Both are painful, and both may require treatment. Here’s how to know what you’re dealing with.
The severity of a headache – how much pain it causes – is not actually a reliable way to tell the difference between a migraine and other headaches.
Vanderbilt Neurology’s headache and migraine team treats people dealing with chronic headaches, of both types.
“There’s a popular perception that a migraine is just a really bad headache,” said Dr. David Curfman, chief of the General Neurology Division at Vanderbilt. “It’s really a bit more complex than that.”
For one thing, severity isn’t always a reliable indicator, Curfman said. There are a constellation of symptoms that occur with migraine, and sometimes a migraine can be less painful than a regular tension headache. Some people can have more severe tension headaches. And sometimes people can have both types of headache.
How do I know it’s a migraine?
The main distinguishing symptoms of migraines, said Curfman, are the features that go along with the headache. While tension headaches are often a pressure that affects the whole head or feel like a band around the head, migraines tend to be located on one side of the head and are accompanied by a throbbing sensation. Migraines typically also include a variety of other symptoms, including nausea, vomiting and sensitivity to light or sound or motion. Some people can also have other neurologic symptoms like changes in vision or speech or numbness and tingling.
“Everybody’s experience with their migraine can be a little individual,” Curfman said. But in general, he continued, “migraines are the most common cause of headaches that lead to disability or impaired function.”
What causes a migraine?
Doctors believe migraines are triggered by a change in electrical activity in the brain. This leads to changes in the blood vessels, and ultimately causes pain. But no one knows why some people get them and some people don’t. Curfman says there does seem to be a genetic component in some cases, and many people can trace migraines back through their family, but there are also many other factors that influence the frequency and severity of headaches.
Tension headaches are even less understood. They got their name because it was believed they were caused by muscle tension in the head, but Curfman said that’s still subject to discussion. “A tension headache often isn’t as limiting as a migraine,” he said, “so I don’t think it’s been studied quite as well as migraines.”
Pain, he added, is a subjective experience, which makes it hard to study.
How do I treat a migraine?
There’s some overlap in the treatment of headaches and migraines. Over-the-counter medicines such as Tylenol and ibuprofen can work for both. Caffeine, either in the form of a pill or a soda or cup of coffee, can also relieve symptoms. But if the headaches persist, to the point that you’re having more than one a week, Curfman recommends visiting a neurologist.
“If you’re having really problematic headaches, it shouldn’t be up to you to figure that out,” he said. “That’s where we can weigh in and make sure it’s migraine and not something less common, and then get you treatment for it.”
“If you’re having really problematic headaches, it shouldn’t be up to you to figure that out.”
Treatment starts with what Curfman calls a “biopsy” of a patient’s lifestyle. Are you drinking enough water? Are you getting enough sleep — or possibly too much (seven to eight hours is optimal)? Are you exercising regularly? Are there any sources of stress or anxiety in your life that could be triggering your headaches?
Strangely enough, because migraine is still so poorly understood, many prescription drugs used to treat it were initially intended for other diseases, but then patients mentioned that they also helped with headaches.
“Many of those medicines are blood pressure or seizure medicines,” Curfman said. “And so the thought is that it just interrupts those blood flow changes or that electrical activity that leads to the migraine.” Some comparative studies based on blood samples taken from patients before, during and after migraines show one chemical that seemed to increase as the headaches built and decrease as they resolved. But it’s only been since 2019 that treatments have been available to specifically target these changes.
“We’re getting better,” Curfman said, “but we’ve still got a lot to learn.”
Are headaches interfering with your life?
The headache specialists at Vanderbilt Neurology treat patients suffering from chronic headaches, including migraines. We’ll help figure out why you’re having frequent headaches, then find the best way to relieve them.
