Migraine vs. headache: a neurologist explains the difference

With that said, a headache can also be an important signal for a deeper health problem. This is what we call a ‘secondary’ headache. These can arise from problems in structures like the nerves, blood vessels or eyes, and can occur as a result of injury or infection, or as a side effect of certain medications. To identify these types of headaches, your GP or a neurologist will consider your symptoms and medical history, and may do a physical examination. In some cases, further tests, such as scans or blood tests, may be used.

What is a migraine?

A migraine is a type of ‘primary’ headache. It is very common and seems to be influenced by many factors in our lives, as well as our genetic make-up. It doesn’t necessarily run in families, but it does appear to be more common in related family members.

What can trigger a migraine or headache?

There are lots of triggers for both migraines and headaches, which can vary from person to person. In my experience of treating people with headaches, some of the most common triggers include:

• tiredness
• poor sleep
• hunger
• dehydration
• lack of exercise
• weather changes
• travel
• stress
• hormonal fluctuations
• dietary factors

You can think of these triggers as being accumulative. At some point, they will reach a threshold and trigger a headache. This threshold will be different for each person, so listening to your body and identifying your own unique triggers is key to successfully managing them.

Is there a practical way to tell if I have a migraine or headache?

Migraine headaches are often reasonably painful, and can make people feel nauseous and dizzy. You may wish to rest or avoid bright lights and loud noises. Some people might also feel the need to stay away from strong smells or tastes. Certain individuals with migraine may further experience a visual aura, with distortion or patterns in one’s vision, before the onset of a headache.

In contrast, tension-type headaches are usually less severe, and won’t prevent you from doing everyday activities like a migraine might. They often feel like a tight band around the head, and are not usually associated with all the other features of migraine, such as nausea or sensitivity to movement, light and sound.

What are the treatment options?

There are very effective medical options for treating migraine and other types of headache, including specialist forms of painkillers, as well as what we call ‘preventatives’ – types of medications that can significantly reduce the burden of headaches over a number of weeks or months. Furthermore, options such as injections around the scalp or even acupuncture can prove very helpful in the right cases.

It is important to note that regular use of over-the-counter painkillers can actually cause headaches to persist if taken more than two or three days per week over a longer period. We call these ‘medication overuse headaches.’

Can I do anything to prevent headaches and migraines?

Addressing lifestyle factors, such as sleep quality and quantity, is an important first step. I will often also tell my patients to ensure that they eat regular meals, stay well-hydrated and undertake regular exercise. Vitamins such as B2, found in lean meat, eggs, milk, green vegetables and grains, might be beneficial for migraine headaches, while other foods, such as red wine or chocolate, can be triggers for a smaller number of individuals.
Dr Saifee is a consultant neurologist at The National Hospital for Neurology and Neurosurgery, Queen Square, where he runs an outpatient and inpatient service for patients with movement disorders. He is also a consultant neurologist at London North West Healthcare NHS Trust, where he runs a neurology service seeing patients with all neurological disorders.

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This page was published on 18 September 2020.

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