. They are called cluster headaches because they often come in clusters for days or weeks at a time, and then there is a period where there are none. They may also be treated by oxygen therapy and other prescription pain relievers.

There are certain warning signs that some headaches could be the symptom of something much more ominous, and you need to get to the doctor or hospital right away. These include “having the worst headache of your life,” a severe headache after weightlifting or sex, or the headache coming on suddenly and described as explosive or violent.

Any headaches associated with slurred speech, paralysis of an extremity or confusion are also true medical emergencies. Finally, any head pain after a fall or trauma, or associated with a fever or stiff neck and vomiting, could indicate a very serious medical condition, including a brain bleed or meningitis.

If you do not normally get headaches, or if the quality or quantity of your headaches has changed or increased, it is important to seek help. There are different treatment options for different types of headaches, so it is always good to start out seeing your primary care provider who can help with the correct diagnosis and treatment. Just in case, there are neurologists and headache specialists who are there to help with the most difficult cases that are not responding to the typical treatments.

Do not wait to go get checked out!

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