Psychiatrist Ahmedabad

Migraine and other headaches

Headache is an extremely common medical symptom and everybody experiences it sometimes in life.

Headache has many causes but generally there are three types of headaches: primary headaches and secondary headaches and other headaches.

Primary headaches are headaches which are not caused by any other diseases. There are three types of primary headaches.
  • Migraine headaches
  • Tension type headaches 
  • Cluster headaches

Secondary headaches are headaches which are caused by other diseases such as brain tumors, meningitis, encephalitis, subarachnoid hemorrhages, caffeine withdrawal, or discontinuation of drugs.

There is also another category which includes cranial neuralgias, facial pain and several other types of headaches.

Tension headaches

Tension type headaches are the most common primary headaches. Over all up to 90% of adults experience this type of headache at least once in their life span.

Tension headaches occur more frequently among women than men.

Tension type headaches are characterized by episodes of stable bilateral pain lasting several days at a time. It is differentiated from migraine by its longer duration, both sided pain, mild to moderate intensity of pain, heaviness type quality rather than pulsating pain, absence of gastro intestinal symptoms, and lack of worsening with physical activity.


Migraine is the most common type of vascular headache and second most common type of primary headaches.WHO has placed migraine in the 20 most disabling medical conditions overall and ranked it 6th for women and 18th for men.

Women are more likely than men to have migraine headaches.

Having genetical component migraines may run in families.

Migraine headaches are generally characterized by severe pain on one or both sides of the head, nausea and other gastrointestinal symptoms with some times presence of various visual, neurological, vascular and endocrinal symptoms.

Diagnosis of Migraine

According to International Headache Society criteria both migraine subtypes are diagnosed with following symptoms and signs.

Migraine without aura

Presence of at least five attacks per year with having duration of 4 hours to 72 hours

Presence of at least two of the following symptoms

1) Pain on one side of the head

2) Pulsating / throbbing type of pain

3) Moderate to severe intensity that inhibits one’s ability to work or continue with the daily routines

4) Aggravation of pain by physical activity

Presence of at least one of the following two symptoms

1) Nausea with or without vomiting

2) Sensitivity to light and/or sound

Migraine with aura

Presence of at least five attacks per year

Presence of aura with at least one of following symptoms which are fully reversible

1) Visual symptoms like blurring of vision, flickering lights, spots or loss of vision

2) Sensory symptoms like pins and needles, tingling, numbness

3) Speech disturbances

• At least two of the following symptoms
1) Same side visual symptoms with or without one sided sensory symptoms
2) Development of At least one aura symptom gradually in 5 minutes
3) Each aura symptom lasts for more than 5 minutes but less than 60 minutes
 Headache starts with aura or within 60 minutes of development of aura

Migraine triggers:
Introduction or withdrawal of certain substances like caffeine, nicotine and some drugs, hormonal changes during a woman's menstrual cycle, lack of sleep or changes in sleep cycle, physical activity, reduced blood sugar due to missing meals, bright light or flickering lights, glare, sound etc.
Foods that can trigger migraine attacks:
Processed foods, pickles, fermented foods ,foods that contain monosodium glutamate (MSG),some chocolates, nuts, peanut butter,red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans and fruits like banana, oranges etc.

For headache treatment,two types of approaches are used.

Acute treatment and prophylactic (preventive) treatment

Acute treatment

For any acute headache attack which is mainly with medicines like aspirin, paracetamol or NSAIDS. There are other several medicines also for severe headache attack.

Preventive treatment

When headaches occur four or more times a month or when its very severe and disabling preventive treatment is recommended.
Drug therapy is important preventive measure and preventive drugs are different from drugs used in acute attack.

There are also other various methods like biofeedback training, stress reduction, and elimination of triggers including certain foods.Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches. 

Not all headaches require urgent medical attention.But some types of headaches are signals of underlying more serious disorders and requires urgent medical care. Severe headache or sudden headache associated with a stiff neck, headaches associated with fever,convulsions, or accompanied by confusion or loss of consciousness; headaches following a trauma to the head, or associated with pain in the eye or ear; persistent headache in a person who was previously headache free and recurring attacks of headache in children.