Understanding the Different Types of Migraine and Headache Disorders: Which Type Do You Have?
​Most people when they hear the word "migraine" they think it is a very bad headache. But the reality is, migraine is a complex neurological disease and is so much more than head pain. Did you know, some migraines do not even have head pain? Since migraine is so complex, there are many different types of migraines and headaches. Most migraine and headache disorders actually affect people differently and it is normal for migraine symptoms to vary from person to person. This is because people with migraine have their own set of personal triggers and migraine attack patterns.
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Difference between Migraine and Headache
So before we dive into the different types of migraines and headache disorders, let's chat about the differences between a Migraine and Headache.
A headache is pain in your head that is generally described as pressure or aching pain. The pain ranges from mild to severe and can be located on the forehead, temples, and back of neck. The pain normally lasts anywhere from 30 minutes and up to 7 days.
On the other hand, a migraine can be with or without severe head pain and is accompanied by associated symptoms. If head pain is present, it is normally located on one of the temples, but it does not have to and can be located in the back of the head and across the forehead. This pain is often described as throbbing and it is very difficult to perform daily tasks during an attack. The accompanying symptoms include nausea, sensitivity to light and sound, dizziness, blurred vision, fatigue, nasal congestion, and irritability. A migraine attack can last anywhere from 4 to 72 hours and has 4 phases: prodrome, aura, attack, and postdrome.
Types of Headaches
Tension Headache
Tension Headache is the most common type of headache. It is generally described as mild to moderate pain that feels like a tight band around the head. It can also cause tenderness in the scalp, neck, and shoulders. This type of headache can last 30 minutes to a few days. It is normally triggered by stress and can be chronic (daily headaches) or episodic (less than 15 headaches per month). The best way to treat tension headaches are to use over the counter painkillers like Acetaminophen (Tylenol) or Ibuprofen (Advil, Motrin). If that doesn't work, talk to your doctor about prescription medication and muscle relaxers. A great way to prevent these types of headaches is to work on stress management including relaxation techniques, acupuncture, yoga, or cognitive behavioral therapy.
Sinus Headache
Sinus Headaches are common in people with seasonal allergies or when they have a sinus infection. This type of headache causes pain and pressure in your cheeks and forehead and the pain gets worse when you bend forward or lie down. The best way to treat a sinus infection is to apply a warm compress to the painful areas on the face, use a decongestant to reduce the swelling, and try a nasal spray. If the sinus headache is caused by allergies, it may be a good idea to get on an allergy medication to prevent this type of headache from occurring.
Cluster Headache
Cluster headaches are one of the most painful types of headaches. The common symptoms of cluster headaches is generally one sided head pain and pain that is in or around one eye. The common symptoms of cluster headaches is generally one sided head pain and pain that is in or around one eye. Cluster headaches generally appear in a cluster of frequent attacks that can last from weeks to months and then is followed by a period of remission when headaches stop. Remission can last months or even years. During a cluster period, the headaches normally occur daily and at the same time each day, usually at night, and last from 15 minutes to 3 hours. Treatment for cluster headaches usually includes pain control and this is done either with over the counter pain medication including Acetaminophen (Tylenol) or Ibuprofen (Advil, Motrin). It can also include prescription medication for acute pain relief including Triptans, applying oxygen, and lidocaine nasal drops. It can also include preventative medication like Topamax, Verapamil, and some CGRP receptor blockers.
Thunderclap Headache
A thunderclap headache is an intense headache that occurs suddenly, like a clap of thunder, and lasts about 5 minutes. Other symptoms can include numbness, weakness, nausea, changes in vision, confusion, or speech problems. This headache could be a sign of a life threatening problem, so it is vital to seek medical attention immediately. Some causes of a thunderclap headache include torn or ruptured blood vessels in the brain, stroke, brain aneurysm, a brain infection like meningitis or encephalitis, or a sudden increase in blood pressure.
Medication Overuse Headache
Medication overuse headache, also known as rebound headache, is a secondary disorder caused by excessive use of pain medication. Excessive use is often characterized as a combination of abortive medications taken more than 10 times per month for 3 months. The headache is often described as a daily or almost daily headache, usually occurring upon awakening. Medications that can cause medication overuse headache include over the counter medications like Acetaminophen (Tylenol) or Ibuprofen (Advil, Motrin) and also include prescription medications like Triptans, Opioids, Barbiturates, and Benzodiazepines. Treatment for medication overuse headache is to stop all use of medications, high dose steroids, and to start a preventative medication (to help treat the underlying disorder).
