Migraines and Headaches
Headaches are among the most common health complaints, but frequent, severe, or changing headaches should not simply be accepted as part of everyday life. Some headaches are occasional and short-lived, while others, including migraine, are neurological disorders that can significantly interfere with work, family responsibilities, sleep, and quality of life.
Migraine is more than a bad headache. It is a chronic neurological disorder that can cause head pain along with nausea, dizziness, visual changes, brain fog, and sensitivity to light, sound, smells, or movement. The American Migraine Foundation estimates that migraine affects more than 40 million people in the United States.
At First Choice Neurology, neurologists evaluate headaches and migraines to determine the type of headache, identify possible triggers or underlying conditions, and develop an individualized treatment plan.
What Is the Difference Between a Migraine and a Headache?
A headache refers to pain or discomfort involving the head, scalp, face, or upper neck. There are many different headache disorders, and symptoms can range from mild pressure to severe, disabling pain.
Migraine is a specific neurological disorder. Migraine attacks commonly cause moderate to severe head pain and may also involve nausea, vomiting, dizziness, visual disturbances, numbness or tingling, and sensitivity to light, sound, touch, or smell. Some people experience migraine symptoms even when head pain is not the dominant symptom.
Fifty percent of migraine sufferers don't even know they get them, or just think they are bad headaches. They are a neurological disorder with extremely incapacitating neurological symptoms. In 15-20% of attacks, other neurological symptoms occur before the actual head pain. Attacks usually last between 4 and 72 hours.
What Causes Migraines and Headaches?
The cause depends on the type of headache. Primary headache disorders such as migraine are not simply symptoms of another disease. Migraine is a complex neurological condition, and genetic and environmental factors can influence a person's susceptibility.
Many patients also notice that certain circumstances appear to trigger or contribute to migraine attacks.
Common migraine triggers may include:
- Stress
- Changes in sleep or inadequate sleep
- Dehydration
- Skipping meals
- Hormonal changes
- Bright or flashing lights
- Strong smells
- Loud sounds
- Changes in routine
- Travel
- Weather or environmental changes
- Alcohol
- Certain foods or ingredients
- Physical exertion in some individuals
- Excessive caffeine or changes in caffeine intake
Triggers are highly individual. Keeping a headache diary can help patients and their neurologists identify patterns involving symptoms, frequency, duration, medications, sleep, diet, stress, and possible triggers.
Common Migraine and Headache Symptoms
Symptoms differ depending on the type of migraine or headache.
Headache symptoms may include:
- Pressure, tightness, aching, or throbbing pain
- Pain on one or both sides of the head
- Pain behind or around the eyes
- Forehead, temple, scalp, face, or neck pain
- Tenderness in the scalp, neck, or shoulders
- Pain that worsens with activity
- Recurrent headaches that follow a recognizable pattern
Migraine symptoms may include:
- Moderate to severe throbbing or pulsating head pain
- Pain on one or both sides of the head
- Nausea or vomiting
- Sensitivity to light
- Sensitivity to sound
- Sensitivity to smells
- Dizziness or balance problems
- Blurred vision or other visual disturbances
- Numbness or tingling
- Difficulty concentrating or “brain fog”
- Fatigue
- Neck stiffness or discomfort
- Symptoms that worsen with physical activity
Migraine symptoms vary considerably from person to person, and not every migraine attack includes the same symptoms.
What Is Migraine Aura?
Some people experience migraine with aura. An aura involves temporary neurological symptoms that usually develop before or during a migraine attack.
Aura symptoms may include:
- Flashing lights
- Zigzag lines
- Blind spots or temporary changes in vision
- Numbness or tingling
- Speech or language difficulty
- Other temporary sensory disturbances
The International Classification of Headache Disorders recognizes migraine without aura and migraine with aura as the two major migraine types.
Facts about Migraines and Headaches
• Migraine is a neurological disease, not simply a severe headache.
• More than 40 million Americans live with migraine.
