A migraine is not just headache pain. Migraine is thought to be a genetic neurological disease characterized by flare-ups often called "migraine attacks" or "migraine episodes." A headache can be one symptom of a migraine attack. Some individuals with migraine disease often have migraine attacks without having a headache.
Migraine attacks, or episodes, occur in phases or parts. A typical migraine attack consists of four phases. Not every individual experiencing a migraine has all four phases. The four phases of a migraine attack are prodrome, aura, headache, and postdrome (see Signs and Symptoms).
Individuals suffering from migraines tend to have recurring attacks triggered by a lack of food or sleep, certain food allergies, exposure to light, or hormonal changes in women, including puberty, menopause, and premenstrual syndrome (PMS). Anxiety, stress, or relaxation after stress can also be triggers. Exposure to a trigger does not always lead to a headache. Conversely, avoidance of triggers cannot completely prevent headaches. Different migraine sufferers respond to different triggers, and any one trigger will not induce a headache in every person who has migraine headaches.
Attacks tend to become less severe as the migraine sufferer ages. The uncertainty of when attacks may occur leads to additional patient anxiety. Symptoms, incidence, and severity of migraine headaches vary by individual.
Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches at one time in their lives.
In the United States, migraine headaches often go undiagnosed or are misdiagnosed as tension or sinus headaches. As a result, many migraine sufferers do not receive effective treatment.
Treatments for migraine attacks involve prevention of the attack and treatment of acute (immediate) symptoms such as the headache.
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types of headaches
A headache is pain in occurring in the head. There are two types of headaches: primary headaches and secondary headaches. Primary headaches are not associated with (caused by) other diseases. Examples of primary headaches are migraine headaches, tension headaches, and cluster headaches. Secondary headaches are caused by associated disease, such as brain tumors. The associated disease may be minor or serious and life threatening. Seven in ten people have at least one type of headache a year.
Migraine with aura: Migraine with aura is a migraine headache characterized by a neurological (nervous system) experience originating in the brain called an aura. Most auras appear as bright shimmering lights around objects (halos) or at the edges of the field of vision (called scintillating scotomas), zigzag lines, wavy images, or other visual hallucinations. Other individuals may experience temporary vision loss. An aura is usually experienced 10-30 minutes before the headache.
Non-visual auras include muscle weakness, speech or language abnormalities, dizziness, and paresthesia (tingling or numbness) of the face, tongue, or extremities.
Migraine without aura: Migraine without aura, or "silent" migraine, is the most prevalent type of migraine headache and may occur on one or both sides of the head. Tiredness or mood changes may be experienced the day before the headache. Nausea, vomiting, and sensitivity to light (also called photophobia) often accompany migraine without aura.
Basilar migraine: Basilar migraine or basilar artery migraine, involves a disturbance of the basilar artery (blood vessel) in the brainstem. Symptoms include severe headache, vertigo (dizziness), double vision, slurred speech, and poor muscle coordination. Basilar migraines pain is usually bilateral, or on both sides of the head. This type occurs in any age, but mostly occurs in females.
Carotidynia: Carotidynia is also called lower-half headache or facial migraine. It produces deep, dull, aching, and sometimes piercing pain in the jaw or neck. There is usually tenderness and swelling over the carotid artery (blood vessel) in the neck. Episodes can occur several times weekly and last a few minutes to hours. This type occurs more commonly in older people.
Headache-free migraine: A headache-free migraine is characterized by the presence of aura without a headache. This occurs in patients with a history of migraine with aura.
Ophthalmoplegic migraine: Ophthalmoplegic migraine begins with a headache felt in the eye and is accompanied by vomiting. As the headache progresses, the eyelid droops (ptosis), and the nerves responsible for eye movement become paralyzed. Eyelid dropping may persist for days or weeks.
Status migraine: Status migraine is a rare type involving intense pain that usually lasts longer than 72 hours. The patient may require hospitalization.
