Migraine vs Headaches – what is the difference? Which one do I have? What’s the best treatment for each type? Aren’t migraines meant to be more severe?
There are so many questions and so much conflicting information out there. I’m so confused, and now I’m not sure what to do or where to go next!
If this sounds like you, you’re not alone.
There are thousands of headache and migraine sufferers around the world asking the exact same questions.
And just like you, they aren’t satisfied with the answers they’re given.
Everything seems to be so vague, why can’t I just get a proper diagnosis and treatment?
The answer, for this question at least, is simple.
Migraine vs Headaches
Headache and migraine conditions are very complex health issues and are unfortunately not fully understood yet.
Although we continue to study migraine vs headaches conditions, we’re a long way from truly understanding their causes and how to manage them, and this is much to the disappointment of doctors all over the world that are working hard to come up with the elusive cause or causes of these debilitating conditions.
So, let’s not make this even more confusing as it can get very technical!
Let’s talk about what we DO know and why it’s important to understand the real differences behind headaches and migraines.
With over 350 classifications of different headaches in the medical literature, it’s no wonder that trying to identify whether you have a headache or migraine is incredibly hard.
The International Headache Society (IHS) has developed a classification system for primary and secondary headache that aims to classify all headaches and migraines into particular categories.
Even though the classification system doesn’t provide a “cause” for migraine vs headaches, using the criteria provided and considering past research, assessing your symptoms and determining whether you have a headache or migraine is much easier.
So, let’s look at the two of the most common presentations seen in the headache clinic:
1. Tension-type headache, and
2. Migraine with or without aura.
Tension-type headache
Let’s start with the tension-type headache.
According to the IHS, headaches are infrequent episodes of head pain that can affect both sides of the head. Headaches feel like tightening or pressing on the surface of your head and causes mild to moderate pain that can last minutes up to days.
The pain you feel isn’t deep inside your skull and brain, it doesn’t worsen with routine physical activity and it doesn’t cause you to feel sick, though you may be sensitive to light (photophobia) and/or sound (phonophobia) during the headache.
The diagnostic criteria for headaches are:
A. You have at least 10 episodes of head pain occurring on <1 day a month on average (<12 days per year) and fulfilling criteria B-D
B. The pain lasts from 30 minutes to 7 days
C. The pain has at least two of the following four characteristics:
1. is bilaterally located, i.e. the pain is on both sides of the head
2. feels like someone is pressing on your head or tightening (non-pulsating) a band around it
3. have only a mild or moderate intensity
4. it’s not aggravated by routine physical activity such as walking or climbing stairs
D. Both of the following:
1. you don’t feel sick, or vomit from the pain
2. you don’t have a sensitivity to light (photophobia) and/or sound (phonophobia), or if you have a sensitivity to one, you don’t have a sensitivity to both
E. your symptoms aren’t better accounted for by another ICHD-3 diagnosis.
Tension headaches can be further broken down into four different types, which mostly vary in the number of headaches experienced throughout the year on one or more days of a month.
There are also another 22 types of headaches you can have, as described in the IHS classification system. Some of these are sinus headaches, cluster headaches, SUNCT headaches, trigeminal autonomic cephalgias, hemicrania continua and paroxysmal hemicrania just to name a few.
Migraine, with or without aura
Migraines (vs headaches) have a different, more complicated definition under the HIS classification system than headaches have.
Migraines are defined as a recurrent headache disorder that manifests in attacks that last 4 to 72 hours. The typical characteristics of migraines are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity, association with nausea and/or photophobia and phonophobia.
The diagnostic criteria for a migraine is:
A. You have at least five attacks that fulfils criteria B-D
B. Your headache attacks lasts 4-72 hours whether they were untreated or unsuccessfully treated
C. Your headache has at least two of the following four characteristics:
1. has a unilateral location i.e. one side of the head
2. a pulsating quality
3. a moderate or severe pain intensity
4. is aggravated by or causes you to avoid routine physical activity (eg, walking or climbing stairs). During headache at least one of the following:
1. nausea and/or vomiting
2.photophobia and phonophobia
D. Not better accounted for by another ICHD-3 diagnosis.
Migraines can have similar pain patterns as headaches, but in cases of migraines with aura there can be clear differences. Migraines can occur in phases, there are usually four.
If you have the symptoms that are listed in these phases below, it may indicate you are suffering from a migraine rather than a headache.
Prodrome phase: this phase usually occurs before the onset of any pain, and the symptoms include food cravings, stiffness or tightness in the neck area, mood swings, yawning etc.
Aura phase: this phase involves sensory disturbances that occur before and after a migraine. It includes symptoms that affect vision, touch or speech.
Headache phase: this phase is when the pain can come on, but not all migraines are accompanied by pain. Some migraines occur without headache.
Postdromal phase: this is the final phase, and involves the pain subsiding. You can still have symptoms of fatigue, foggy feelings, exhaustion and unwellness.
There are many other classifications of migraine headache types, but the above is the most common. The other types of migraines include vestibular migraine, menstrual migraine, abdominal migraine, cyclical vomiting migraine, chronic migraine and retinal migraine just to name a few.
What does all this mean – Migraine vs Headaches? And how does it help?
Using the classification system helps doctors diagnose your condition, provide you with the most appropriate medical treatment and help manage your condition moving forward – usually starting with medications.
Unfortunately, it is still impossible for doctors to provide you with a full diagnosis and this is where the difficulty in managing headache and or migraine starts.
If you don’t know what triggers them, you can’t stop them.
It’s also important to note that you can suffer from both conditions at the same time.
They aren’t mutually exclusive and the treatment for each can differ. Symptoms of headaches and migraines can overlap and it can be difficult to know which one you are suffering from.
To help distinguish between the two, keep a headache diary to note the features of each headache or migraine you have and work with your doctor to determine which one you are suffering from – or whether you are suffering from both.
It is also important to determine whether you are suffering from headaches or migraines, or both, as some migraine treatments are not effective as headache treatments
And some medications used for the treatments of migraines can cause medication-induced headaches.
To put it simply, the symptoms of headache and migraine can overlap, which can make it difficult to know which one you’re suffering from.
Talking to a headache consultant can help determine if you’re suffering from a headache condition or migraine condition so that you can receive the best treatment specific to your unique problem.
However, keep in mind headaches and migraine conditions are extremely complex.
There are a number of factors in your control and a number that aren’t that can affect your condition and the treatment.
What’s Next?
It’s important to find a consultant that’s willing to work with you, listen to you and provide you with the correct information so you get the best available advice specific to your condition.
Migraine vs headaches are both extremely debilitating and affect millions of people around the world. With more and more research and education being done in this area, we are starting to gain a better understanding of these conditions, what causes them and how to manage them.
While it can be frustrating if your clinician can’t give you a specific diagnosis, please don’t get angry with them.
In some cases, it takes time to determine which classification is most suitable for your symptoms and what treatment is going to be the most effective.
Be prepared to work together to find a solution that best works for you.
If you would like more information about the classification of headache and migraine, visit https://ichd-3.org/
Or click here for a free no obligation online assessment.
