Migraines and Headaches
Headache is classified according to the symptoms a person reports and the signs found on clinical examination. There always has to be an index of suspicion for any more ominous cause of the headaches but more often the diagnosis will be one of the manifestations of migraine.
Migraine is one of the most common and often debilitating forms of headache. It is classically characterized by unilateral (one side of the head), location often behind one eye, pulsating (throbbing) quality, worsening by routine activity and by its moderate or severe intensity of pain. Migraine is typically accompanied by nausea or vomiting and or light and sound sensitivity. However, we now recognize that just as many people who have classical migraine will have variations of migraine with bilateral pain, steady pressure pain, and pain in the neck or back of the head more than the front. Previously those with pressure head pain or pain in the back of the head were misdiagnosed as tension headache that often would suggest that the person is having trouble dealing with stress. We now accept that most headaches that are severe enough to interfere with life are migraine irrespective of the location or type of the pain. Only 20% of people with migraine have the flashing light aura before the headache so it is more common to have migraine without the aura.
Too often people who have not had migraine and even many medical professional do not recognize the immensity of the impact on life of migraine. They cannot understand how a person can miss major family activities or work “just because of a headache”. They do not recognize that migraine can be the worst pain that humans can suffer and even if the pain can be controlled, the associated symptoms of vomiting, severe light or sound sensitivity and cognitive impairment are often just as disabling from life. Even though migraine is not a life threatening disorder, it all too often steals precious days of life from people.
If left untreated or if frequent analgesics medications are used, the episodic migraine can transform to a daily headache pattern with intermittent severe intensifications. Often this is confused with mixed migraine and tension headaches but most often is a continual lower grade smoldering migraine that erupts frequently into severe migraine. Unless the daily headache cycle can be controlled, the episodic severe migraine pain cannot be prevented.