What Are Headaches and Migraine? Symptoms, Causes and Treatment

What Is a Headache?

A headache is pain or discomfort felt in the head or face.

The brain tissue itself does not directly feel pain. Headache pain can arise from pain-sensitive structures including the meninges, blood vessels, nerves and muscles of the head and neck.

A headache may be a primary neurological disorder or a symptom of another medical condition.

What Types of Headache Are There?

Headaches are broadly divided into primary and secondary headache disorders.

Primary headache disorders include migraine, tension-type headache and cluster headache.

Secondary headaches can result from another medical condition such as infection, head injury, vascular disease or changes in intracranial pressure.

When Is a Headache an Emergency?

How Are Headaches Treated?

Treatment depends on the headache diagnosis and underlying cause.

Primary headache disorders may be managed with acute medication, preventive treatment when appropriate and lifestyle strategies such as regular sleep, exercise and management of individual triggers.

Secondary headaches require treatment of the underlying condition.

What Is Migraine?

Migraine is a chronic neurological disorder characterised by recurrent attacks of headache and associated neurological symptoms.

Migraine is more than simply a severe headache. Nausea, sensitivity to light and sound, fatigue, cognitive symptoms and aura can form part of an attack.

What Are the Symptoms of Migraine?

A typical untreated migraine without aura usually lasts 4–72 hours.

The headache can have features such as unilateral location, pulsating quality, moderate or severe intensity and worsening with routine physical activity.

Nausea, vomiting, photophobia and phonophobia commonly occur.

What Is Migraine With Aura?

Migraine aura consists of fully reversible neurological symptoms that usually develop gradually before or during a migraine attack.

Aura can include visual symptoms, sensory changes such as tingling or numbness, and speech or language symptoms.

Typical individual aura symptoms generally last 5–60 minutes.

Aura can occasionally occur without a subsequent headache.

What Is Chronic Migraine?

Chronic migraine is defined by headache occurring on at least 15 days per month for more than 3 months, with migraine features on at least 8 days per month.

Is Migraine Genetic?

Genetic susceptibility plays an important role in migraine.

Having family members with migraine can increase an individual's likelihood of developing the disorder, although most migraine is not caused by a single gene.

What Can Trigger Migraine?

Potential triggers vary between individuals and can include irregular sleep, missed meals, stress, hormonal changes, bright light, certain smells, alcohol and changes in caffeine intake.

Routine elimination of multiple foods is not necessary for every person with migraine. A headache diary can help identify individual patterns.

How Is Migraine Diagnosed?

Migraine diagnosis is primarily based on a detailed clinical history and neurological examination.

Attack duration, headache frequency, pain characteristics, nausea, sensory sensitivity, aura and medication use are considered.

MRI or CT is not automatically required in every patient with typical migraine and a normal neurological examination. Imaging is guided by clinical features and red flags.

How Is a Migraine Attack Treated?

Acute treatment aims to stop or significantly reduce an attack once it has begun.

Depending on individual circumstances, options can include paracetamol, NSAIDs, triptans, antiemetic medicines and CGRP receptor antagonists known as gepants.

Treatment selection depends on cardiovascular health, pregnancy, other medicines, previous response and the severity of the attack.

How Is Migraine Prevented?

Preventive treatment may be considered when migraine attacks are frequent, prolonged or significantly affect quality of life.

Depending on the patient, options can include beta blockers, topiramate, amitriptyline, CGRP-targeting therapies and botulinum toxin type A for chronic migraine.

Treatment is individualised according to medical history, pregnancy plans, side-effect profile and patient preference.

What Are CGRP-Targeting Treatments?

Calcitonin gene-related peptide (CGRP) plays an important role in migraine biology.

CGRP-targeting treatments include monoclonal antibodies used for prevention and gepants that can be used for acute or preventive treatment depending on the product.

Current American Headache Society guidance considers CGRP-targeting therapies a first-line preventive option for appropriate patients rather than requiring failure of older preventive medicines first.

When Is Botulinum Toxin Used for Migraine?

Botulinum toxin type A is an established preventive treatment option for chronic migraine.

It is administered according to a specific medical protocol at defined sites around the head and neck and is different from cosmetic botulinum toxin treatment.

What Is Medication-Overuse Headache?

Using acute headache medicines too frequently can contribute to increasingly frequent headaches in susceptible patients.

This is known as medication-overuse headache.

People with frequent migraine should monitor how many days each month they use painkillers, triptans or other acute treatments.

Living With Migraine

Regular sleep, consistent meals, adequate hydration, physical activity, stress management and a headache diary can support long-term migraine management.

Frequently Asked Questions

References

1. Academic Hospital. Headache and Migraine
2. International Headache Society. ICHD-3: Migraine Without Aura
3. International Headache Society. ICHD-3: Migraine With Aura
4. International Headache Society. Migraine Treatment Guidelines
5. American Headache Society. Clinical Practice Guidelines
6. NICE. Headaches in Over 12s: Diagnosis and Management