1988 was an exciting year at the Calgary Winter Olympics. The Jamaican bobsled team made their debut, and self-taught “Eddie the Eagle” became the first ski jumper from England in 60 years.
Both the Jamaicans and Eddie faced insurmountable odds to achieve seemingly impossible dreams. Their Olympic success stories became hit movies.
In 1988, I was 10. I suffered from migraines from time to time, but I didn’t know the difference between a headache and a migraine back then.
I also had no idea that one of the seemingly impossible dreams I eventually would face was overcoming migraine headaches. Multiple doctors told me no cure for migraines existed.
Later in life, one doctor told me that all my headaches were migraines. Was he right?
I believe so. But answering the question, “What’s the difference between a headache and a migraine?” is a bit more complicated than one might think.
Because headaches fall into literally hundreds of different types!
The Difference Between a Headache and a Migraine: the Definitive Source
In 1988, the International Headache Society published the first edition of their International Classification of Headache Disorders (ICHD). And at more than 200 pages, the third edition (printed in 2018) makes for quite the Saturday afternoon read!
For anyone seeking to understand the difference between a headache and a migraine, the ICHD is the definitive source. The first thing to note is that “headache” is an umbrella term that includes, but isn’t limited to, migraines.
The ICHD classifies headaches as primary or secondary. Primary headaches stand alone as a distinct condition; secondary headaches result from another cause.
Primary headaches include:
- Trigeminal autonomic cephalgia (including cluster headaches).
Secondary headaches include:
- Injury or trauma to head and/or neck
- Cervical or cranial vascular disease
- Nonvascular intracranial disorder
- A substance or its withdrawal
- Disorder of homeostasis
- Disorder of the skull, mouth, nose, ears, neck, eyes, teeth, sinuses, or any other part of the face, neck, or head
- Psychiatric disorder
Tension-type headaches are by far the most common. Studies vary on the prevalence of tension headaches in the general population; estimates range between 30 and 78 percent.
Migraine headaches are the second most frequent, affecting closer to 10 percent of people. Their severity qualifies them as a serious disorder, and the ICHD suggests they’re the “third most prevalent disorder in the world.”
Far fewer – only 1/10th of 1 percent of us – experience trigeminal autonomic cephalalgias, including cluster headaches. That’s a blessing because their nearly unbearable pain has earned them the nickname “suicide headaches.”
Other Primary Headaches:
Primary headaches in the “other” category vary in frequency and are typically associated with other issues. They include:
- Cough headaches
- Exercise headaches
- Cold-stimulus headaches
- Thunderclap headaches
- Stabbing headaches
More than 180 types of headaches make up the secondary list.
Diagnosing Migraine Headaches
Any headache can be the cause of someone’s head pain. But when people ask about the difference between a headache and a migraine, they’re probably referring to the two most common primary types, tension headaches, and migraines.
I was in my late teens or early 20s when my doctor diagnosed all my headaches as migraines. How did he know?
He may have used the following mnemonic: POUND. It stands for:
-hOurs duration is 4 to 72 hrs (also referred to as One day severe)
-Unilateral location (one side of the head or the other)
-Nausea and/or vomiting
Typically, if a patient complains about four out of these five symptoms, there’s a 92-percent chance they have a migraine. If they report three of the symptoms, the chances are 64 percent.
With two symptoms, the chances drop to 17 percent, making some other type of headache the likely culprit.
Auras and Migraine Headaches
According to this Australian Physiotherapy Association review, other migraine symptoms such as sensitivity to light and sound didn’t improve the POUND analysis’ diagnostic accuracy.
Yet, another strong indicator of a migraine is the aura that can precede a migraine.
Auras are distinct disturbances lasting for minutes up to an hour. They affect one’s sensations, vision, speech, muscle coordination, and balance.
An estimated one in four migraine sufferers experiences auras.
Although the POUND assessment doesn’t include auras, they’re significant enough that an ICHD search for the term yields 428 results.
Of the 29 distinct migraine different types, nine mention an aura:
- Migraine without aura
- Migraine with aura
- Migraine with typical aura
- Typical aura with headache
- Typical aura without headache
- Migraine with brainstem aura
- Persistent migraine without infarction
- Probable migraine without aura
- Probable migraine with aura
The 2018 ICHD edition introduced the term “chronic migraine.” A near-constant condition, its sufferers experience headaches 15 or more days a month. On at least eight of those days, they have migraines. The headaches persist at these frequencies for at least three months.
Imagining such suffering is beyond me, yet many people live with it. Some estimates suggest that chronic migraines afflict 3 percent of us!
Despite the ICHD’s astonishing level of detail, we still don’t understand what causes migraines or tension headaches.
Tension headaches are typically associated with dull, bilateral pressure and mild to moderate pain.
Chronic tension-type headaches can also be a serious problem. Still, almost everyone has infrequent tension headaches at some point in their lives. They usually don’t merit medical attention.
The Difference Between a Headache and a Migraine: Conclusion
Comparing the two most common primary headache types, the difference between a headache and a migraine becomes clear. It comes down to the difference between the dull, bilateral pressure of a tension headache vs. the POUNDing, unilateral migraine pain.
Next, I’ll share my personal story of overcoming migraine headaches. My story isn’t as funny as the Jamaican bobsled team’s saga Cool Runnings. Yet, I think I feel about as satisfied with my success as Eddie the Eagle did with his!