Headaches and Migraines

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Reviewed by: Dr. Ella Akkerman

Seeing patients from across Northern Virginia, including Reston, Herndon, Fairfax, Sterling, Chantilly, and Leesburg

Headache and Migraine: Quick Facts

  • What’s the difference between a headache and migraine? A migraine is a specific type of headache with severe, throbbing pain, often accompanied by other symptoms like nausea, vomiting and sensitivity to light and sound. Headaches are a broader term for head pain, with tension headaches being the most common type, typically causing a less intense, dull pressure on both sides of the head without the same associated symptoms.  
  • How long do migraines last? Typically, a migraine headache lasts between 4 and 72 hours. However, the entire migraine episode that precede and follow the migraine can last for days, sometimes triggering further headaches or migraines or other symptoms.
  • When are migraines considered chronic and I should see a specialist? Migraines are considered chronic when you experience them on 15 or more days per month for at least three months, or when they disrupt your daily life. You should seek care from a neurologist if your headaches are becoming more frequent, your current treatment is becoming less effective, or you have a headache accompanied by neurological symptoms like confusion, weakness or vision changes. It’s vital to seek immediate medical help for sudden, severe headaches or any headache that comes with fever, stiff neck or confusion.

Learn More about Migraines from Dr. Akkerman, VSI’s Neurologist

What is a Migraine?

Migraines are the sixth most disabling illness worldwide, affecting nearly 40 million Americans and approximately one in every four households. More than just a headache, a migraine is a complex neurologic disorder. It not only causes pain, but it can also result in light and sound sensitivity, vision changes, difficulty concentrating, nausea, vomiting, and other neurologic symptoms. Certain triggers can alter the brain’s ability to maintain its chemical balance. Once this balance is overwhelmed, a migraine may occur.

What Are Common Migraine Symptoms?

Common symptoms of Headaches and Migraines include:

  • Moderate to severe pain, often on one side of the head but can also be located behind the eyes, along the temples or at the back of the neck
  • Pounding or throbbing sensation
  • Changes in vision, called an aura. These effects can include streaking lines, blurred vision or fog.
  • Sensitivity to light, sound and certain odors
  • Nausea or vomiting

Migraine symptoms can even manifest without the typical head pain, often called a silent migraine. All of these symptoms can add up for a pretty miserable experience, and inevitably cause a patient to call out of work or impede them from accomplishing their daily activities.

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When Should You Seek Treatment for Migraines?

Migraines are considered chronic when you experience them on 15 or more days per month for at least three months, or when they disrupt your daily life. You should seek care from a neurologist if your headaches are becoming more frequent, your current treatment is becoming less effective, or you have a headache accompanied by neurological symptoms like confusion, weakness or vision changes. It’s vital to seek immediate medical help for sudden, severe headaches or any headache that comes with fever, stiff neck or confusion.

What are Common Causes of Migraines?

Our brains work at their best when they can maintain a chemical balance. Stress from outside the body (arguments, work deadlines, etc.) and inside the body (hormones) can overwhelm the brain’s ability to keep this balance. When the brain cannot maintain this balance, it releases proteins that lead to pain and other symptoms.

Certain triggers can throw off the brain’s pain regulation – this disruption causes a release of many substances that trigger a sensation of pain that spreads throughout the brain. In patients with migraines, avoiding headache triggers is a major part of managing their attacks. Once you identify your triggers, you can work on reducing them and having fewer migraines. Many patients have found it helpful to keep a diary of what triggers set off each migraine attack.

Below is a list of the four most common migraine triggers.

WebMD turned to Dr. Akkerman for tips on how to improve your quality of life if you suffer from chronic headaches and migraines.

“You don’t have to ‘tough it out’ or feel dismissed. We’ll work with you and find an approach to your migraine to allow you to live happily ever after. Don’t feel that you’re alone in this, and don’t lose hope. We’re here to help.”

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How Are Migraines Diagnosed?

Migraine is diagnosed clinically based on the description of the headache and the symptoms associated with it. Headaches lasting 4 – 72 hours, occurring at least 5 times, and having some of the following characteristics are consistent with migraines:

  • Pain on one side of the head
  • Pulsating, throbbing pain
  • Moderate to severe pain
  • Worsening pain with physical activity (such as climbing stairs or walking)
  • Pain associated with nausea or vomiting
  • Pain associated with light or sound sensitivity

What are Common Treatments for Migraines?

While every patient’s care is unique to them, we do have many ways we can help treat and even prevent migraines.

Common migraine treatments include:

  • Avoid triggers as best as possible
  • Over-the-counter pain medications (do not take more than three days out of the week as this can cause rebound headaches)
  • Prescription migraine medications
  • Physical therapy
  • Hyperbaric Oxygen Therapy
  • Botox Injections
  • Intranasal, subcutaneous, or intravenous medications if necessary

Frequently Asked Questions about Migraines

The pain associated with a migraine is a sharp throb that tends to be more bothersome than the dull ache associated with more mild headaches. Additionally, other neurologic symptoms such as light or sound sensitivity, difficulty concentrating, dizziness, vision changes, nausea, and vomiting all suggest that it is a migraine rather than an ordinary headache.

Migraines typically start at a young age, usually by adolescence and sometimes as early as childhood. They typically peak in the 30s. Some, but not all, people will notice their migraines become milder and less frequent with age. Patients who at one point needed migraine medications may not need them later in life.

Some people have genes that make it harder for their brains to keep their chemical balance, making them more likely to have migraines. Due to hormone cycles, women are more likely to have migraines than men. Also, people who have had prior injuries to the brain such as concussions or surgeries are more likely to have migraines.

Classically, there are four phases of a migraine, though not every patient with migraines experiences all four:

  1. During the premonition phase, patients feel they may experience a migraine and can have mood changes and fatigue. This phase typically occurs the day before the headache phase.
  2. During the aura phase, patients have an unusual feeling, which may include vision changes, numbness, changes in speech, and muscle weakness. Approximately one-third of patients with migraines experience this phase, and it usually occurs just before the headache phase.
  3. During the headache phase, the pain begins and gradually builds up to a sharp throb, either on one or both sides of the head. Nausea, vomiting, light and sound sensitivity, and dizziness are all common during this phase. This phase can last several hours to, in severe cases, several days.
  4. During the resolution phase, the pain gradually lessens but is replaced with depressed mood, difficulty concentrating, and decreased energy.

Migraines, when severe, can completely limit the ability to concentrate. However, even the severe migraines fortunately do not cause any brain damage.

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