Are All Headaches Migraines?
We talk a lot in this blog about the different types of headaches: migraines, tension-type headaches, cervicogenic headaches, cluster headaches, and so forth.
Classifying headaches can help us to identify some of the triggers and factors which are involved in our pain.
This in turn can help us to make smarter treatment decisions.
But recently I read an interesting article from Yale Medicine which suggested that treating all headaches as if they are migraines may be best.
Should All Headaches Be Treated As Migraines?
Let’s go over the key points which emerge from reading the article linked above.
Key Point #1: Most headache patients feasibly could be classified as having migraines.
The article references a study of 1,203 adult patients from countries around the world.
Of those patients, a whopping 94% could be diagnosed with migraine going by the formal criteria.
The article quotes neurologist Christopher Gottschalk as saying, “That means that almost every other diagnosis typically offered to patients—‘tension,’ ‘sinus,’ ‘stress’—wasn’t even on the table. What’s more, migraine medications cure both “tension” headaches and migraines—and the “tension” types respond more quickly.”
It is interesting to read this in light of the fact that I recall another article written by a medical professional (unfortunately, I cannot locate the reference at this time) which asserted that all migraines have a cervicogenic component.
His argument was that unless a structural factor were involved, we would expect a headache that is neurologically sourced to present unilaterally. In order for it to present only on one side (as is typical with both migraines and cervicogenic headaches), a structural defect would need to be causing the pain signals to favor that side.
When I read this, it did seem somewhat logical, particularly since my chiropractor told me that a trigger point located in the upper back near the shoulder blade seems to be tied to migraines for many patients. Indeed, I’ve noticed that trigger point is usually active when I have a particularly harsh headache.
When you think about it, asserting that all headaches are migraines or that all migraines are cervicogenic headaches are not such different claims that they might sound.
In fact, these could just be two different ways of looking at the same phenomenon. Whether we assert that all migraines are cervicogenic headaches or that all cervicogenic headaches are migraines, we are essentially stating the same thing. We’re just calling it by different names and emphasizing different components of the problem.
Key Point #2: We look at “triggers” the wrong way.
Returning to the article, Gottschalk also had some fascinating comments and observations regarding migraine triggers.
This is quite relevant, as knowing one’s migraine triggers is important both for 1-preventing a headache, and 2-recognizing when one may be at the onset of one.
Gottschalk explains, “Most of the things that people have thought of as triggers—stress, weather fronts, diet—when we have studied them, we’ve come up empty-handed every time. It’s not that they cause headaches, but that when you’re getting a headache, weather changes and perfumes feel worse.”
The article further elaborates, “The Headache and Facial Pain Center also helps patients to understand that what they once thought of as “triggers” are actually warning signs of impending headaches. In so doing, they can treat pain before it starts, preventing headaches from becoming debilitating.”
So to take an example, let’s say that you glance out your window at a bright, sunlit day. The light feels particularly harsh and glaring to you, even though your head doesn’t hurt.
You then find yourself getting a headache a little bit later. The traditional view has always been that the bright light triggered your headache into existence.
But it could be that this interpretation is backwards. It is possible that one is already getting a migraine when one looks outside and sees the bright light and thinks that it seems particularly harsh. In other words, the light is not a trigger per se, but rather a symptom which strikes before the pain of the headache itself.
This would seem to make some sense considering that migraines appear to be a neurological condition involving improper processing of pain. We might expect that other stimuli would also be inappropriately processed—like bright lights, loud noises, strong perfumes and so forth.
Does this mean that none of these things actually can literally trigger migraines? Not necessarily. If there’s one thing that we can take away from this article for sure (and quite a few other articles about migraines), it is that we do not have a strong understanding of migraines or any other “types of headaches” at this time.
That means that we cannot jump to conclusions about the role or roles that bright light, loud sounds, or other triggers/symptoms might play.
What are the Top 3 Actionable Items on Treating Headaches as Migraines?
If you read this article in full and found it as fascinating as I did, you probably will also agree with me that it raises more questions than answers. We clearly still do not know enough to declare that all headaches are migraines or otherwise. But there is still some useful actionable information that we can take away from the article.
