If you’ve ever suffered from any type of headache, you know that there is nothing funny about them. However, because migraines and headaches are not fatal and often do not result in permanent disability for most, their importance to public health has long been understated. This is particularly unfortunate for that subset of patients who are disabled by these afflictions.
Headaches and migraines can knock out even the toughest of us. Understanding the difference between headaches and migraines, though, can help us better treat these problems.
What is a Headache?
According to an article in the American Journal of Medicine, headaches are “an almost universal human experience and are one of the most common complaints encountered in medicine and neurology.” People have been complaining about headaches for all of recorded history and their economic burden on the world is estimated at $14 billion annually.
There are two types of headaches: primary and secondary. These headaches are classified on a chart called The International Classification of Headache Disorders. The primary headaches are those that happen most frequently, like migraine, tension-type, trigeminal-autonomic cephalgia, and others.
The secondary headaches include those caused by trauma, vascular disease, intracranial disorders, substance abuse or withdrawal, infection, or other problems. The biggest difference between primary and secondary headaches is the cause. With a secondary headache, the cause is known; but with primary headaches, there is no known cause.
What is a Migraine Headache?
A 2016 Lancet study found migraine was the second highest cause of disability worldwide. It’s easily the most common neurological disorder in the U.S., affecting almost 20% of women and 6% of men. Migraine also appears to be very common in fibromyalgia and chronic fatigue syndrome (ME/CFS) with incidence rates ranging from 20 to 80%, depending on the study.
One study found that more people with fibromyalgia met the criteria for migraine (56%) than met the criteria for ME/CFS. Having fibromyalgia and migraine appear to open a kind of Pandora’s box of afflictions. People diagnosed with both diseases were also significantly more likely to be diagnosed with hypertension (p<.004), asthma (p<.01), irritable bowel syndrome (p<.02), depression (p<.0002), anxiety ( p<.001), PTSD (p<.005) and, most of all, chronic fatigue syndrome (p<.0001).
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Some studies suggest that the blood flow issues, the hypoxia, increased lactate levels in the brain and hypersensitivity reactions found in migraine, fibromyalgia and ME/CFS may link the three disorders together.
The fact that migraine, like chronic fatigue syndrome and fibromyalgia, tends to affect people in the most productive years of their lives (between 18 and 55), makes the disease doubly injurious to society. Yet the NIH spends just $0.67 per migraine patient per year – far below what it provides, even for people with ME/CFS and FM.
For a headache to be classified as a migraine, it must have a few distinct symptoms. Migraines may or may not have auras, which are a “fully reversible set of nervous system symptoms” that will come and go. In many situations, patients will experience a visual aura that is followed by a migraine within 60 minutes.
To be diagnosed as a migraine, sufferers should have at least five severe headaches that typically last between four and 72 hours, with several of these symptoms:
- Pain on one side of the head
- Pulsation at the points of pain
- Moderate to severe pain
- Nausea and/or vomiting
- Pain is aggravated by sound or light
- Pain is aggravated by routine activities.
The American Journal of Medicine reports that migraines usually have four phases: the prodrome (pre-migraine), aura, attack, and postdrome (post-migraine). People who experience regular migraines often recognize the prodrome symptoms (irritability, hyperactivity, euphoria, depression, and food cravings) and know a migraine is on the way. During the postdrome phase, patients often experience ME/CFS-like symptoms (extreme fatigue, confusion) and head pain that occurs when the head is tilted.
Symptoms and Causes of Tension-Type Headaches
A 2016 Lancet study found tension-type headaches to be the third most prevalent disorder worldwide. Like other pain and fatigue disorders, tension-type headaches were originally thought to be pyschogenic in nature. However, further study is revealing a neurobiological basis for them.
Despite their name, tension-type headaches can be caused by different pathologies, possibly mental or muscular. This type of headache is often described as producing dull, pressure like, constricting symptoms or causing a sense of fullness in the head. Quite frequently, tension headache patients describe their pain as like wearing a tight hat or a tight band around the head, or “bearing a heavy burden on the head.”
The location of a typical tension-type headache changes over time. They can be on the left, right, or both sides of the head as well as at the front or back of the head. Sometimes patients with tension headaches can have sound or light sensitivity, but not both concurrently. Tension-type headaches do not cause nausea or vomiting, like migraines do. Patients report that tension-type headaches often begin with mild pain that increases throughout the day.
