Splitting Headaches - Migraine or Mind Game?

Headaches are a common ailment – we all have them from time to time. But when does a simple headache morph into something more concerning? This article aims to provide some clarity on the matter, particularly for those who tend to worry about their health. With headache disorders affecting approximately 40% of the global population, or 3.1 billion people as of 2021, it’s a topic that touches many of us. In Australia, 4.9 million people, or 20.55% of the population, live with migraines.

There are four distinct types of headaches: Sinus, Tension, Migraine and Cluster.?However, to play our part in Migraine Awareness Month 2024 - we have put together an article to outline the biggest things to look out for when it comes to Migraines!

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Understanding Migraines

Migraines are a type of headache characterised by intense pain, often accompanied by nausea, vomiting, and sensitivity to light or sound. They can be triggered by various factors, including stress, certain foods, or hormonal changes. Migraines are particularly prevalent, affecting 18% of American women, 6% of men, and 10% of children. They are most common between the ages of 18 and 44. Globally, migraines are the sixth-leading cause of years of life lost due to a disability.

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Migraine sufferers often experience recurring attacks, which can significantly impact their quality of life. The World Health Organisation classifies severe migraine attacks as among the most disabling illnesses, comparable to dementia, quadriplegia, and active psychosis.

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Types of Migraines

There are several types of migraines, each with its unique characteristics:

1. Migraine with Aura: Previously known as classic migraine, this type includes visual disturbances such as flashes of light, blind spots, or tingling in the hand or face, followed by a severe headache.
2. Migraine without Aura: Also known as common migraine, this type does not include the visual disturbances associated with aura. It is the most common form of migraine.
3. Chronic Migraine: Defined as having headaches on 15 or more days per month for more than three months, of which at least eight days are with migraine.
4. Hemiplegic Migraine: A rare form that involves temporary paralysis or neurological symptoms on one side of the body, often mistaken for a stroke.

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When to Worry

While most headaches are not cause for concern, there are certain ‘red flag’ symptoms that should prompt immediate medical attention. These include a sudden, severe headache; a headache accompanied by a stiff neck, fever, or confusion; or a headache following a head injury.?

It is also important to note the prevalence of headaches or Migraines. Whilst pain in the head can be simple causes, like dehydration, it can also be a sign of something more severe if pain occurs on a regular or long-term basis.??

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Case Studies:

• Case Study 1: A 52-year-old man presented to his GP with worsening headaches. He had been experiencing these headaches for months, and they were associated with palpitations, unexplained anxiety, and light-headedness. The headaches usually started suddenly, lasted about an hour, and were often associated with exertion or straining during bowel movements.

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• Case Study 2: A 31-year-old woman came to the emergency department because of a severe headache in the occipital region. She described it as “the worst headache of my life.” The pain was constant and was accompanied by nausea. She had frequently had similar headaches beginning about 2 years ago. The headaches had increased in frequency this past week, and this episode was by far the worst.

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Recognising the Red Flags

While some acute migraines are often benign, they can sometimes be mistaken for more serious conditions such as a stroke, tumour, or cerebrospinal fluid (CSF) leak. It’s important to be aware of the “red flags” that might indicate a more serious underlying condition:

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1. Sudden Onset: A headache that comes on suddenly, often described as a “thunderclap headache,” can be a sign of a serious condition such as a stroke or aneurysm.
2. Change in Pattern: A significant change in the pattern of your headaches — such as new onset after age 50, or an increase in frequency or severity — can also be a red flag.
3. Neurological Symptoms: Symptoms such as confusion, loss of balance, difficulty speaking or understanding speech, or vision changes can be signs of a stroke or tumour.
4. Physical Changes: Symptoms such as fever, weight loss, or pain that is worse when lying down or early in the morning can indicate a more serious condition.
5. Headache following a Head Injury: If a severe headache follows a head injury, it could indicate a concussion or other injury.

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If you experience any of these symptoms, it’s important to seek medical help immediately. While it may turn out to be a migraine, it’s better to be safe and get it checked out.

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Misdiagnosis: Migraines or Something More Serious?

Unfortunately, migraines are often misunderstood and under-diagnosed. In Australia, it is estimated that 50% of people with migraines have not been diagnosed by their general practitioners. This can lead to unnecessary suffering and can even be dangerous if a more serious condition is overlooked. For example, Natalie Oh suffered from migraine attacks for 17 years following a car accident before finding a cure. Her migraines were so debilitating that at times she couldn’t get out of bed.

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Stroke

The symptoms of some types of migraines can mimic those of a stroke, such as hemiplegic migraines, which can cause weakness down one side. Migraine auras can be confused with transient ischemic attacks (TIAs), where someone has stroke symptoms that pass in a short time. In fact, migraines can be so similar to a stroke that they can be misdiagnosed as one in a medical setting.

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Tumour?

Brain tumour headaches are sometimes confused with migraines because the pain can be quite intense. However, many brain tumours don’t cause a headache or similar pain at all, until they have grown to a concerning size. Other symptoms of a tumour are likely to be noticed before then.

