Not All Headaches are Created Equal (part 2)
In Part 1 of “Not All Headaches Are Created Equal”, I shared my story with chronic migraines including a devastating attack that mimicked a stroke, paralyzed the left side of my body, and hospitalized me for nearly a week.
Part 2 will explore variations in headaches. Understanding key differences among headaches is an important tool in your self-care tool kit. In order to receive the right treatment, you must get the proper diagnosis which is often easier said than done. Furthermore, knowing when to seek immediate medical attention for a severe headache just might save your life.
Here’s how headache experts describe different types of head pain:
1) Tension Headache: The most common type, a tension headache, You may feel:
Dull, pressure-like pain (not throbbing)
A tight band or vise on or around the head
All over pain (not just in one point or one side)
Pain worse in the scalp, temples, or back of the neck, and possibly in the shoulders
The pain may occur once, constantly, or daily and may last anywhere from 30 minutes to seven days. It may be triggered by or get worse with stress, fatigue, noise, or glare. While tension headaches are common, their causes are not well understood.
2) Sinus Headaches: Sinus headaches are actually quite rare and often confused with migraines. A sinus headache occurs when swelling in the sinus passages behind the cheeks, nose, and eyes causes pain in the front of the head and face. Sinus headache symptoms may include:
Stuffy nose
Facial pain
Pressure around the eyes and behind the cheekbones
Weaker sense of smell or inability to smell
Aching in the upper teeth
Fever
To determine whether you’re experiencing sinus headaches or migraine, you can ask yourself the following questions from the ID Migraine Questionnaire developed by Dr. Richard Lipton, Albert Einstein College of Medicine:
In the past three months, how disabling are your headaches? Do they interfere with your ability to function? Are you missing work, school or family activities?
Do you ever feel nausea when you have a headache?
Do you become sensitive to light while you have a headache?
If you answer “yes” to two of the three questions, there’s a 93% chance you have migraine. If you answer “yes” to all three, a migraine diagnosis is 98% likely.
3) Cluster Headaches: Very sharp and extremely painful, cluster headaches occur daily, sometimes up to several times a day for months. They may go away for weeks to months and then return or never come back. Each headache in a cluster cycle usually lasts less than an hour, but the pain can be excruciating. “Cluster pain is described as being at least 10/10 in severity, and typically there is an inability to lie still,” says Dr. Deborah E. Tepper, MD, of Dartmouth University. “People with a migraine tend to lie down in a dark, quiet room, while, in contrast, those with cluster will pace, rock in one place, or sometimes even bang their head to distract themselves from the pain. People almost never lie down during a cluster attack.”
Symptoms of cluster headaches may include the following:
A cycle of severe headaches on one side of the head
Can include red or teary eye, runny or stuffy nostril, and flushing or sweating of the face
May develop a smaller pupil or a drooping eyelid on the headache side
Restlessness, agitation, inability to stay still or lie down due to severe pain
4) Sex Headaches: In rare instances, headaches can be brought on by sexual activity, especially with orgasm. You may notice a dull ache in the head and neck that builds up as sexual excitement increases. Or, more commonly, you may experience a sudden, severe headache just before or during orgasm.
5) Headaches Associated with Other Conditions: Other types of headaches occur in conjunction with other medical conditions such as having a cold, the flu, a fever, or premenstrual syndrome.
6) Giant cell arteritis (GCA) or Temporal Arteritis: This headache-causing disorder results from a swollen, inflamed artery that supplies blood to part of the head, temple, and neck area. Common symptoms include new throbbing headache on one side of the head or the back of the head and tenderness when touching the scalp.
7) Migraines: Migraine is a neurologic disorder that causes moderate-to-severe headaches along with other symptoms that make it difficult for people to function normally. The pain is often characterized as throbbing or pulsing and is more frequently on one side of the head but can be on both. In addition to the throbbing pain, migraine sufferers frequently also experience nausea, vomiting, and extreme sensitivity to light, sound, and/or odors. Migraine attacks can last for hours to days, and the pain can be so intense that it interferes with daily activities. Symptoms of migraines may include the following:
Nausea
Vomiting
Sensitivity to light, noise, odors, and/or touch
Dizziness or light-headedness
Fatigue, sometimes severe
Mood changes
Scalp pain or tenderness
Neck pain
Numbness or tingling in the hands, face or other body partsVisual disturbances
Speech disturbances
Confusion
Vertigo
Inability to perform normal activities
There are different subcategories of migraine including the following:
Chronic Migraine: Chronic migraines occur on 15 or more days per month for more than three months, where at least eight of those headache days have additional migraine symptoms such as those listed above.
Episodic Migraine: Episodic migraines occur on 0 to 15 days per month. Both the severity and duration of these migraines tend to be lower than chronic migraines.
Ocular Migraine: Also known as a retinal migraine, an ocular migraine causes visual disturbances in one eye such as blind spots resulting in partial or total blindness, zigzagging patterns, shimmering or flickering lights, and/or floating lines. These visual changes usually last five to 60 minutes, but the other more typical aspects of this type of migraine can last for days. While the effects are ordinarily temporary, ocular migraines can result in permenant damage to the eye.
Migraine with Unilateral Motor Symptoms (MUMS): MUMS is a relatively new and rare subtype of migraine. People with this kind of migraine experience very severe and unusual symptoms. In addition to the normal migraine symptoms, MUMS patients may experience:
Weakness in limbs
Giveaway weakness - where the sufferer can initially provide resistance but then suddenly no longer can
Weakness may persist for some time after an attack and some patients may have some variable weakness most of the time
General sensory symptoms
Difficulty speaking
As you can see from the list of symptoms, a MUMS attack can mimic a stroke.
5. Hemiplegic Migraine: An extremely rare subtype of migraine, a hemiplegic migraine causes weakness on one side of the body (hemiplegia) along with headache and other typical migraine symptoms. While migraine affects 1 billion people worldwide, hemiplegic migraine only occurs in approximately 0.01% of those cases.
There are two types of hemiplegic migraine:
Familial which runs in the family
Sporadic which occurs someone who has no family history
Symptoms may include:
Muscle weakness on one side of your body
Vision changes (blind spots, flashing lights, zig-zag patterns, double vision)
Numbness or tingling sensations in your face, arms and legs
Difficulty with speech
Fatigue
Confusion
The impact on muscles, speech, and vision is different and more severe than with other migraines. Just like MUMS, hemiplegic migraines can mimic a stroke.
What Does This Mean for Patients?
As you can see from the list above, not all headaches are created equal, and some can even mimic serious, potentially life-threatening conditions. Therefore, it’s important to understand the differences among conditions that cause head pain, and it’s essential to know when to seek emergency medical help.
If you experience any of the following, call 911 or seek emergency medical help:
Headache starts very suddenly and/or is "the worst headache of your life"
Have trouble with any of the following:
Slurred speech
Vision disturbances
Muscle weakness or movement problems
Mental confusion
Memory loss
Loss of balance
Seizures
Double vision
Headache occurs with repeated vomiting
Have high fever or stiff neck with your headache
Headache occurs after a head injury and gets worse
The bottom line is that YOU are the single most knowledgeable expert about your body. You know it best, and you know when something’s off. Trust your gut! If you have a headache that worries you – or worries one of your loved ones – seek help.
Take charge of your own health journey!
