When your head starts to throb and you feel the pressure building in your forehead and nose, is it just sinus pain? Well, it could be — but don’t discount the idea that you might have a migraine coming on. Over 30% of women experience migraine headaches, but fewer than 5% of people who suffer from these head-pounders ever receive an accurate diagnosis and treatment from a healthcare provider, according to the American Migraine Foundation.
“There is a general lack of education regarding headaches and migraines in the medical community,” says neurologist Lauren Natbony, MD, assistant clinical professor of neurology at the Icahn School of Medicine at Mount Sinai and a specialist in headache medicine. “Doctors may not know the questions to ask to make an accurate diagnosis, or they may mistake migraine for another condition. In studies, patients are commonly diagnosed with sinusitis when migraine is the true offender. And migraine is only one of many headache disorders — there are actually more than 200 different types of headaches!” Identifying and seeking care for migraines can help you find relief from this disabling pain.
First, what are common types of headaches?
A sinus headache, as we mentioned above, will happen when — you guessed it — you have a sinus infection. We’ll get more in-depth about migraines shortly, but two other types of headaches you may have heard about are cluster headaches and tension headaches.
- Cluster headache: “This is a rare and extremely painful disorder,” says Dr. Natbony. “Pain is severe and is usually one-sided and focused around the eye. The pain may be accompanied by a red or teary eye, swollen or drooping eyelid, nasal congestion, or a runny nose on one side. Patients are usually restless during the attack, walking around or pacing. Attacks last about 15 minutes to 3 hours and tend to be seasonal in nature. Cluster headaches, like the name implies, typically occur in clusters: They can be present for weeks at a time and then disappear. Some patients have attacks multiple times per year while others can go years between attacks.”
- Tension headache: “Tension-type headache is everything that migraine is not: It’s usually on both sides of the head, pressing or tightening, mild to moderate in severity, not aggravated by activity, rarely associated with light or sound sensitivity, and there is no nausea or vomiting. Attacks can last anywhere from 30 minutes to 7 days. The most common triggering factor for tension-type headache is stress,” says Dr. Natbony.
What is a migraine? Is it just a bad headache?
“Headache is a general term for any type of pain in the head,” says Dr. Natbony. “Migraine, however, is more than just a headache. It is a chronic and disabling neurologic disease that affects the way the brain processes pain. We think that migraine is likely genetic, meaning that it runs in families and is inherited. Headache is only one of the many symptoms of migraine. A migraine headache usually presents with moderate to severe pain on one side of the head that is throbbing or pounding, made worse by movement and lasting more than 4 hours. The pain is accompanied by other symptoms including sensitivity to light, sound, or smells, nausea, and vomiting. Some people may also see spots or flashing lights in their vision.”
Another sign of a migraine: It’s hard to go about your life. “Typically, a migraine prohibits you from routine activities — you want to lie down or rest until the attack goes away — and a migraine can last 4 to 72 hours, so it’s pretty impressive in its ability to do harm,” says Lawrence Newman, M.D., neurologist, and director of the Headache Division at NYU Langone Health. Often difficult to prevent and treat, a migraine can make you miss work and other obligations.
What happens in the brain during a migraine?
A migraine can start when the trigeminal nerve, which supplies sensation to the head, gets activated. “When that nerve gets excited, there’s a release of certain chemicals that cause the blood vessels and the covering of the brain to become swollen,” Dr. Newman says. “Then other chemicals get released to cause inflammation around there. That’s why it hurts so much.” That pain then gets carried up into different areas of the brain, causing sensitivity to light and sound, nausea, and other side effects.
What are some symptoms of a migraine?
People often confuse migraines with other types of headaches or pain, such as sinus pain. Sufferers can also mistakenly attribute the discomfort to dental or eye pain, Dr. Newman says.
According to the American Migraine Foundation, if you’re experiencing two or more of the symptoms below, you may have a migraine and should think about reaching out to your doctor:
- Severe head pain that’s hard to endure or even unbearable
- Throbbing sensations, often on one side of your head
- Nausea and vomiting
- Sensitivity to light, noise, and smells
- Head pain that gets worse with movement
- Head pain that makes you miss work or other activities
- Head pain that lasts from 4 hours to several days
Can you get a migraine without aura?
Auras may present as bright spots, a flickering arc of light, flashes, bright lines, or a blind spot or partial loss of vision. They can also come in the form of sound (tinnitus or music) or sensory changes (tingling or numbness). Research shows that auras only happen with about 25% of migraine sufferers.
How do you treat migraines?
It’s true that a migraine headache doesn’t typically respond well to OTC drugs (even those that claim to treat it). But a doctor can prescribe effective prescription medication in the form of pills, nasal sprays, and injections that may bring you relief. There is also some evidence that magnesium supplements may be effective in preventing migraines: The American Migraine Foundation points out, “In 2012, the American Headache Society and the American Academy of Neurology gave magnesium a Level B rating among medications used for migraine prevention.” (Level B means it’s “probably effective” as an option.)
Another smart step, in terms of preventing migraines from occurring in the first place is: Establish a regular daily routine. “The gene for migraines gives us basically a hyperactive or overly sensitive brain,” Dr. Newman says. “Because of that, any change can induce migraines.”
To ward off migraine attacks, Dr. Newman recommends following the mnemonic SEEDS:
- Sleep: Get enough sleep and follow roughly the same snoozing schedule every day.
- Eat: Have three regular meals per day.
- Exercise: Work out at least three days per week.
- Drink: Stay hydrated and avoid too much caffeine and alcohol.
- Stress Reduction: Try yoga, biofeedback, or other mindfulness exercises.
Should you see a headache expert?
“Medications and/or devices can help to lessen migraine frequency and severity when lifestyle changes aren’t enough,” says Dr. Natbony. “It happens to be an exciting time in migraine treatment, because we now have many options, including daily oral medications, monthly home injectable medications (CGRP monoclonal antibodies), Botox, and medical devices. There’s no one-size-fits-all treatment for migraines. Patients need an individualized treatment plan based on their unique migraine symptoms and triggers.”