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CSF Leak

A cerebrospinal fluid leak occurs when fluid escapes through a small tear or hole in the outermost layer of tissue that surrounds the brain or the spinal cord. Because headache is a common symptom, patients are often misdiagnosed or mistreated for migraines. In fact, research shows that these similarities routinely result in the misdiagnosis of a CSF leak .

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It’s important to remember that while these conditions can present similarly to migraines, they are much less common. If you’re experiencing severe or persistent headaches, particularly if they’re accompanied by other symptoms or ‘red flags’, it’s crucial to seek medical help to ensure a correct diagnosis and appropriate treatment.

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Living with Migraines

Living with migraines can be challenging. Besides the physical pain, migraines can take a toll on mental health. Many sufferers experience anxiety and depression due to the unpredictability and severity of their symptoms. Effective management often requires a multifaceted approach, including lifestyle changes, medication, and sometimes alternative therapies such as acupuncture or biofeedback.

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Tips for Managing Migraines:

1. Identify Triggers: Keeping a headache diary can help identify triggers and patterns. Common triggers include certain foods, stress, sleep disturbances, and hormonal changes.
2. Maintain a Healthy Lifestyle: Regular exercise, a balanced diet, and adequate hydration can help reduce the frequency and severity of migraines.
3. Medication: Both preventive and acute medications can be effective. Consult with a healthcare provider to develop an appropriate treatment plan.
4. Stress Management: Techniques such as mindfulness, yoga, and cognitive behavioural therapy (CBT) can be beneficial in managing stress and reducing migraine frequency.

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Conclusion

In conclusion, while migraines can be painful and disruptive, they’re usually not a sign of anything serious. However, if you’re experiencing any ‘red flag’ symptoms, don’t hesitate to seek medical help. Your health is always worth prioritising. By understanding migraines and their potential to mimic more serious conditions, you can take proactive steps to manage your health and ensure you receive the appropriate care.

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Written by: Gabrielle Street (BPT, APAM)

References?

1. Migraine and Headache Australia. (2021). Migraine Statistics. Retrieved from https://www.migraine.org.au/burden

2. Headache Disorders. (2021). Global Burden of Disease. Retrieved from https://www.who.int/news-room/fact-sheets/detail/headache-disorders

3. Lipton, R. B., Bigal, M. E., Diamond, M., Freitag, F., Reed, M. L., & Stewart, W. F. (2007). Migraine prevalence, disease burden, and the need for preventive therapy. Neurology, 68(5), 343-349.

4. GBD 2016 Headache Collaborators. (2018). Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 17(11), 954-976.

5. Mayo Clinic. (2021). Thunderclap Headaches. Retrieved from https://www.mayoclinic.org/diseases-conditions/thunderclap-headaches/symptoms-causes/syc-20378327

6. American Stroke Association. (2021). Understanding Stroke. Retrieved from https://www.stroke.org/en/about-stroke

7. National Institute of Neurological Disorders and Stroke. (2020). Stroke Information Page. Retrieved from https://www.ninds.nih.gov/disorders/all-disorders/stroke-information-page

8. Harvard Health Publishing. (2021). Headaches: When to worry, what to do. Retrieved from https://www.health.harvard.edu/pain/headaches-when-to-worry-what-to-do

9. ABC News. (2024). Migraine: The misunderstood and untreated condition. Retrieved from https://www.abc.net.au/news/2024-03-27/migraine-headache-misunderstood-untreated-women-at-risk/103585646

10. Oh, N. (2023). My Migraine Journey. Retrieved from https://www.migraine.org.au/natalie-oh-migraine-story

11. Stroke Foundation. (2021). Migraines and Stroke. Retrieved from https://www.stroke.org.uk/stroke/managing-risk/migraines-and-stroke

12. Verywell Health. (2021). Stroke vs. Migraine: How to Tell the Difference. Retrieved from https://www.verywellhealth.com/stroke-versus-migraine-4102018

13. WebMD. (2021). Migraines or Brain Tumor: Symptoms to Watch For. Retrieved from https://www.webmd.com/migraines-headaches/migraine-brain-tumor

14. Dana-Farber Cancer Institute. (2018). Is a headache a sign of a brain tumor? Retrieved from https://blog.dana-farber.org/insight/2018/05/headache-sign-brain-tumor/

15. Spinal CSF Leak Foundation. (2021). Patient Stories: Spinal CSF Leak and Migraine. Retrieved from https://spinalcsfleak.org/patient-stories-spinal-csf-leak-and-migraine/

16. Cleveland Clinic. (2021). Cerebrospinal Fluid (CSF) Leak. Retrieved from https://my.clevelandclinic.org/health/diseases/14431-cerebrospinal-fluid-csf-leak

17. Migraine Research Foundation. (2021). Misdiagnosis and Treatment Challenges. Retrieved from https://www.migraineresearchfoundation.org/misdiagnosis-and-treatment-challenges

18. WebMD. (2021). CSF Leak: Symptoms and Treatment.