Headache and Migraine Diagnosis

  • Diagnosis

    Headache is one of the most common human pains. Headaches are usually little more than a passing annoyance. However, headaches can also be chronic and severe, and can disrupt your daily life. Some headaches are so intense that they require bed rest. Headaches can signal a more serious problem such as an infection or a tumor.

    About 70% to 80% of the population experiences headaches. Fifty percent of the population experiences headaches at least once per month, 15% experience headaches at least once per week, and 5% experience daily headaches. One survey found that more than 80% of people who have migraine headaches miss work or are unable to perform their household duties.

    While migraine headaches can begin at any age, they typically begin between the ages of 10 and 30. The headaches generally become less intense after age 50. Women experience headaches more often than do men.

    Tension and migraine headaches are the two most common types of headache. A tension headache is a dull, steady pain that is sometimes described as a tight band-like or vise-like gripping pressure around your head. A migraine headache is an intense throbbing pain that usually affects one side of your head, and often is accompanied by nausea and vomiting. Migraine headaches may also be preceded by an aura such as a visual hallucination or a pins-and-needles feeling on one side of your body.

    Tension headaches usually subside within a few hours. Migraine headaches are much more intense than tension headaches. If untreated, migraine headaches can linger for days. Exercise will make a migraine headache worse, but may improve a tension headache.

    Migraine headaches happen when the arteries of your head widen and become inflamed. Some people get a migraine headache after eating chocolate, oversleeping, or drinking red wine. Skipping a meal or going without food for too long can cause them, too. Sleep deprivation and emotional stress are other well-known triggers. In women, hormonal fluctuations associated with menstruation and ovulation may induce migraine headaches.

    Tension headaches are caused by muscle tension in the head and neck. Stress is a major factor that initiates tension headaches. Sitting in an uncomfortable position for too long or being fatigued can also lead to tension headaches. Like migraine headaches, tension headaches can also be triggered by lack of sleep or skipping a meal.

    Tension headaches produce a steady pain across your forehead or in the back of your head Table 01 Figure 01. The pain may take over your whole head or radiate down your neck and shoulders. Some people say tension headaches produce the sensation of having a tight band around your head. The pain typically occurs during the day (typically in the late afternoon), and may resolve by evening.

    The throbbing pain of a migraine begins abruptly in your eye or temple, and may spread to other areas of your head. Migraine headaches can cause nausea and vomiting and, as a result, have earned the nickname “sick headache.” Often, people with migraine headaches experience mood changes before the headache starts. In about 15% or cases, people with migraines may see flashing or jagged lights, develop a blind spot, or see distorted images about 30 minutes before the pain starts (auras). Occasionally, tingling in an arm or leg occur before the headache. Not all migraine sufferers get auras, and those who do don't necessarily get them each time. It is possible to experience an aura, but not develop a headache afterwards. Once the headache starts, you may become sensitive to strong smells, bright lights, and loud noises. Migraine headaches generally last from one to three days.

    Click to enlarge: Tension and Migraine Headache Pain

    Figure 01. Tension and Migraine Headache Pain

    Table 1.  Symptoms of Tension and Migraine Headaches

    Tension headache Migraine headache
    Dull, constant pain across forehead, in back of head, or throughout head Pain begins during the day and gets progressively worse
    Gripping pressure in head Nausea and vomiting
    Throbbing or pulsating pain on one side or both sides of head Visual disturbances
    Pain in neck and shoulders
    Tingling in arm or leg
    Mood changes
    Sensitivity to light, noises, and smells

    Women are more prone to headaches than are men. Tension headaches, which usually begin in adulthood, affect slightly more women than men. Women also suffer more from migraine than men: about 20% of women and 10% of men in the U.S. have migraines. This discrepancy is due to the fact that estrogen is a powerful trigger of more intense headaches.

    Migraines sometimes run in families, and appear to have a genetic component. One extremely rare type of migraine-familial hemiplegic migraine—has been traced to an abnormality on chromosome 19.A doctor will suspect this type of migraine if you have a close relative (i.e., a parent or sibling) who also has migraine headaches.

    Your doctor will perform physical and neurological examinations to make sure that your headache is not a sign of a serious underlying problem. Headaches can be caused by such serious conditions as hypertension, a brain tumor, or meningitis. Brain tumors are very rare, however. Therefore, your doctor will perform a physical and neurological examination to try to determine what is causing your headache. Loss of strength in an arm or leg and impaired cognition or reflexes can reveal a neurological cause for your headache, though this is an uncommon finding.

    If your doctor suspects that meningitis is causing your headache, he or she will send you to an emergency department for further evaluation and treatment.

    Several radiological tests may be run to rule out structural causes of headache. Imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans can detect tumors, aneurysms, subarachnoid hemorrhage, arteriovenous malformation, or structural disease of the brain or cervical spine that can cause headache. Younger people who are otherwise healthy and who have a normal neurologic exam rarely need an MRI or CT for further diagnosis. New headache or migraine symptoms in someone older than 50 usually require an MRI or CT to rule out any serious neurological diseases affecting the brain.

    Your doctor will take a careful medical history to determine which headache disorder you have. Answering key questions can help your doctor distinguish one type of headache from another. Your doctor will want to know how frequent and intense your headaches are, as well as how long the pain lasts, and where it occurs. Your doctor will ask how old you were when your headaches began, and if your headaches are accompanied by other symptoms, such as nausea, vomiting, dizziness, weakness, visual disturbances, or mood changes. Keeping a diary of what triggers and/or relieves your headaches can be useful to your doctor during the diagnostic process. In addition, if you are a woman, try to determine whether your headaches are linked to your menstrual cycle.

    Avoid stress. Stress is a common factor in tension and migraine headaches. Reduce the amount of stress in your life by taking yoga, practicing meditation, or avoiding situations that make you anxious. Some physical activities, including certain sports and sexual intercourse, can cause headaches or make them worse (although they can also prevent headaches). Take it easy if certain activities make your head pound.

    Avoid foods or beverages that trigger migraine headaches. Some people have traced their migraine headaches to specific foods and beverages. Red wine, coffee (although coffee can also relieve a migraine headache), fermented cheeses, chocolate, sardines, anchovies, pickled herring, cured meat, and the artificial sweetener aspartame have all been implicated.

    Be sure to get enough rest. Lack of sleep may promote a tension or migraine headache. Oversleeping, however, may also trigger a migraine headache.

    Avoid eye strain and schedule regular eye exams. Try to avoid situations where you must squint or strain to see or read. If you wear glasses, make sure that your prescription is current.

  • Prevention and Screening

    Avoid stress. Stress is a common factor in tension and migraine headaches. Reduce the amount of stress in your life by taking yoga, practicing meditation, or avoiding situations that make you anxious. Some physical activities, including certain sports and sexual intercourse, can cause headaches or make them worse (although they can also prevent headaches). Take it easy if certain activities make your head pound.

    Avoid foods or beverages that trigger migraine headaches. Some people have traced their migraine headaches to specific foods and beverages. Red wine, coffee (although coffee can also relieve a migraine headache), fermented cheeses, chocolate, sardines, anchovies, pickled herring, cured meat, and the artificial sweetener aspartame have all been implicated.

    Be sure to get enough rest. Lack of sleep may promote a tension or migraine headache. Oversleeping, however, may also trigger a migraine headache.

    Avoid eye strain and schedule regular eye exams. Try to avoid situations where you must squint or strain to see or read. If you wear glasses, make sure that your prescription is current.

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