Pay attention to your triggers—in a different way.
Probably the most useful element from the discussion potentially involves the notion of triggers as symptoms.
Paying attention to triggers in order to avoid them can certainly prevent a migraine from being exacerbated.
And if any of the triggers are genuine causative triggers in any sense, avoiding them could have preventative value as well.
But the next time you notice a trigger, you should ask yourself if you are noticing it so intensely because you may already have a migraine developing.
So as an example, let’s return to the bright sun. If you look outside and it seems really harsh and unpleasant, ask yourself:
“Is it possible I have a migraine starting up, and this is making the sun seem extra bright?”
Especially if you spot other potential signs (like for me, having to use the restroom more than usual), it might be time to think about medicating—even if you are not yet in pain (see below).
Don’t wait to treat a headache.
It seems like a lot of migraine treatments work best if you don’t allow a headache to get into full gear before you attempt treatment.
The article quotes Gottschalk as saying, “If you treat a migraine-type headache when it’s mild, you’ll get better quicker.”
This gels with the instructions that come with medications like Imitrex. Patients are directed to take Imitrex at the very first signs of a migraine, even before the attack phase.
So in the scenario where the light seems awfully bright, you might think about taking a medication right away instead of waiting for the attack to start.
With a medication like Imitrex, you have to be careful not to overuse it. You are only supposed to take Imitrex a few times a month.
But that doesn’t mean you cannot use a milder medication right away. For example, you could try taking Ibuprofen at the first sign that one of your triggers might be presenting as a symptom. This may be more effective than waiting.
Even if you’ve been told you have another type of headache, consider whether you might also have migraines.
The Cleveland Clinic writes, “Nearly 200 million Americans are affected by tension headaches, the most common type of headache in adults … Many patients diagnosed with tension headaches actually have migraine.”
Consider these stats alongside what the other article reported to us previously:
- Around 94% of patients with headaches could be diagnosed with migraine.
It seems likely that a doctor who encounters a patient complaining of a headache without an aura, for example, might feel inclined to give a diagnosis only of “tension headache.” But if 94% of headache sufferers might have migraines after all, there is a really good chance that diagnosis is incomplete.
I may be an example of such a scenario. The first time that I talked to a doctor about my headaches, I was told quite plainly that I must be experiencing “tension.”
I was prescribed a few muscle relaxants and kicked out the door, despite the dramatic onset of severe and debilitating pain which have become intractable for the instant it appeared.
No doctor that I ever saw actually even mentioned migraines to me. It seems likely that this could be because of two things.
The first is that muscle tension is involved in my headaches (but it turns out that is one of the most common features of migraines as well). The second is likely that I do not seem to experience an “aura” in the classical sense.
More than a decade later, based on results from trying out Imitrex, it seems that I might have migraines after all along with the referred pain from my myofascial issues.
So if you suspect it is even possible that you have migraines, statistically, it seems entirely sensible to assume that you likely do until proven otherwise.
Note that does not mean that there are no other important factors that could be involved with your head pain (like muscle tension or trigger points). It just means that you should consider migraine treatment ideas and preventative advice alongside whatever other avenues you might be pursuing.
Conclusion: Are All Headaches Migraines?
We cannot take a conclusion away from this discussion—only one possible theory . But that theory does provide a new perspective which in turn could lead to new approaches to dealing with your head pain.
So what can you do? Do this:
- Because it seems that more than 90% of headache sufferers could potentially be diagnosed with migraines, if you think there is even a chance that you have them, you might consider proceeding as if you do.
- You will have the best luck in treating a headache if you attempt to do so as early as you possibly can. At the same time, you do need to be strategic, especially with certain medications that you cannot take every day.
- Consider looking at migraine triggers differently than you have in the past. While they may indeed function as triggers, they might also sometimes be symptoms which are present before pain or other clear signals of a developing migraine can be detected. This can clue you into when you might want to consider taking evasive action in order to prevent a full-on migraine attack.
Regardless of whether all headaches are migraines or not, hopefully following the recommendations above will help you to more effectively manage your head pain and enjoy more functional, comfortable days.