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Ooooh my aching head – Is this a headache or migraine?

Dr. Sian Spacey, staff neurologist at Vancouver Coastal Health explains what may be triggering the debilitating pain in your head, how to differentiate between a headache and a migraine, and how to prevent and treat them.

Q: As a migraine sufferer, I know that a migraine isn’t just a bad headache. For non-sufferers, what are the key differences between the two? 

A: Some key features that most strongly distinguish a migraine from other forms of headache include nausea, light sensitivity (photophobia) and disability.
A simple three-question migraine screener has been developed by neurologists (Lipton R. B et al Neurology 2003) to allow patients to quickly identify if they have a migraine. Over the last the last three months:
  1. Did you have a headache where you felt nauseated or sick to your stomach?
  2. Did light bother you when you had a headache (a lot more than when you did not have a headache)? 
  3. Did your headache limit your ability to work, study, or do what you needed to do for at least a day? 
If you answer “yes” to two questions, you likely have migraines.

Q: What are the most common migraine triggers?

A: Triggers for migraines vary from person to person and they can be accumulative, so keeping a migraine diary can be helpful. Chocolate may not trigger a migraine for you one day, but when combined with another trigger (e.g. menses) this may be additive and sufficient to start a migraine. Certain dietary items have been recognized to trigger a migraine, however, how you eat is just as important as what you eat. Rather than eating a couple of meals per day or only when you're hungry, plan to have small frequent light meals every four hours. 
Some common migraine triggers:
  • Foods: citrus, dairy, alcohol, aspartame, MSG and nitrates, processed foods and meats,
  • Hormones: fluctuations in estrogen levels
  • Sensory stimuli:  harsh lighting, loud sounds, strong smells
  • Sleep: lack of sleep, disrupted sleep, sleeping later than usual, jetlag
  • Physical activity: intense exercising (often combined with fasting and dehydration)
  • Environmental conditions: heat, humidity, change in air pressure, smog, air quality, chinook winds, seasonal allergies (sinus irritation)
  • Medications: consult a doctor or pharmacist as there are a number of medications that can cause headache.

Q: How much does stress play a role in causing tension headaches?

A: Stress can be a trigger for both tension type headaches, as well migraines. However, it is not just negative stress (illness, anxiety, difficult situation, depressive episode) that can trigger headaches; positive stress, such as planning a big event can be an equal trigger.  
We would all like to lead stress-free lives, but this just is not possible. We need to learn how to cope with and better manage stress by trying different approaches like journaling, walking, meditation, yoga, and biofeedback.

Q: How can I alleviate the pain of a migraine, e.g. dark room, silence, prescription medications? 

A: Even if you try to avoid triggers, you will likely still experience migraines. It is important to have an approach to alleviate the migraine as quickly as possible. Try removing yourself from excessive stimuli and lie down in a dark, quiet, cool room and keep hydrated.
The key to aborting the headache is to take acute abortive medication as early in the headache course as possible. As an initial step, the Canadian Headache Society Guidelines recommend over-the-counter medications such as Ibuprofen, ASA, or acetaminophen (Tylenol). These should not be taken if you are pregnant without discussion with your doctor. Prescription anti-inflammatories may include naproxen sodium and diclonfenac potassium.
If these steps fail to abort your migraine, migraine-specific medication may be prescribed by your doctor. These typically include one of the triptans: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan.

Q: At what point should I be concerned enough to see a neurologist about my headaches and/or migraines?

A: Most headaches are benign and can be controlled with the correct medications. If you are still experiencing three or more migraine days per month after avoiding triggers, you may need to start a daily medication regimen to prevent migraines. Your family doctor can initiate this. However, if your headaches are occurring in conjunction with fever, weight loss, cancer, HIV, impaired alertness, abrupt onset or new onset headache over the age of 50, you will likely need an evaluation by a neurologist.
Dr. Sian Spacey is a staff neurologist with Vancouver Coastal Health and clinical associate professor in the Division of Neurology at the University of British Columbia (UBC). She is also director of the UBC Headache Clinic, vice president of the Canadian Headache Society, and director of the UBC Neurogenetics Clinic and the UBC Clinician Investigator Program.
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