Other primary headaches
Tension headaches are the most common type of primary headache. As many as 90% of adults have had or will have tension headaches. Tension headaches are more common among women than men, possibly due to hormonal changes. Tension headaches often begin in the back of the head and upper neck as a band-like tightness or pressure. Tension headaches also are described as a band of pressure surrounding the head with the most intense pain over the eyebrows. The pain of tension headaches usually is mild (not disabling) and bilateral (affecting both sides of the head). Tension headaches are not associated with an aura or visual disturbances, and the patient normally has proper vision. Tension headaches are seldom associated with nausea, vomiting, or sensitivity to light and sound. Tension headaches usually occur sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people. Most people are able to function despite their tension headaches. Tension headaches do not have a clear cause. Many healthcare professionals attribute tension headaches to excess stress during daily activities and anxiety.
Cluster headaches: Cluster headaches are headaches that come in groups lasting weeks or months, separated by pain-free periods of months or years. During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily. Each episode of pain lasts from 30 minutes to one and one-half hours. Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep. The pain typically is excruciating and located unilaterally around or behind one eye. Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery. The nose on the affected side may become congested and runny. Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures. Cluster headaches are much more common in males than females. Cluster headaches do not have a clear cause, although alcohol and cigarettes can precipitate attacks. Many healthcare professionals believe that cluster and migraine headaches share a common cause that begins in the nerve that carries sensation from the head to the brain (trigeminal nerve) and ends with the blood vessels that surround the brain dilating (widening) and contracting (narrowing), which causes pain. Others believe that the pain arises in the deep vascular channels in the head and does not involve the trigeminal nerve. Cluster headaches are a rare type primary headache, affecting 0.1% of the population. An estimated 85% of cluster headache sufferers are men. The average age of cluster headache sufferers is 28-30 years, although headaches may begin in childhood.
Secondary headaches are headaches caused by conditions other than those related to primary headaches, such as migraine. Secondary headaches have diverse causes, ranging from serious and life threatening conditions such as intracranial hemorrhage (bleeding within the skull), cerebral venous sinus thrombosis (blood clot within the membrane that covers the brain), cerebral stroke or infarct (lack of oxygen to the brain causing neurological damage), cerebral aneurysm (bulging blood vessel in the brain), Lyme disease (a bacteria from ticks), excess cerebrospinal fluid in the brain (hydrocephalus), meningitis (inflammation of the membranes of the brain or spinal cord), low level of cerebral spinal fluid (CSF), nasal sinus blockage, postictal headache (occurs after a stroke or seizure), temporomandibular joint dysfunction(TMJ), and brain tumor. Secondary headache pain can vary in severity.
Less serious but common conditions may also cause headaches, such as withdrawal from caffeine and the discontinuation of pain medications. Overuse of pain relievers causes the pain relievers to become less effective. As the effect of the pain reliever wears off, headaches recur (rebound headache). These drugs include Over-The-Counter (OTC) or prescription pain relievers, such as acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), or opiates such as oxycodone (Percocet®, Oxycontin®) and hydrocodone (Lortab®, Vicodin®). Medications such as estrogen, progestins, calcium channel blockers (commonly used for treating high blood pressure), and selective serotonin reuptake inhibitors (SSRIs, commonly used to treat depression) can cause secondary headaches.
Individuals with a subarachnoid hemorrhage typically report having a sudden onset of severe headache. The pain of recurrent migraine headaches tends to build up gradually. Sometimes the headache of subarachnoid hemorrhage is triggered by exertion, such as exercise or sex.
Musculoskeletal problems, such as injuries or poor posture, can cause or contribute to headaches such as tension and migraine headaches.
Headaches soon after trauma (injury) to the head may be caused by subdural (inner layer of the brain) or epidural (outer layer of the brain) hematomas (blood clots).
Headaches that persistently occur on the same side are often secondary headaches associated with conditions such as brain tumors or arteriovenous malformations (abnormal clusters of blood vessels in the brain).
Bacterial meningitis is a rapidly progressive and life-threatening disease with fever, headaches, stiff neck, and deterioration in mental function. Herpes simplex encephalitis (brain swelling caused by a herpes virus) is an infection of the brain that causes death of brain tissue. Symptoms include fever, headache, and deterioration in mental function. Early treatment with antibiotics and anti-viral agents can decrease the extent of brain damage and improve survival.
Associated temporary weakness of the extremities or facial muscles can be symptoms of transient ischemic attacks (TIAs, or temporary lack of oxygen to the brain). TIAs are warning signals for future strokes that can cause permanent brain damage. Headache also can accompany strokes and intracerebral bleeding (bleeding into the brain).