Tension-type headaches tend to occur when patients are tired, stressed, or hungry. Women sometimes have them during their menstrual cycles. Some patients connect them to drinking alcoholic or caffeinated beverages.
Similarities Between Migraines and Tension-type Headaches
Differentiating between tension-type headaches and mild forms of migraine, which do not produce auras, has been difficult, in part because many people with one may also experience the other.
In a study in the Indian Journal of Psychiatry, researchers seeking to uncover distinct differences between migraine and tension-type headaches found inaccuracies in the diagnostic criteria found in the International Classification of Headache Disorders-2 (ICHD-2). (See the ICHD-3 here.)
Several overlaps between the two types of headaches complicate a diagnosis. The researchers found, for instance, that contrary to accepted knowledge, some migraines can occur on the left and right sides of the head. Plus, not all migraine sufferers had troubles with nausea, vomiting, and light or sound sensitivity, while some tension-type headache sufferers do. Scalp tenderness (allodynia) and blurred vision appear to be relatively common in both conditions.
Differences Between Migraines and Tension-Type Headaches
One goal of the study was to uncover distinct differences in the two types of headaches despite the similarities in symptoms, and the researchers did find some clear differences. Migraine sufferers had more episodes with severe pain when compared to people who had tension-type headaches. In contrast to the relatively stable tension-type headaches, migraines tended to worsen over time (more frequent, more severe and longer duration) with a tendency to become chronic.
Light, noise, odors, moving one’s head, exercising or straining tended to exacerbate migraines but not tension-type (TT) headaches. Lightheadedness was common in migraine and rare in TT headache. While nausea was found in a subset of those with tension-type headaches, it was far more common in migraine. Vomiting occurred in a third of migraineurs but did not occur in TT headache at all. A post-headache period of fatigue and lethargy was much more common in migraine (40%).
Muscle para or dysfunction such as bruxism (teeth grinding, clenched and contracted muscles) and muscle hypertrophy (enlarged muscles) were more common in tension-type headaches.
Pain-killers, interestingly, were more effective in migraine than in tension-type headaches.
Migraineurs also try many more ways to relieve their pain (cold packs, staying in bed, pain-killers, isolating themselves, inducing vomiting, changing diet and remaining immobile) than people with tension-type headaches (scalp massage).
While some triggers for migraine are known (weather, odors, smoke and light), the study suggested that stress is a more common trigger of tension-type headaches than migraine. (Not all TT headaches are caused by stress and not all migraine triggers can be recognized.)
The study was unable to find out why more people miss work due to tension-type headaches, especially since migraines are more frequent, severe, and complicated.
Other Types of Headaches
The International Headache Society lists 14 different kinds of headaches and breaks down each of those into subsets. For instance, it lists over 20 different kinds of migraines.
Websites differ as to the type of primary headaches found. Medicine.net lists three, while Medical News Today lists five. Here are some more common types of headaches:
- Cluster headaches – the most severe headaches of all cluster headaches usually affect men, and are characterized by an intense burning or piercing pain behind or around one eye which reddens, the pupil reduces in size, and/or the eye tears. They tend to occur in groups several times a day for two weeks to three months, lasting each time for 15 minutes to three hours. Often, they are so painful that the person cannot remain still. According to the National Headache Foundation, oxygen, ergotamine; sumatriptan; or intranasal application of a local anesthetic agent may help.
- Sinus headaches – occur when the sinuses or cavities in your head become inflamed, usually from an infection. They produce a deep and constant pain in your cheekbones, forehead, or the bridge of your nose. A runny nose, a feeling of fullness in the ears, fever, and a swollen face may accompany them. The National Headache Foundation recommends antibiotics, decongestants and surgical drainage, if necessary.
- Exertional Headaches – often co-occurring with migraines, these headaches occur when the blood vessels in your head, neck, and scalp swell to provide more blood – causing a pulsing pain on both sides of the head that can last from 5 minutes to 2 days. They can be triggered by physical exercise or by coughing, sneezing, sexual intercourse, and/or straining during a bowel movement. Anti-inflammatories such as indomethacin, Rofecoxib or even aspirin taken before the exertion may help.
Other Headaches to Take Note of in Fibromyalgia and ME/CFS
- POTS (postural orthostatic tachycardia syndrome) headaches – many people with POTS have orthostatic headaches which occur when they stand up.
