Is it a Headache or Migraine?

Patient Expert

Sometimes telling the difference between a Migraine attack and a  headache  can be difficult.  Migraines  can come on  suddenly, or have clear cut  cues that an  impending attack is on  the  way.  Headaches are  different in a few ways. They may be slow and steady, or short and stabbing. Either way, Migraines and headaches are not fun.

A Migraine attack  has  four possible  phases.  Prodrome, aura, headache, and postdrome. Not everyone will experience each of these phases with every Migraine. In fact, only about 25% of Migraineurs have aura at all. During the prodrome phase one may feel irritable, tired, depressed and may have food cravings. This may be our bodies way of telling us an attack is on the way and now is the time to take an abortive medication -such as the  Axert  I take.

The aura phase has many interesting  possible symptoms: flashing lights, blurry vision, and  partial loss of sight  can be part of it. Others include difficulty finding words,  olfactory and auditory hallucinations (smelling things that aren't there), confusion, dizziness and  hypersensitivity to feel and  touch.

During the headache phase, it's not just the head that hurts; the entire body may be affected. Hot flashes, chills, runny nose,  nausea  and vomiting are just some of the ways the body responds to a Migraine attack.  Head pain during this phase  may be unilateral (one sided)  or  bilateral (both sides) is mild to severe and many times is pulsating and  potentially debilitating. Sensitivity to light and sound is common. The pain is made worse by activity.

Postdrome is the last phase of a Migraine. Migraineurs may feel  "hung over" or totally out of it. Confusion, depression, fatique and  difficulty concentrating have also been reported. Others experience a  euphoric-like state. This phase can last for up to 24 hours after the headache phase. Anatomy of a Migraine will provide  you  with the details of a Migraine attack.

Headaches  do not  have four phases. Tension-Type Headaches  (TTH)  are the most common type of headache affecting people's social activity and work capacity. Tension-type headaches are bilateral, can be mild to moderate in intensity, and may feel like a band or vise around the head. TTH is  not made worse with activity, and usually there is no nausea or vomiting. One can either have sensitivity to light or sound, but not both.

How do we  tell the difference between a headache and a  Migraine? The bottom line is that Migraine pain tends to be pulsating rather than band-like. During a Migraine, light and/or sound may bother us. Any type of  physical activity such as climbing stairs or  bending over will make Migraine pain worse. A quick way to see if you have a Migraine or headache is to bend over and put your head between your knees. If your head pain is worse, you probably have a Migraine rather than a headache. Here's an Ask the Clinician question regarding this topic: Question #67.