• Migraines affect approximately 1 in 4 U.S. households.
• More than 90% of people affected by migraine report that it interferes with education, work, or social activities.
• Migraines can occur with or without aura.
• Migraines are 3 times more likely to affect women than men
• About 90% of people with migraines have a family history of the condition
• Stress is one of the most common triggers
• Migraine symptoms can extend beyond head pain and may include nausea, dizziness, brain fog, visual disturbances, and sensitivity to light and sound.
• Migraine treatment is highly individualized.
Common Types of Headaches
There are many different headache disorders. Identifying the correct type is important because treatment can vary significantly.
Tension-Type Headache
Tension-type headaches often cause mild to moderate pressure or tightness that may feel like a band around the head. They may also involve tenderness in the scalp, neck, and shoulders.
Migraine
Migraine is a neurological disorder associated with recurrent attacks that can include moderate to severe head pain, nausea, sensory sensitivity, dizziness, cognitive symptoms, and other neurological symptoms.
Cluster Headache
Cluster headaches cause extremely severe pain, usually around or behind one eye. Attacks tend to occur in groups or “clusters” over a period of weeks or months and may be accompanied by tearing, eye redness, nasal symptoms, or restlessness.
Medication-Overuse Headache
Frequent use of certain medications intended to relieve headaches can sometimes contribute to increasingly frequent headaches. Medication-overuse headache can also occur in people who have migraine or another underlying headache disorder.
Secondary Headache
Unlike primary headache disorders such as migraine and tension-type headache, a secondary headache is caused by another condition. Causes can include head or neck injury, infection, vascular disorders, medication or substance effects, and other medical conditions.
Types of Migraine
Migraine is not the same for everyone. Recognized migraine types and subtypes include:
- Migraine without aura
- Migraine with aura
- Chronic migraine
- Migraine with brainstem aura
- Hemiplegic migraine
- Retinal migraine
- Typical aura without headache
The International Headache Society also recognizes complications and related conditions, such as status migrainosus and episodic syndromes associated with migraine.
When Should You See a Neurologist for Headaches or Migraines?
Consider scheduling a neurological evaluation if:
- Experience frequent or recurring headaches
- Headaches become more frequent or severe
- Headache pattern has changed
- Headaches interfere with work, school, sleep, exercise, or daily activities
- Over-the-counter medications no longer help
- Rely on headache medication frequently
- Dizziness, numbness, tingling, visual changes, or balance problems occur
- Migraine symptoms and never received a formal diagnosis
- Previous treatments are not effective
- Medication side effects
- Explore preventive migraine treatment
- Unsure whether symptoms are migraine or a type of headache
Migraine is generally diagnosed from a patient's symptoms, medical and family history, and neurological examination. There is no single test that confirms migraine. When appropriate, a neurologist may order MRI, CT, laboratory testing, or other evaluations to rule out another cause for the symptoms.
When Is a Headache an Emergency?
Some headache symptoms require immediate emergency medical attention rather than a routine neurology appointment.
Seek emergency medical care for:
- A sudden, extremely severe or “thunderclap” headache
- The worst headache you have ever experienced
- Headache with new weakness or numbness
- Difficulty speaking
- Confusion
- Fainting or loss of consciousness
- Seizures
- Double vision or significant new vision changes
- Fever with a stiff neck
- A severe or worsening headache following a head injury
- New or rapidly worsening neurological symptoms
Sudden severe headaches and headaches accompanied by new neurological symptoms can indicate a medical emergency and should be evaluated immediately.
Migraine Resource Guides
Are You at Risk for Chronic Migraines?
Is your migraine becoming more intense or frequent? With our guide, you will learn to define episodic and chronic migraine by intensity and frequency, recognize the symptoms that your migraine is progressing, and reduce the progression of your migraine.
Descarga Nuestra Guía “¿Está Usted en Riesgo de Sufrir Migraña Crónica?
