Headache and migraine overview

Understanding headaches and migraines

Headache Australia lists 36 different types of headache, either by symptom or cause. The International Headache Society has more than 400 headache types in their classification.

Headache is one of the most common medical conditions in Australia and affects men and women alike, and people of all ages (although more headaches are reported by people aged 25-44). At any one time around 1 in 8 people will be taking some form of medication for headache in Australia.

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Headache symptoms and warning signs

When headache symptoms need attention

The majority of headaches are temporary and are not caused by any serious underlying condition, but there are circumstances where it is advisable to seek medical assistance straight away if the headache is accompanied by any of the following symptoms…

  • Very sudden onset
  • Very severe
  • Loss of consciousness
  • A head injury
  • Stiff neck
  • Rash
  • Fever (otherwise unexplained)
  • Nausea (otherwise unexplained)
  • Numbness in either arms or legs or paralysis
  • Vomiting (otherwise unexplained)
  • Difficulty with vision, walking or speaking (i.e. slurring words)

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Headache causes, tests and diagnosis

Finding the cause of your headaches

Medically speaking, all headaches are caused by something stimulating pain receptors in the head or the neck.

Headaches are considered to be either ‘primary’ headaches or ‘secondary’ headaches. Primary headaches are those where the cause is not an ‘illness’ as such and secondary headaches are those caused by a specific injury or illness.

It is important to get anything more than occasional headaches (where there is not an obvious cause), checked by a doctor to see if there is an underlying cause. The doctor will need to review symptoms such as frequency and duration of the headaches, location of the pain in the head and any other accompanying symptoms, for example neck pain or visual problems.

Medical evaluation

Reviews symptoms, headache patterns and possible causes

X-rays

Checks for sinus-related causes or structural concerns

MRI & CT scans

Provides detailed imaging of the head and brain

Eye tests

Checks vision and possible eye-related headache causes

Understanding migraine and its symptoms

Migraine

A migraine is a form of severe headache, but differs in many ways from other headaches, with the main difference being that regular headaches generally affect both side of the head, whereas a migraine generally affects only one side. Migraine is usually accompanied by other symptoms in addition to the severe headache.

Migraines are divided into two broad types – ‘migraine with aura’ and ‘migraine without aura’. A migraine with aura involves visual disturbance/s, in addition to the symptoms of a migraine without aura.

  • Around 80% of people who experience regular migraines have migraine without aura.
  • Globally, around 1 in 7 people have regular migraines.
  • People with migraines can suffer them as rarely as once a year, or several times a year.
  • Migraine attacks can last for anything from a few hours to 2-3 days.

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Common migraine causes and triggers

What can trigger a migraine?

Medical science does not fully understand the cause or causes of migraines, although they are believed to be connected with the trigeminal nerve and the brainstem and/or imbalances in levels of certain chemicals in the brain (serotonin for example).

Hormonal changes in women

Menstruation or intake of medication containing hormones.

Certain food and drinks

Salty and processed food, coffee, wine and other alcoholic drinks.

Routine changes

Changes in sleeping pattern, altered eating times or fasting.

High activity levels

High levels of physical activity (including sexual activity)

Stress

Stress-induced migraines.

Dehydration

Even at low levels, dehydration can cause migraines.

Prolonged coughing

Coughing fits may induce migraines.

Environmental factors

Changes in weather, high or loud sound levels, strong smells.

Risk factors

This includes gender, age, genetics, head trauma.

The four phases of a migraine

Understanding each stage of a migraine

Migraines generally occur in four phases, referred to as ‘prodrome’, ‘aura’, the attack itself and ‘post-drome’.

First phase – prodrome

Mood swings, food craving, stiffness in the neck, thirstiness, increase in urination, bouts of yawning, constipation.

Second phase – aura

Visual disturbances, temporary vision loss, numbness, tingling, involuntary movement, weakness, dizziness, speech or hearing difficulties and memory changes.

Third phase - attack

One-sided or bilateral head pain, throbbing or pulsing pain, increased sensitivity to light, sound, touch or smell, nausea and vomiting.

Fourth phase - post-drome

Fatigue for up to 24 hours, occasional feelings of elation and brief pain triggered by sudden head movement.

Migraine diagnosis and assessment

How migraines are investigated

There is no test which diagnoses migraine, although your doctor may recommend a range of other tests to exclude other possible causes.

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  • Comprehensive pain assessments
  • Individual treatment planning
  • Medication review and optimisation

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