From Baptist Health South Florida
6 min. read
For people who suffer from migraines, the pain is often described as an intense pulsing or throbbing in one area of the head. But for some, acute migraines can be debilitating, with additional symptoms that include nausea and/or vomiting, or sensitivity to both light and sound.
But when does a bad headache qualify as a migraine? For example, some people experience sensitivity to light or sound with tension headaches. June is National Migraines and Headache Awareness Month. The U.S. Centers for Disease Control and Prevention (CDC) says that about 15 percent of U.S. adults report a migraine or severe headache in the previous three months.
Your primary care physician can start the process of a migraine diagnosis, which may require some testing and a chronicling of any family history of migraines. Baptist Health experts on migraines and headaches say that patients who keep a diary of symptoms and “common triggers” of their headaches, such as stress or certain foods or drinks, can help narrow down their diagnosis.
Migraines are three times more common in women than in men, and affect more than 10 percent of people worldwide.
“Initially, we all might just say that it’s a headache,” explains Pooja S. Patel, M.D., neurologist and director of the Epilepsy Program at Marcus Neuroscience Institute, established at Boca Raton Regional Hospital, part of Baptist Health. “And then over time as the symptoms become a little bit clearer, and obviously with the help of the doctor, you’re able to differentiate between the two (headaches and migraines).”
The most distinct differences between migraines and headaches are related to duration, intensity and other symptoms. Migraines are usually considered chronic if they occur for 15 or more days per month for more than three months. And often, migraines are linked to separate underlying health issues.
“In our world in primary care, this is a very common diagnosis and a common complaint that we have,” said Patricia Feito-Fernandez, M.D., a family medicine physician with Baptist Health Primary Care. “Yes, there are links to other diseases that we tend to see quite often with the complaint of headache as a general term. But, also, the diagnosis of migraines in some cases can be linked to other disease processes.”
Here are some of the questions and answers from the broadcast, which can be seen in its entirety here.
Jeannette Kaplun: What are the differences between a migraine and a headache? Do they build on each other?
Dr. Patel: “Headache is a very generic term that we use to describe any kind of head pain. So, it can be a symptom of a disease. It can be by itself. It’s a common, generic term which can mean many different types of headaches. Migraine is a specific type of primary headache disorder. What it means is that it does not have any cause. So, migraines can have various symptoms other than a headache. But, it’s a disease of its own. It’s a very particular type of a headache disorder.
Jeannette Kaplun: Is there something that we can do to differentiate between the both of them? Or is it okay for people to group them together sometimes?
Dr. Patel: “Initially, we all might just say that it’s a headache. And then over time as the symptoms become a little bit clearer, and obviously with the help of the doctor, you’re able to differentiate between the two. However, it does take time because it can be months before you start seeing other symptoms, and sometimes years. So, a lot of times, migraines do go misdiagnosed for years. Or it’s just something that wasn’t too bad and they were diagnosed as simple headaches.”
Jeannette Kaplun: We might not realize what a chronic migraine or chronic episodes of migraines might indicate. Could there be a more serious issue?
Dr. Feito-Fernandez: “The diagnosis of migraines in some cases can be linked to other disease processes. One of the biggest ones that we see is hypertension, which is high blood pressure. In this subset of patients, we tend to see a lot of blood pressure dysregulation or hypertensive patients that come in complaining of migraines. Equally, we see other diagnoses, such as even depression, anxiety, a psychological diagnosis, that in some patients can be linked to migraines as well …
“Another very common one that we see is seizures because there’s somewhat of a genetic predisposition. We also believe that there are some patients that have had history of seizures that are also linked to migraines. So, very often this is what we see in our primary care with patients. It’s common and linked definitely to other disease processes.”
Jeannette Kaplun: What are the most common triggers of migraines or of headaches?
Dr. Patel: “You bring up a good point between differentiating the two things — like the root cause versus triggers. Migraine is a primary disorder and does not have a root cause. That’s really the definition of a migraine. It does have genetic predisposition. So, you might be exposed to it more, or you might be predisposed to having it more, if your family members have it. That’s an important connection. We see that as a common family history in patients who have migraines. But the triggers — there can be many, many triggers. We can really write books on how many triggers there are because it’s so different for everyone.
“Common triggers that I see are obviously stress, hormonal changes and weather. Those three are definitely the most common triggers that we see in migraines. But a lot of foods and drinks can be triggers, but that’s where the differences come in — where one patient might say that they’re extremely sensitive to eating this particular food. And the other one is not.
“There are some common grounds between those two though. Alcohol is a big one where wine and beer can be a big trigger for patients – as can chocolate and cheese. There are some common ones (triggers). But because they’re so different among patients … we will realize it when they experience multiple headaches after having these particular foods.”
Jeannette Kaplun: Do over the counter medications help relieve migraines and headaches”
Dr. Feito-Fernandez: They definitely can. I think that this is probably one of the most important things that we see in primary care leading into the diagnosis of chronic migraines or just migraines as a diagnosis. Once we sit down and review diaries (a patient’s written chronicle of potential triggers), we develop a plan. And based off that plan, a lot of times over-the-counter medications do justify a need for treatment at the point we are reviewing what their triggers are.
“And it really depends on the types of headaches and if they are migraines — as to whether medications may help them and may not necessarily be as effective. In the over-the-counter world, when you’re walking into the pharmacy you’re kind of thinking: I can just pick up anything. And it may not necessarily be the case for that particular patient. So, the headache diary is important for us to look at. And when we look at the over-the-counter medications, we tend to commonly use are anti-inflammatories.”
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