La señal más obvia de que su migraña está progresando es que sus ataques de migraña son más frecuentes. Si usted nota un cambio en la frecuencia de sus migrañas, es hora de encontrar a un especialista en dolores de cabeza para explorar sus opciones.
What Type of Headache Do You Have?
There are over 100 different types of headaches, so pinpointing which one is ailing you can take some time, and probably a visit with a headache specialist. Use our guide to help narrow down the most common types of migraine.
Meal Planning
It’s not uncommon for migraine patients to notice that their symptoms correspond with certain food triggers. However, which foods or ingredients contribute to head pain varies widely from person to person. Our guide will help you examine your eating habits, maintain a balanced diet, and identify patterns that could help reduce migraine attacks.
Guide to Healthy Sleep
Your body needs rest, and getting a consistent, adequate amount of sleep provides the foundation for healthier living and potentially fewer and less intense migraine attacks. Download our free guide on healthy sleep to see how you can improve your sleep to better manage your migraine.
Caring for a Child with Migraine
Does your child have a migraine? Early diagnosis, open dialogue, and a specialized treatment plan can equip you and your child with the tools needed to best manage their migraine. Download our guide to learn how to identify the signs, maintain a productive dialogue, and practice good headache habits.
How Are Headaches and Migraines Treated?
There is no single treatment that works for every patient. Treatment depends on the type of headache, frequency and severity of attacks, medical history, other health conditions, medications, and the degree to which symptoms affect daily life. A personalized treatment plan may include:
Acute Treatment
Acute or “rescue” treatments are used when a headache or migraine attack occurs. Depending on the patient and diagnosis, these may include over-the-counter or prescription medications designed to reduce pain and associated symptoms.
Preventive Migraine Treatment
Patients with frequent, prolonged, or disabling migraine attacks may benefit from preventive treatment designed to reduce the frequency, severity, or duration of attacks. Preventive options can include oral medications, injectable treatments, and newer migraine-specific therapies.
CGRP-Targeting Migraine Treatments
Medications that target calcitonin gene-related peptide, or CGRP, have expanded treatment options for both the prevention and acute treatment of migraine.
BOTOX® for Chronic Migraine
BOTOX® injections may be an option for appropriately diagnosed patients with chronic migraine. Several First Choice Neurology physician profiles specifically list Botox injections among their neurological services.
Treatment for Nausea and Other Symptoms
Migraine treatment may also address nausea, vomiting, dizziness, and other symptoms associated with an attack.
Neuromodulation
Certain noninvasive or minimally invasive neuromodulation devices may be considered for selected migraine patients.
Lifestyle and Behavioral Strategies
A treatment plan may also include:
- Consistent sleep
- Adequate hydration
- Regular meals
- Routine physical activity when medically appropriate
- Stress management
- Relaxation techniques
- Identifying individual triggers
- Maintaining a headache diary
Behavioral and lifestyle approaches can be valuable components of comprehensive migraine management.
Frequently Asked Questions About Headaches and Migraines
What is the difference between a headache and a migraine?
A headache is pain or discomfort involving the head, face, scalp, or neck. Migraine is a neurological disorder that can cause moderate to severe head pain along with symptoms such as nausea, sensitivity to light or sound, dizziness, visual changes, fatigue, and difficulty concentrating. Not every severe headache is a migraine, and migraine symptoms can vary from person to person.
What doctor should I see for migraines?
A neurologist is a physician who specializes in conditions affecting the brain, spinal cord, nerves, and nervous system. Neurologists can diagnose different types of headaches and migraines, evaluate concerning neurological symptoms, and recommend acute and preventive treatment options.
When should I see a neurologist for headaches?
Consider seeing a neurologist if your headaches are frequent, severe, becoming more common, changing in pattern, or interfering with work, sleep, school, or everyday activities. You should also consider an evaluation if over-the-counter medications are no longer effective or your headaches are accompanied by dizziness, numbness, weakness, balance problems, or visual changes.
How does a neurologist diagnose migraines?