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Types of Migraine Disorders
Migraine (No Aura)
A migraine is severe head pain accompanied by associated symptoms. This pain is described as throbbing and interrupts daily tasks. It is normally located on one side of the head, but it can be on both sides, back of head, or not present at all. The accompanying symptoms include nausea, sensitivity to light and sound, dizziness, blurred vision, fatigue, nasal congestion, and irritability. A migraine attack can last anywhere from 4 to 72 hours. Treatment includes both pain relief for attacks and prevention. For pain relief, this can include over the counter medication for pain relief like Tylenol or Ibuprofen and also prescription medication like Triptans and Ergotamines. To note, taking too much medication for pain relief can cause medication overuse headache. Preventative treatment includes a wide variety of medication including Botox and CGRP receptor blockers and it can also include supplements like, CBD, Riboflavin (B2) and magnesium.
Migraine with Aura
A migraine with aura is a migraine that is accompanied by an aura which is a warning sign that occurs about 30-60 minutes before the head pain (or attack phase) of a migraine. An aura is a series of sensory disturbances that can range from vision disturbances like seeing flashes of lights, stars, or zigzags; sensory changes like feeling tingling or numbness in the face or hands; or speech problems that cause the inability to produce the right words or slurring or mumbling words. Aura is very unique to migraine, as it does not occur for everyone and those that have aura will not have an aura before every migraine attack.
Migraine with Brainstem Aura
Migraine with Brainstem Aura, also known as basilar migraine, is a type of migraine with aura that is accompanied by symptoms that originate from the base of the brain known as the brain stem. These accompanying symptoms include vertigo (spinning sensation), tinnitus (ringing in ears), diplopia (double vision), ataxia (uncoordinated movements), and dysarthria (slurred speech).
Silent Migraine (Migraine Aura without Headache)
Silent migraine, also known as acephalgic migraine, is a migraine with an aura with no accompanying head pain. This is a migraine attack that skips the headache phase. Silent migraine can be difficult to treat because an aura typically lasts 30-60 minutes, and most medications take about an hour to work. Some people with this condition choose not to take anything, as the symptoms do not last long, others have lingering symptoms of nausea and sensitivity to light and sound and medication can help ease these symptoms.
Hemiplegic Migraine
Hemiplegic migraine is a very rare form of migraine. When this occurs, people experience a migraine with hemiplegia, which is weakness to one side of their body. The hemiplegia normally begins before the "headache" pain of the attack and lasts about 30 minutes to 1 hour.
***Hemiplegia can be a sign of a very serious condition, so if this ever happens to you and it is not normal, you need to seek medical attention.
Retinal Migraine
Retinal migraine, also known as ocular migraine, is a type of migraine that affects vision before the migraine hits. It can cause complete or partial blindness in one or both eyes, twinkling lights, or flashes of light. Normally these vision changes go away within one hour.
**Changes in vision can be a sign of a very serious condition, so if this ever happens to you and it is not normal, you need to seek medical attention.
Vestibular Migraine
Vestibular Migraine can cause balance issues or dizziness with or without head pain. People with vestibular migraine can experience a combination of visual aura, dizziness, and sensitivity to visual stimulation and motion at different times. Diagnosis for vestibular migraine can be difficult because the symptoms of dizziness can overlap with other diagnoses such as Méniére’s disease.
Chronic vs Episodic Migraine
Some people assume that chronic migraine is a constant migraine episode. On the contrary, chronic migraine refers to more than 15 migraine and headache days per month. Whereas, episodic migraine is less than 14 migraine and headache days per month. The thing with chronic and episodic migraine is that one can go from being chronic migraine and then fall into episodic migraine and vice versa. Things like medication overuse headache can cause one to fall into chronic migraine. Things like adding in preventative medication, lifestyle changes, diet changes, and understanding their migraine triggers can all help and contribute to someone going from chronic migraine to episodic migraine.
Diagnosis of Migraine or Headache Disorder
Generally speaking, there is no specific test to diagnose a certain type of migraine or headache disorder. A diagnosis is made from talking to your doctor about what you have been experiencing.
According to the diagnosis code for migraine, a patient must have at least 5 attacks that fulfill the following criteria:
-Attack lasts for 4-72 hours
-Attacks has 2 of the following characteristics: unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
-During the headache, the patient has nausea, vomiting, sensitivity to light, sensitivity to sound etc
Also, the doctor will want to do a physical exam to rule out any other possible causes of headache or migraine symptoms. They may order a CT or MRI to make sure that there are no underlying causes. The doctor may refer you to a neurologist for further management.