- Craniocervical Instability (CCI) – not typically mentioned in headache classifications, CCI often causes a feeling of a “heavy headache which feels like the head is too heavy for the neck to support”. Plus, an impairment of cerebral spinal fluid can cause “pressure headaches” that are aggravated by yawning, laughing, crying, coughing, sneezing or straining. Other symptoms can include neck pain, dysautonomia, POTS, balance problems, vertigo, muscle weakness, fatigue, etc. See Jeff’s ME/CFS CII story here.
- Cerebral Spinal Fluid Leak headaches – caused by low spinal fluid pressure, CSF headaches are characterized by a headache that occurs when one is upright (sitting or standing) or when one raises one’s head from the bed, which improves when one is lying down. One test is to determine if lying flat with one’s head lower than one’s body causes symptoms. Other CSF leak symptoms can include neck pain, neck stiffness, nausea, vomiting, sensitivity to light and/or sound, sense of imbalance, ringing in the ears and changes in hearing. Check out Caroline’s ME/CFS, POTS, EDS, spinal fluid leak story here.
- Chiari Malformation headaches – are characterized by headaches which begin at the back of the head (neck) and radiate upwards. Coughing, sneezing or straining can bring on these headaches. Other symptoms of Chiari malformation include double or blurred vision, balance problems, vertigo and dizziness, breathing problems, muscle weakness, gagging, swallowing difficulties, facial numbness or syncope (temporary loss of consciousness).
Record Your Headaches
One way to determine what type of headaches you get is to keep a record of them. Journaling the symptoms and when they occur will help you better explain your experiences to your health care provider. When you record the experiences, note the date, time of day, and exactly what you are experiencing. If you do take medication, record when you took it and whether or not it was helpful. Check out a headache diary form from the National Headache Foundation here.
Since tension-type headaches are often triggered by stress, it is also important to note how you are feeling at the time a headache arises. You could record:
- How you are feeling physically
- How much sleep you got the previous night
- What stress is happening in your life.
According to the study in the Annals of Indian Academy of Neurology, people who experience tension-type headaches often do not seek medical treatment. Instead, they self-medicate with over-the-counter pain medication like ibuprofen or acetaminophen. The study also reports that absenteeism from work in the United States and Europe due to tension-type headaches can be three times higher than absenteeism from migraines.
Regardless of the type of headache you get, it is important to take care of yourself. Health care providers can help you manage both migraines and tension-type headaches.
About Dr. Wells
Serving Wasilla, Anchorage, and the surrounding communities, Dr. Brent Wells offers patient-centered, personalized, and innovative chiropractic care. A California native, Dr. Wells earned a Bachelor of Science degree from the University of Nevada. He then attended Western States Chiropractic College in Portland, Oregon. In 1998, he and his wife Coni moved to Alaska and opened Better Health Chiropractic in Juneau. .
He is a proud member of the American Chiropractic Association and the American Academy of Spine Physicians, and has authored over 700 online health articles which have been featured on sites such as Dr. Axe and Lifehack. He’s committed to remain updated on studies related to neurology, physical rehab, biomechanics, spine conditions, brain injury trauma, and more
Headache Resources on Health Rising
Migraine Self Tests – Check out two self-tests for migraine here and here.
Sorry, I can’t resist a posting under the general category of “humor”. In the novels of P G Wodehouse, Bertie Wooster’s intellectual and resourceful Valet named Jeeves used to mix up a tonic for hangovers, after enquiring which of six categories the hangover fell into:
The Broken Compass
The Sewing Machine
The Cement Mixer
The Gremlin Boogie
I used to love PG Wodehouse 🙂
It would be interesting to add sleep apnea to the triad of fibro and migraines! I’ve recently had a bout of migraines and vertigo but only when I wake up. I also have severe sleep apnea only during REM sleep and only mild apnea during other sleep stages. My increasing memory issues and other factors are made worse without providing some oxygen to my brain but my attempts at using c-pap causes very disruptive sleep inspite of comfort with my mask,ability to go to sleep etc. Anyone else have insight into this combo of issues?
A couple of the headaches do sometimes come with sleep apnea. I’m not sure which. Sleep apnea certainly does seem to be part of the assemblage. Dr. Klimas stated that she’s finding it in a surprising number of people with ME/CFS/FM
My hubby has sleep apnea but couldn’t tolerate the mask. Doctor found out his diaphragm was not functioning properly and only half was doing the job of both sides. There is a type of “pacemaker” that can be used to regulate breathing, which can be discovered by undergoing several tests. This may hold the key for his particular problem. It wouldn’t hurt to look into it with a sleep specialist from a research hospital in your area.
