Most of us have had a headache at some point. It might be a dull ache after a long day, a tight band of pressure around the forehead, or a pounding head that makes us want to retreat to a dark room.
But when does a headache become a migraine?
The terms are often used interchangeably. Someone has a particularly bad headache and describes it as a migraine, while someone else experiences visual disturbances, nausea and difficulty thinking clearly but doesn't recognise it as migraine because they don't have much head pain.
The reality is that migraine is much more than just a bad headache. And understanding the difference matters, particularly when it comes to finding the right treatment.
Headache is simply a description of pain in the head. It can have many different causes and characteristics.
Migraine, on the other hand, is a neurological disorder and one of several recognised primary headache disorders. Others include tension-type headache and cluster headache. There are also secondary headaches, which occur as a result of another underlying condition.
In fact, headache disorders are classified into hundreds of different diagnoses and subtypes. So having a headache, however unpleasant, doesn't automatically mean you have migraine.
Migraine is diagnosed by looking at the pattern of symptoms, rather than simply how much your head hurts.
A typical migraine attack can last between 4 and 72 hours if untreated. The pain is often moderate to severe, sometimes throbbing or pulsating, and may affect one or both sides of the head. One of the distinguishing features is that ordinary physical activity, such as walking upstairs or bending down, can make the pain worse. Nausea, sensitivity to light and sensitivity to sound are also common.
But not everyone experiences migraine in the same way. You don't have to tick every box, and the symptoms can vary between individuals and even between attacks in the same person.
This is probably one of the most misunderstood aspects of migraine. Migraine is a neurological event that can involve several phases, and headache pain is only one possible part of the experience.
Some people experience aura: temporary neurological symptoms that can occur before or during a migraine, and sometimes without any headache at all.
Visual aura is probably the best known. This might involve flashing lights, zigzag patterns, blind spots or other changes in vision. Some people experience tingling or numbness, or temporary difficulties with speech. Aura typically develops gradually and lasts between 5 and 60 minutes.
And then there are the symptoms that can occur before the headache even starts.
Have you ever found yourself yawning repeatedly, craving particular foods, feeling unusually tired or struggling to concentrate, only to develop a migraine several hours later? These can be part of the prodrome phase.
For some people, these early warning signs are quite recognisable. Personally, I tend to notice them and then carry on regardless, until it's too late!
Recognising your own pattern can be useful, particularly if you have medication that works best when taken early in an attack.
And then there is the bit that doesn't get talked about nearly enough: what happens after the migraine.
When the headache finally lifts, there is usually a huge sense of relief. But that doesn't necessarily mean you feel normal again.
Postdrome, sometimes called the migraine hangover, can feel like wading through treacle. Everything is hard work. You're tired, your brain feels foggy and thinking is slow, concentrating takes effort and even fairly ordinary things can feel like too much.
You know the migraine has passed, but you still don't quite feel like yourself. And that can be frustrating, particularly when everyone else assumes that because the headache has gone, you're fine again.
Postdrome is a recognised part of the migraine experience and can last for up to 48 hours.
This is where things get a little more complicated.
Migraine is a neurological disorder. There isn't a simple mechanical problem in the neck that a chiropractor can correct to make migraine disappear.
However, the neck can be part of the picture. Many people with migraine also experience neck pain or stiffness, sometimes before the headache even begins. The upper cervical spine and the trigeminal nerve system share connections involved in processing sensory information and pain. This provides a possible explanation for why input from the neck might influence headache symptoms in some people.
Manual therapy may also help with associated musculoskeletal problems, such as neck pain and restricted movement. But it's important to distinguish between treating associated neck symptoms and treating migraine itself.
So while some people may find chiropractic care helpful as part of their overall management, we shouldn't promise that it will prevent or cure migraine. And it certainly shouldn't replace appropriate medical assessment or migraine-specific treatment.
If you regularly experience headaches, or your symptoms are changing, it's worth discussing them with your GP. Getting the diagnosis right matters because different headache disorders can require very different approaches to treatment.
A headache diary can also be useful. Recording when headaches occur, how long they last, associated symptoms and any medication taken can help identify patterns and support a diagnosis.
A sudden, extremely severe headache, new neurological symptoms or a substantial change in your usual headache pattern needs prompt medical assessment rather than assuming it's another migraine.
A migraine isn't simply a particularly bad headache, and a headache doesn't automatically mean migraine. The distinction matters because understanding what you're experiencing is the first step towards finding the right management.
And while chiropractic care may have a role in addressing associated neck pain and musculoskeletal symptoms, migraine is a complex neurological condition that deserves an equally thoughtful approach.
