Headache, Migraine or Something More? How to Tell the Difference

(Submitted by By Dr. Kristen Sahler, Neurologist at White Plains Hospital)

Almost everyone gets a headache from time to time but not all headaches are the same.

Dr. Kristen Sahler, a neurologist specializing in Headache Medicine at White Plains Hospital, explains how to recognize when a headache may be something more—and what you can do about it.

A Migraine Is More Than a Headache

Head pain can have many different causes, and understanding what’s behind it is important to finding the right treatment.

“A headache is a symptom that can have many different causes, while migraine is a chronic neurological condition,” Dr. Sahler explains. “That distinction is important because not every bad headache is a migraine.”

Migraine can cause recurring attacks and symptoms beyond head pain, including nausea, sensitivity to light or sound, dizziness and, for some people, visual or other neurological symptoms known as aura.

Other headache disorders include tension, cluster and post-concussive headaches, as well as headaches originating from the neck. Because each can require a different approach to treatment, getting the right diagnosis is the first step toward finding relief.

When Should You See a Headache Specialist?

Dr. Sahler recommends seeking medical evaluation if you experience more than five or six headache days a month, or if headaches are interfering with daily life—such as causing you to miss work, school or other activities.

Certain symptoms warrant more urgent attention because they may indicate a more serious condition, including a headache that begins suddenly and reaches peak intensity within seconds to a minute—sometimes described as a “thunderclap” headache—or a headache accompanied by fever, unexplained weight loss or new neurological symptoms such as weakness or numbness on one side, slurred speech or vision loss.

Your Triggers Are Personal

Migraine triggers vary widely from person to person. Common ones can include stress, disrupted sleep, hormonal changes, changes in barometric pressure, alcohol and caffeine withdrawal, but this is only part of the story.

But identifying triggers does not mean migraine is something a patient has caused.

“People often blame their migraines on their lifestyle and habits, but migraine is a genetic, chronic neurological disease,” says Dr. Sahler. “You can do everything ‘right’ and still have migraines.”

Keeping a headache diary can be helpful for identifying individual patterns and giving your physician a clearer picture of when headaches occur and what may be contributing to them.

Dr. Sahler also cautions against repeatedly turning to caffeine for relief. While caffeine may temporarily ease headache pain for some people, frequent use can contribute to rebound or withdrawal headaches and make recurring headaches more difficult to manage.

Finding the Right Treatment

At White Plains Hospital, patients receive a thorough assessment that may include a detailed headache and symptom history, neurological examination and review of medications, potential triggers and lifestyle factors. Imaging or additional evaluation may be recommended when appropriate.

Once the headache disorder is identified, the focus turns to finding the treatment that works best for each patient.

More good news: migraine treatment has advanced significantly, with more options available to help prevent attacks or reduce their severity.

“There are more than 40 medications that can potentially be used for migraine prevention, and each patient responds differently,” Dr. Sahler says. “We can’t necessarily predict which treatment will work best based on someone’s history or migraine type, so treatment really needs to be personalized based on each patient’s symptoms, needs and response to treatment.”
In addition to medications, advanced treatments available at White Plains Hospital include:

• Botox® for chronic migraine: An FDA-approved treatment for adults with chronic migraine that can help reduce the frequency and severity of attacks.
• Nerve blocks: Minimally invasive procedures that may provide relief for severe or difficult-to-control headaches.

• Sphenopalatine ganglion (SPG) blocks: A procedure delivering a local anesthetic targeting nerves behind the nose involved in certain headache disorders, including migraine and cluster headache.
• Infusion therapy: An option for prolonged or severe migraine attacks that can help break a headache cycle and potentially avoid an emergency department visit.

Lifestyle and trigger management may also be part of a comprehensive treatment plan.

Dr. Sahler concludes, “With the right diagnosis and treatment, we can help people take back a significant part of their quality of life.”

Learn more about White Plains Hospital’s Neurosciences program, offering comprehensive, cutting-edge treatment for a variety of complex neuroendovascular, neurological, spine and cranial conditions right here in Westchester, NY.

Neurologist Dr. Sahler is an expert in all headache conditions including all varieties of migraine, tension headaches, cluster headaches, post-concussive headaches and cervicogenic headaches. To schedule an appointment, call 914.723.8100.