Thanks Cort and Maureen. I do have a sleep study scheduled this week and will get to try a bi-pap machine which works differencly than C-pap. Also having some VERY positive results using 5mg. Belsomra to help regulate my REM sleep cycle. Belsomra is a orexin-receptor antagonist and acts differently in the brain compared to other sleep meds. I am experiencing much more daytime alertness!
I would describe another type of headache which I call a toxic headache. Burning, you can point to exactly where in the head it is, but it is different locations at different times. When really bad feels like a rocket ship is in there ready to take off. Hard to concentrate, causes neck pain too…
Cluster headaches can produce burning sensation but usually behind one eye. Check this out
“The sensation of burning is very unique and closely linked to cluster headaches. However, sinus headaches are also known to cause burning pain in some people.
Burning can be felt at the back of the head, behind the eyes, around the sinuses, and in other parts of the head as well.”
Another condition which can cause burning head pain is called occipital neuralgia which effects the nerves extending from the spinal cord to brain
Occipital neuralgia is characterized by piercing, throbbing, or electric-shock-like chronic pain in the upper neck, back of the head, and behind the ears, usually on one side of the head. Typically, the pain of occipital neuralgia begins in the neck and then spreads upwards. Some individuals will also experience pain in the scalp, forehead, and behind the eyes. Their scalp may also be tender to the touch, and their eyes especially sensitive to light.
The location of pain is related to the areas supplied by the greater and lesser occipital nerves, which run from the area where the spinal column meets the neck, up to the scalp at the back of the head. The pain is caused by irritation or injury to the nerves
Headaches are so interesting. In my 49 years I have experienced many different types and can relate them to various causes. I have fibromylgia, EDS and autism. I get migraines rarely and I can usually prevent them or stop them before they develop when they are related to a histamine or similar type of reaction. For example I may have eaten avocados or overdone the histamine foods and this will trigger a headache which can develop into a migraine. If I catch it early enough and take paracetomol, ibuprofen, inderal and Cetirizine (anti-histamine)I can avoid the migraine itself. When I was going through my phase of making kefir and drinking avocado smoothies I suffered a lot more headaches. They became far too regular and eventually I linked the two.
I have also had migraines triggered by chlorine. These are bad. I also experience them if I take codeine products and I believe there is a link with chlorine and choline relating to liver detoxification. ( I happen to know that I have fast phase one and slow phase two, if that means anything to anyone!)
I get bad headaches after crying. I sometimes wake up with bad headaches which can develop into a migraine if I’m unlucky. I’m not sure if these headaches are related to my neck and my sleeping position or a delayed histamine reaction. But they are more frequent in the middle of the night or early morning.
When I get headaches I get poor vision as well.
Also, my husband (also Autistic) has had migraines all his life. He also has Addison’s Disease (adrenal insufficency) and he has discovered a small benefit from that! He gets auras before his migraines and as soon as he feels one he takes a large dose of his adrenal medication (hydrocortisone) and it usually stops the migraine in its track.
I really hate headaches. They make an already difficult life with chronic illness so much more difficult. You try to get on with things and then you get a miserable headache. Just surviving that makes you more fatigued and it becomes a vicious cycle. And people don’t understand. They say it’s just a headache. Take some paracetomol and get on with it. Sigh.
I’ve found the most helpful resource on migraine – besides my neurologist – to be the book on migraine by the Johns Hopkins University Med School headache specialist David Buchholz, MD. Simple and to the point. I learned through it that bananas were a trigger for me — I’d always doubled up on them before when a headache struck. Dr. Buchholz doesn’t get hung up on whether its a migraine headache or presumably some lesser form of headache. He also has a fascinating discussion of non-headache symptoms of migraine, and symptoms that, e.g., are like the classic male pattern heart attack.
Woops! Forget to give the name of the book: “Heal Your Headache”, Workman Publishing, c. 2002.
Thanks for the tip.
My partner and her doctor used a book called “Natural Hormone Balance for Women” by Uzzi Reiss to use hormones to stop her horrendous migraines.
You are missing SO MUCH information! Migraines can last much longer than 72 hours. You have totally missed Cluster Headaches classified by W.H.O. as the mist painful condition known to man! Also many suffer PTSD/panic attacks/depression/suicide knowing the extreme pain and that it WILL happen again. I’ve had only 2 migraine free days in 3 years! We are among the most stigmatized disabled persons on earth.
