When a migraine strikes, it can feel like the world is ending. Akin to an out-of-body experience, whether your place of solace is a darkened room, underneath a pillow or the depths of your duvet (we’ve definitely been there), how do we stop them ruining our lives and why are painkillers not always the best option for easing the ache? Furthermore, is there actually a difference between a migraine and a really really bad headache or are they one and the same?
We asked Dr Katy Munro, headache specialist at the National Migraine Centre , for her advice on the different types of headaches and migraines you can suffer from and identifying the main symptoms and ways to stop them in their tracks before it’s too late.
GTG: Is there actually a difference between a migraine and a headache?
KM: Although we commonly see people who feel that they have some migraine attacks and some which are just headaches, it is increasingly thought by headache specialists that the underlying mechanism of pains in the head is the same. We now think of headaches and migraines as being on a spectrum of severity. The management of them is very similar as the pain triggering mechanism in the brain is the same.
As the underlying pain process for headaches and migraines is the same, there is no need to be too concerned about distinguishing between the two. In fact, delaying treatment too long because it is 'just a headache' may result in a longer period of pain and debility. The momentum of a headache can build up if pain-relieving medication is taken too late or in too small a dose.
GTG: What are the different types of migraines and headaches you can suffer from? What are the main causes and symptoms?
KM: Migraines can occur with or without aura. Aura is seen in about 15-20 per cent of sufferers so is less common than migraine without aura. Aura can be a variety of symptoms including zigzag lights, blind spots in the vision, numbness, tingling or speech problems and it usually comes and goes within an hour before the headache pain starts. Some people get migraine aura but little or no headache pain.
Other types of migraine do occur but are much rarer e.g. hemiplegic migraine. They can also include the following:
Tension headaches: Neck strain and poor posture can contribute to triggering headaches and migraines but also migraines can give rise to neck pain. Tension headaches are often attributed to stress, but of course, stress is also a strong trigger for migraines so once again we tend to consider them as part of the migraine spectrum.
Cluster headaches: these are very different from migraines and it is not certain why they occur in some people. They are characterised by a sudden onset of excruciating pain which makes the sufferer feel very agitated. There may be watering and redness of the eye and a runny nose. They often occur at a regular time of day and often reoccur at the same time each year. They are nicknamed the 'suicide headache' because sufferers find the pain so unbearable. Intense bouts of pain last up to three hours and can recur several times a day for weeks at a time.
Sinus headaches: Sinusitis is often diagnosed when patients present with headaches but it may later transpire that the pain was actually due to migraines. True sinusitis is an acute infection of the small air spaces in the cheeks and forehead. It is characteristically worse on bending down and there may be tenderness over the inflamed sinuses.
GTG: Are there any other common problems that you see in your practice?
KM: People who suffer from migraine have a tendency to treat their headaches with small doses of painkillers repeatedly. This can lead to changes in the brain which cause a background daily headache which doesn’t respond to the normal migraine treatments. They may then increase the number of days on which they take painkillers and find that the headache just stays and stays. This is medication overuse headache and it is one we commonly see in the National Migraine Centre.
This can be overcome by stopping all painkillers for eight-12 weeks, but sometimes the headaches get much worse before they get better. We have a lot of ways we can help patients through this detoxifying time.
GTG: What are your top recommendations for preventing and treating the above types of headaches and migraines?
KM: Migraine and tension-type headache: The brain of a migraine sufferer does not like change, so keeping to a routine of eating and sleeping is very important. We advise that migraine sufferers have something to eat every three to four hours and a bedtime snack of slow-release foods, e.g. protein, fat and slow-release carbohydrates.
Identifying triggers, which start 24 hours before the headache comes, is helpful. Early treatment of the headache repeated on day one is less likely to give medication overuse headache than treating it with small doses spread out over several days.
Stress-relieving techniques and checking posture can be helpful.
Cluster headaches need specialist advice and medications including oxygen and injectable medications are usually required.
Having a personalised plan can be very helpful and is what we aim for at the National Migraine Centre as every migraine sufferer has their own unique story. There are many other ways we can advise to help tackle debilitating headaches.
For further information, visit www.nationalmigrainecentre.org.uk