Migraine is usually diagnosed based on your symptoms, medical history, family history, headache patterns, and a neurological examination. Your neurologist may ask about the location, severity, frequency, and duration of your headaches as well as associated symptoms and possible triggers. Additional testing may be recommended when another cause needs to be ruled out.
What are the most common migraine symptoms?
Common migraine symptoms can include throbbing or pulsating head pain, nausea, vomiting, sensitivity to light or sound, dizziness, fatigue, neck discomfort, visual disturbances, and difficulty concentrating. Some patients also experience numbness, tingling, or other neurological symptoms.
Can you have a migraine without a headache?
Yes. Some people experience migraine-related neurological symptoms without significant head pain. These may include visual changes, numbness, tingling, dizziness, or other symptoms associated with migraine aura.
What causes migraines?
Migraine is a complex neurological condition influenced by genetic and environmental factors. Individual attacks may be associated with triggers such as stress, dehydration, skipped meals, changes in sleep, hormonal changes, bright lights, strong smells, travel, weather changes, alcohol, or changes in caffeine intake.
What are common headache triggers?
Headache triggers vary by individual. Common triggers can include stress, dehydration, lack of sleep, missed meals, prolonged screen time, changes in caffeine consumption, alcohol, certain foods, bright light, strong smells, travel, and changes in routine.
How long can a migraine last?
A migraine attack can last several hours and, when untreated, may continue for up to several days. The duration and severity of migraine attacks vary from person to person.
What is chronic migraine?
Chronic migraine refers to a pattern of very frequent headaches in which headaches occur on many days each month and migraine features are present on a portion of those days. Patients experiencing frequent headaches should discuss their symptoms with a neurologist because preventive treatments may help reduce the number of headache days.
Can migraines be prevented?
Although migraine cannot always be completely prevented, treatment can often reduce the frequency, severity, or duration of attacks. Preventive treatment may include prescription medications, injectable therapies, migraine-specific medications, lifestyle changes, trigger management, and other individualized strategies.
What treatments are available for migraines?
Migraine treatment may include medications taken during an attack, preventive medications, CGRP-targeting therapies, BOTOX® for certain patients with chronic migraine, treatment for nausea or other associated symptoms, neuromodulation devices, and lifestyle or behavioral strategies.
Is BOTOX® used to treat migraines?
BOTOX® may be used as a preventive treatment for appropriately diagnosed patients with chronic migraine. A neurologist can determine whether BOTOX® is appropriate based on headache frequency, diagnosis, treatment history, and individual medical needs.
Should I keep a headache diary?
Yes. A headache diary can help you and your neurologist identify patterns and possible triggers. Consider recording when headaches occur, how long they last, their severity, accompanying symptoms, medications taken, sleep patterns, meals, hydration, stress, and other possible contributing factors.
When is a headache considered an emergency?
Seek immediate medical attention for a sudden and extremely severe headache, a headache described as the worst of your life, or a headache accompanied by new weakness, numbness, difficulty speaking, confusion, fainting, seizure, significant vision changes, fever with a stiff neck, or other sudden neurological symptoms.
Can children and teenagers get migraines?
Yes. Migraines can affect children and adolescents as well as adults. Symptoms in younger patients may differ somewhat from those seen in adults. A pediatric neurologist can evaluate recurrent or concerning headaches in children and recommend age-appropriate treatment.
First Choice Neurology Headache and Migraine Specialists
First Choice Neurology provides headache and migraine evaluation and treatment throughout Florida. Our physician directory includes over 50 neurologists who treat headaches and migraines in multiple communities across South, Central, Eastern, and Southwest Florida.
You do not have to simply live with frequent headaches or migraines. A neurological evaluation can help determine what type of headache you are experiencing, identify possible contributing factors, rule out other neurological conditions when appropriate, and develop a treatment plan based on your individual symptoms and needs.
Find a First Choice Neurology headache or migraine specialist near you and schedule an appointment today.