Sorry to hear about your plight! Cluster headaches are actually in the overview, however and headaches are a huge topic. My partner’s doctor, by the way, used a book called Natural Hormone Balance for Women by Reiss to end her disabling migraines. If you haven’t checked it out maybe it could help (??)
Also – Hemiplegic Migraine – which is actually reduced blood flow to half the brain (constricted vessels) that can get stuck and so you start losing function to one side of body like stroke, but there is no pain. In some people, like my daughter, they get stuck and have to go to doctor within hours for vasodialator shot just like stroke. I was diagnosed with atypical Hemiplegic migraines – mine also stick, but at a higher blood flow level, so not a big loss of function, but spazming vessels (once a minute or so) per EEG.) looks somewhere between cerebral palsy and Parkinson’s from spectator viewpoint when I’m having an attack.
Thank you for your info.(comment) as I have had this experience(s) and last one most recent was both limbs and legs totally para.as this helped me understand what happened ?
Has anyone tried Botox injections for migraines or pain related to a tight trapezius muscle?
I have had them in my head and shoulders for migraine and shoulder pain. It did help somewhat for awhile. I had to get it done fairly frequently and the efficacy diminishes over time. I had them for about three years. I feel it’s worth trying, but like more injections, you might have to move on to some other treatment after a while.
My migraines caused me to be in bed in a dark room for 3 days.
I haven’t had any since I started eating carnivore in Aug 2017
When you line up all those symptoms of migraine alongside ME/CFS…the similarities are quite remarkable. Irritability, hyperactivity, euphoria, depression, food cravings, fatigue and confusion. Also, symptoms worsening with exertion, stress, light and noise. Except for the euphoria bit, sounds like a crash to me! Shelley.
I have head pressure, screeching ears and insomnia, are there any doctors in the uk who can help/any drugs?
Dehydration is one common cause of headaches – I mean the common everyday type of headache (not migraines). It’s not well recognised and if anyone tells me they have a bad headache, I often suggest they try drinking a couple of glasses of plain water (and drink water regularly throughout the day in future). Dehydrated tissues can also contribute to tension and worsening pain in FM/CFS sufferers. Of course, not all people can drink plain tap water. Some people are intolerance/allergic to fluoride and other tap water additives and need filtered water.
Food allergies and food intolerance is also a much undiagnosed headache and histamine ‘shed’ cause.
My own food allergies and intolerances have now increased to the point where I can pinpoint Dairy as making my daily headaches instantly worse. I also get an instant headache changing the ink cartridge in my home printer or even sitting near the computer for extended periods. MCS (Multiple Chemical Sensitivity) is bad enough, but when one is instantly more nauseous, headache, IBS and so indoors, but can’t ‘prove’ it to a medical practitioners or have the money/energy to move homes yet again, the frustration can be worse than the actual symptoms.
Does anyone have more info on this story? It looks like the rheumatologist in the study is well thought of by patients.
In 1984, I was first diagnosed with chronic encephalopathy and immune dysfunction(this was before the name CFS appeared) by an allergist who was doing research with a professor of immunology from our local university. My symptoms included a sense of brain inflammation; severe fatigue; horrible migraine-like headaches that could go on for several days and repeated infections. I also developed sensitivities to all kinds of chemicals and foods. I was treated with dextran sulfate, a non-anticoagulent form of heparin. This was not available in the U.S. When I had a very severe headache, a shot of heparin would knock it out. Later I was treated by Dr. Cheney. Following one protocol that involved intranasal silver and EDTA, my headaches disappeared and have not come back.
Thanks for passing that on Betty.
I have been diagnosed with a tension headache but have not found any information on it specifically as it started well over a year ago and has not stopped. I have seen neurologists for it and have been given a 360 block and a cervical block. The only thing that has helped is Nortriptyline and that has only helped it to be less intense. Does anyone know of this type?
Hi, I have long-term ME/CFS and Fibro, and from childhood regular severe headaches. But not so much since I started regular deep tissue massage and Chiropractic in the last ten years. But recently have started having episodes where I get an aura / flickering around the edges of my vision for 20-30 mins then feel really stressy and wiped out, queasy, and have heaviness and pressure in my head and am a bit head-achey but don’t get strong pain. I then feel really wiped out for a day or two. I’ve read about silent migraines where you get all the migraine symptoms except strong head-ache. Can anyone else relate to this? Thanks, Jane