Millions of people experience migraine. Some patients arrive after seeing several physicians and trying many medications, while headaches continue to interfere with work and family life.
Migraine Without Aura
Most migraines occur without aura. Typical diagnostic features include at least two of the following:
- One-sided pain
- Pulsating or throbbing quality
- Moderate to severe intensity
- Worsening with routine activity such as walking or climbing stairs
In addition, nausea/vomiting or sensitivity to light and/or sound may occur. Attacks commonly last 4–72 hours.
Migraine With Aura
Aura consists of reversible neurologic symptoms that generally develop gradually and are followed by headache. The current-site material notes that aura symptoms should be reversible, individual symptoms are limited in duration, and headache commonly follows within about an hour.
Tension Headache
Episodic tension headache
- Tightening, steady, non-pulsating or band-like discomfort around the head or neck
- Usually mild to moderate and does not completely prohibit activity
- Often bilateral, though it can be one-sided
- Usually not worsened by routine physical activity
- Typically no vomiting; light or sound sensitivity may occur, but generally not both together
Chronic tension headache
Similar features can become chronic when headaches occur on 15 or more days per month over a prolonged period.
Cluster Headache
Cluster headache is characterized by severe or excruciating attacks that come on suddenly, usually on the same side and around or behind the eye or temple.
- Attacks may last roughly 15–180 minutes
- Same-side tearing, eye redness, eyelid swelling or drooping, pupil change, or nasal symptoms may occur
- Attacks can occur from every other day to several times daily
- They often occur in clusters lasting weeks
- People may become restless, pace, or rock during an attack
- Alcohol can precipitate attacks during a cluster period
Transformed Migraine / Medication-Overuse Headache
Frequent use of some acute headache medicines can contribute to a shift from episodic migraine to chronic daily headache. Medication-overuse headache is associated with frequent treatment days over a period of months and headache on more than 15 days per month. The specific threshold varies by medication, so medication use should be reviewed with a clinician.
Hemicrania Disorders
Hemicrania continua
A continuous, one-sided headache that can include brief stabbing exacerbations. Nausea, light/sound sensitivity, nighttime awakening, or a foreign-body sensation in the eye may occur.
Chronic paroxysmal hemicrania
Short, frequent one-sided attacks, commonly around the eye, accompanied by autonomic symptoms. Attacks can occur many times per day and may be triggered by neck movement.
Episodic paroxysmal hemicrania
Very brief, repeated one-sided attacks that can resemble cluster headache.
Hormonal Headaches
Hormonal changes can influence migraine patterns. The current Kitaj Headache Center material discusses menstrual migraine, oral contraceptives, pregnancy, and peri- and post-menopausal migraine.
Menstrual migraine
Some women have migraine attacks closely linked to menstruation, while others experience menstrual worsening in addition to migraines at other times.
Pregnancy
Migraine patterns can change during pregnancy. Some patients improve, while others—particularly those with aura—may experience a different pattern and should discuss treatment choices with their clinician.
Perimenopause and menopause
Fluctuating estrogen levels may affect migraine frequency or severity during perimenopause and after menopause.
Post-Traumatic Headache
Headache after head or neck trauma can be intermittent or continuous and one-sided or bilateral. Symptoms may resemble migraine, tension headache, or a mixture of both. Associated symptoms can include dizziness, concentration or memory difficulty, and mood symptoms.