A migraine is a form of vascular headache. Migraine headache is caused by a combination of vasodilatation (enlargement of blood vessels) and the release of chemicals from nerve fibers that coil around the blood vessels. During a migraine attack, the temporal artery enlarges. (The temporal artery is an artery that lies on the outside of the skull just under the skin of the temple.) Enlargement of the temporal artery stretches the nerves that coil around the artery and cause the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the artery magnifies the pain.
Tension headaches account for nearly 90% of all headaches and are probably experienced by most people at some time during their lifetime. These headaches are frequently associated with fatigue and stress, and generally respond to simple measures such as rest or over-the-counter pain medicines. The pain from a tension headache usually occurs on both sides of head and consists of a dull, steady ache.
Signs and Symptoms
- Duration of 30 minutes to 7 days.
- No nausea or vomiting (anorexia may occur).
- Photophobia and/or phonophobia.
- Minimum of 10 previous headache episodes; fewer than 180 days per year with headache to be considered “infrequent”.
- Bilateral and occipitonuchal or bifrontal pain.
- Pain described as "fullness," "tightness/squeezing," "pressure," or "bandlike/viselike".
- May occur acutely under emotional distress or intense worry.
- Often present upon rising or shortly thereafter.
- Muscular tightness or stiffness in neck, occipital, and frontal regions.
- Duration of more than 5 years in 75% of patients with chronic headaches.
- Difficulty concentrating.
- No prodrome.
- Throbbing or pulsating headache on one side of your head.
- Moderate to severe headache intensity.
- Worsening of your headache with routine physical activity.
- Nausea, vomiting, or both.
- Sensitivity to light and noise, and sometimes smells.
In the US: Headache is the ninth most common reason for a patient to consult a physician. Physicians classify 90% of headaches reported to them as muscle contraction or migraine headaches.
Internationally: No literature suggests that headache frequency is different in other regions of the world.
A female preponderance exists in both Migraine and tension headaches.
According to the National Library of Medicine's Medical Encyclopedia, Migraine attacks may be triggered by:
- Allergic reactions
- Bright lights, loud noises, and certain odors or perfumes
- Physical or emotional stress
- Changes in sleep patterns
- Smoking or exposure to smoke
- Skipping meals
- Alcohol or caffeine
- Menstrual cycle fluctuations, birth control pills
- Tension headaches
- Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans),
- monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
- Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods
- Stress - Usually occurs in the afternoon after long stressful work hours
- Sleep deprivation
- Uncomfortable stressful position and/or bad posture
- Irregular meal time (hunger)
The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":
- 5 or more attacks
- 4 hours to 3 days in duration
- 2 or more of - unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
- 1 or more accompanying symptoms - nausea and/or vomiting, photophobia, phonophobia
- By clinical signs and symptoms
- Lab Studies:
- Laboratory work should be unremarkable in cases of tension-type headache. Specific tests should be obtained if the history or physical examination suggests another diagnostic possibility.
- Head CT scan or MRI is necessary only when the headache pattern has changed recently or neurologic examination reveals abnormal findings. Such history or physical exam evidence would suggest an alternate cause of headache.
Over-the-counter NSAIDs, such as Advil and Aleve, may provide relief for less severe tension headaches and migraines. Tension headache sufferers may also benefit from a combination drug therapy, which couples NSAIDs with a sedative; some such drugs are available over-the-counter. Migraine sufferers often make use of anti-nausea drugs as well, since many experience nausea or vomiting during a migraine.
Triptan drugs are used for more severe tension headaches and usually for migraines; on rare occasion, narcotics, like opioids, may be temporarily prescribed. Triptan drugs, such as sumatriptan and zolmitriptan, are usually prescribed in the form of injections and nasal sprays; sometimes tablet forms are available, as is the case for zolmitripan.
Preventive treatment may be recommended. Lifestyle or dietary changes may be recommended, and medication is often prescribed. Those who suffer from frequent tension headaches or migraines, for example, are often prescribed tricyclic antidepressants, as these have been shown to help prevent episodes. Cardiovascular drugs may prove a good preventive medicine for some migraine sufferers, too.
And though Botox is typically associated with its cosmetic purposes, Botox injections have also been found to be useful in treating chronic migraines.