Headache / Migraine
What Are Headaches and Migraines?
Headaches are divided into two main categories: primary headaches (not caused by another condition) and secondary headaches (symptoms of underlying diseases). According to MedlinePlus’s Migraine Encyclopedia, migraines are a specific type of primary headache involving abnormal brain activity that affects one in five women and one in 16 men.
Types of Headaches
The International Headache Society classifies over 200 types of headaches into four primary categories:
| Type | Characteristics |
|---|---|
| Tension Headaches | Dull, aching pain across the head; feels like a tight band around the skull |
| Migraine | Throbbing, one-sided pain with nausea, vomiting, light/sound sensitivity |
| Cluster Headaches | Severe, burning pain around one eye; occurs in cyclical patterns |
| Trigeminal Autonomic Cephalalgias | Include cluster headaches, hemicrania continua, and other rare conditions |
For comprehensive information about headache types, visit Healthline’s Types of Headaches Guide.
Signs and Symptoms
Migraine Symptoms
Migraines typically progress through four phases:
Prodrome (Pre-headache): Fatigue, food cravings, mood changes, increased urination
Aura (25% of patients): Visual disturbances (zigzag lines, flashing lights), numbness, difficulty speaking
Headache Phase: Throbbing pain (usually one-sided), nausea, vomiting, sensitivity to light and sound
Postdrome: Exhaustion, confusion, mood changes lasting up to 24 hours
Other Headache Warning Signs
Seek immediate medical attention for:
Sudden, severe headache (“worst of your life”)
Headache with fever, stiff neck, rash
Headache after head injury
Progressive worsening of headache pattern
Visual loss, confusion, or slurred speech
What Causes Headaches and Migraines?
Migraine Triggers
Common migraine triggers include:
Hormonal Changes: Menstrual cycles, pregnancy, birth control pills
Dietary Factors: Alcohol (especially red wine), caffeine withdrawal, aged cheeses, processed meats
Environmental: Bright lights, loud noises, strong odors, weather changes
Lifestyle: Sleep pattern changes, stress, missing meals, dehydration
Genetic Factors: 50% chance if one parent has migraines
Underlying Mechanisms
The Migraine Disorders Foundation explains that nervous system dysfunction causes hypersensitivity, leading to abnormal brain waves and trigeminal nerve activation.
How Are Headaches Diagnosed?
Dr. Budhwar’s evaluation includes:
Detailed Headache History: Pattern, triggers, duration, associated symptoms, family history
Physical and Neurological Examination: To rule out secondary causes
Headache Diary: Track frequency, severity, triggers, and medication use for 2-4 weeks
Imaging Studies: MRI or CT scan if red flags present or atypical features
Diagnostic Criteria: International Classification of Headache Disorders (ICHD-3) guidelines
Treatment Options
Evidence-based treatment involves both acute and preventive strategies:
1. Acute (Abortive) Treatment
First-Line Medications:
NSAIDs: Ibuprofen (400mg), aspirin (1000mg), diclofenac for mild-moderate attacks
Acetaminophen: 1000mg dose, though less effective than NSAIDs
Second-Line Medications:
Triptans: Sumatriptan, rizatriptan, eletriptan for moderate-severe migraines
CGRP Antagonists: Ubrogepant, rimegepant for patients who cannot use triptans
Refer to the American Family Physician’s Acute Migraine Treatment Strategies for detailed guidelines.
2. Preventive Treatment
For patients with ≥2 migraine days per month:
Beta-blockers: Propranolol, metoprolol
Anticonvulsants: Topiramate, valproate
Antidepressants: Amitriptyline, venlafaxine
CGRP Monoclonal Antibodies: Erenumab, fremanezumab for refractory cases
Botulinum Toxin: For chronic migraine (≥15 headache days/month)
3. Non-Pharmacological Treatments
Cognitive Behavioral Therapy: Stress management and coping strategies
Biofeedback and Relaxation Training: Muscle tension reduction
Neuromodulation Devices: Transcranial magnetic stimulation, vagus nerve stimulation
Self-Help Strategies
Sleep Hygiene: Consistent 7-9 hours nightly, regular sleep-wake schedule
Stress Management: Regular exercise, meditation, yoga, deep breathing techniques
Dietary Modifications: Identify and avoid trigger foods, maintain regular meal times
Hydration: Drink adequate water throughout the day
Trigger Avoidance: Use headache diary to identify and minimize personal triggers
Environmental Control: Sunglasses, noise-canceling headphones, ergonomic workspace
When and How to Seek Help
Consult Dr. Budhwar if you experience:
Headaches that interfere with daily activities
Change in headache pattern or increasing frequency
Headaches requiring frequent pain medication
New-onset headaches after age 50
Contact us for questions
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Headaches and migraines are highly treatable. With proper diagnosis, individualized treatment plans, and proactive management strategies, patients can significantly reduce headache frequency and severity while maintaining active, productive lives.