Not all headaches are created equal. Just about everyone gets an ordinary tension headache on occasion. But there are two other types of headache: cluster headaches and migraines. Cluster headaches affect men more often than women. They are characterized by sudden severe pain that strikes behind or around the eye, on one side of the head. Onset is usually rapid. Pain may peak within 10 minutes, lasting from 15 minutes to three hours. Tension headache is the most common type of headache. Sufferers usually feel dull pain, as if a tight band is squeezing the head. Triggers can include muscle tension in the neck and scalp, caffeine withdrawal, inadequate sleep, or dehydration. Tension headache usually responds to treatment with common over-the-counter analgesics, although overuse or misuse may lead to rebound headaches. In other words, if used indiscriminately, the very medications taken to relieve headaches can actually make them worse, resulting in the headaches being both more frequent and more resistant to treatment.
Migraine is different from other headaches. It’s a neurological disorder, like epilepsy. Pain is usually severe, and disabling, manifesting as intense throbbing on one side of the head. Migraines occur more frequently in women, and may run in families, but even children are susceptible. Some people experience nausea, vomiting, or sensitivity to light during attacks, which may last from four hours to three days. Some migraine sufferers report warning symptoms, known as “auras.” Symptoms may include blurred vision, or seeing stars, before the onset of an attack. Auras may occur from one day to 10 minutes before a migraine, or not at all. Migraine is surprisingly common, affecting more than 10 percent of Americans, yet up to half of sufferers are never diagnosed.
Migraines are caused by a complex cascade of abnormal events in the brain. Although many details remain unclear, this abnormal activity is known to begin in the body’s largest cranial nerve—the ganglion of the trigeminal nerve. Cranial nerves are nerves that emerge directly from the brain. Changes within the ganglion quickly spread to a network of nerves that twine throughout the delicate outer lining of the brain; the dura mater. The brain messenger chemical, dopamine, is believed to play a role in these changes, along with numerous other chemicals. Blood vessels dilate, altering blood flow. These changes may persist after an attack has passed. Within as little as 10 minutes after a migraine begins, pain-sensing nerves in this network undergo molecular changes, becoming hypersensitive to pressure. This hair-trigger response creates throbbing pain as blood pressure naturally rises and falls with each heartbeat.
It’s well known that migraine attacks can be triggered by a number of factors, although precisely why is not entirely clear. More than half of migraine sufferers who also experience aura symptoms report having at least one trigger for their migraines. Possible triggers include the following: changing hormone levels (especially among women); stress or anxiety; certain foods—including fermented and pickled foods, cured meats and aged cheeses, and fruits such as bananas, avocados and citrus; skipped meals; too little—or too much—sleep; bright or strobing lights; and fluctuations in atmospheric pressure due to changing weather. Other weather-related triggers may include changes in barometric pressure, hot or cold temperatures, and dry or humid air. Drinking alcohol or withdrawing from caffeine may also trigger migraine.
Emerging research suggest there is a small window of opportunity to stop the escalation of molecular changes in the brain by beginning treatment within 10-20 minutes of the first symptoms. Another window of opportunity closes within one to two hours of headache onset. After this, the skin of the face and scalp may become hypersensitive to touch. Numerous drugs are available to treat migraine. Over-the-counter drugs, like aspirin, ibuprofen and acetaminophen, sometimes combined with caffeine, can treat mild to moderate migraine. As these drugs enter the bloodstream they spread throughout the tissues to reduce pain and mounting inflammation, as well as helping swollen blood vessels to contract. Doctors may prescribe other drugs, including antidepressants, blood pressure drugs known as beta blockers, certain anti-seizure drugs, ergots, or a newer class of drugs called triptans. Some of these prescription drugs can also be used to help prevent headaches. The herbal remedies, feverfew and butterbur also show some promise.
About 30 million Americans suffer from migraine. It is most common among people age 25 to 55, though it can affect children and teens as well. There are two main branches of treatment for migraine. Acute treatments seek to stop a migraine headache or to reduce its severity or duration while it is happening. Preventive treatments seek to keep headaches from happening or to reduce their frequency and severity. While a migraine headache is in progress, ending it or reducing pain and other symptoms is of primary importance. Learn more.