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Is it a headache, a migraine or something more serious?

By Pat Crossley 5 min read

Although all migraines are headaches, how do you know whether what you're experiencing is just a headache or if it's the more debilitating migraine?

"Just about everyone experiences headaches," said Suhag Patel, PA-C, UPMC Neurology.

A run-of-the-mill headache usually is characterized by a pressure sensation, like a vice grip, affecting both sides of your head, he said.

"Most of the time you can function through them without any other symptoms associated," he explained.

"They're really not debilitating. They can be more annoying than anything, but usually people can function through a headache," he added.

The defining characteristics of a migraine compared to a headache are debilitating pain, light and sound sensitivity, and possibly nausea and vomiting.

"A miserable kind of pain that patients experience," he added.

The most common cause of migraines is a family history -- about 90% of the people who experience migraines have a family history of them.

"A lot of other things can cause them as well," Patel said, "such as environmental factors."

An example of these might be the wildfires last year which sent smoke into the area. Other triggers include bright lights, the sun and certain foods, such as wine or chocolate. An infection can lead to someone experiencing a migraine as well as head trauma or in severe situations, a brain tumor can trigger a migraine.

"Those are very uncommon," Patel said, referring back to the genetic, environmental and food triggers as the usual causes of migraines.

Migraines, he noted, tend to be underdiagnosed.

"About 40 to 60 million people are diagnosed with migraines, but about half of the country are actually undiagnosed migraines. So, you're looking at 150 to 160 million people have migraines, but are not appropriately diagnosed," he said.

Sensitivity to changes in the weather and barometric pressure are also often cited as causes of headaches.

"If someone is driving and the sunlight is flickering through the trees, that potentially can trigger as well," Patel said.

When to seek treatment for a headache is dependent on several factors.

"If you work a very busy job and you don't drink enough water…you're probably going to get a headache at the end of the day and it's probably not something severe," he said.

"But, if you don't really have a history of headaches and then all of a sudden you start getting headaches, that sort of can be concerning. If you're a younger person -- not quite as concerning," he said.

On the other hand, if you're over the age of 50 and you start having new onset headaches, that can be what is called a "red flag symptom," Patel said.

"If it's a sudden onset of the worst headache of your life, we tell patients to go to the emergency room. If symptoms are progressively worsening, then seeking medical help is important," he added.

About 95% of headaches are referred to as primary headaches, which means they're caused by something internally -- what doctors refer to as idiopathic, he explained.

"We tell patients we don't know why you're having headaches, you're just having them," he said.

A secondary type of headache that could be caused by some type of head trauma, such as a car accident or by a mass are considered more severe and would prompt more urgent medical treatment.

It's also important to seek early treatment for chronic headaches.

"If you're a 22-year-old female that's been having headaches ever since she's been a teenager -- typically the earlier you get the headaches treated, the better the later on in life, rather than waiting until your 40s and 50s before seeking help," he said.

There are three classes of medicine that are used to treat headaches in general -- blood pressure medicines, and anti-seizure and anti-depression medications.

"They all seem to work very well, for patients with both headaches and migraines. Some do better with just headaches and some do better with patients who have migraines," he said.

Some medications for migraines are preventative and some are acute treatments. Monthly injectables or tablets as well as a quarterly infusion fall in the preventative category.

"They all work the same way. Some medications will block the activity of the molecules and other medications will block the activity of the receptor," Patel explained.

The important thing is to be proactive. If there is a family history of migraines, seek treatment early, starting with a primary care physician..

"Better to evaluate the headache problem and make sure it's not something serious rather than letting it go and God forbid something bad happens later in life," Patel said.

Headache sufferers also need to be aware that overusing medication for a headache can actually cause a headache.

"There's a phenomenon called medication overuse headache where if people take any type of pain medication, either prescribed or unprescribed over-the-counter more than two to three days a week over a long period of time -- maybe two or three months -- it actually increases the severity of headaches," Patel said."Any medication we would give the patient wouldn't work."

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