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HeadWay, Issue #044 -- Which headache is it?
March 21, 2007

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In this month's issue:

Which headache is it?

Primary headaches: Migraine

Say what?! unilateral

Which headache is it?

Sally walks in to the doctor's office with a headache. "Sounds like a migraine," says the doctor after 5 minutes, handing her a prescription.

Years later, Sally has been to 7 doctors. 5 of them said it "sounded like migraine", and she tried 12 different treatments. But still no solutions.

Was it really migraine? Was Sally getting the best treatment possible? What kind of migraine was it? Was it only migraine?

I'm starting a series this month. Normally, I won't dedicate the entire newsletter to it, just a part. But today we'll be staying on the one topic, so that I can introduce it properly.

What I want to do is go through the document from the Headache Classification Subcommittee of the International Headache Society, entitled The International Classification of Headache Disorders, published in 2003. Wait! Take your finger off that "delete" button. It won't be that bad, really. I promise.

You need to know a little about this document, because - well, for a lot of reasons! It can help you understand what type of headache you have and it can help you and your doctor find common ground. In the process of clarifying your symptoms and diagnosis, you may be able to short cut your way to a better treatment.

Don't worry, I'll keep it short and sweet. So first, let me give you a quick introduction to the document, then we'll talk about the first classification.

The document itself...

This document is an attempt to classify headaches. Already you can see there's a problem - some people with migraine don't get headaches, and yet migraine is one of the categories. Don't worry, the committee is aware of that. There are many challenges like that in the document, simply because we don't completely understand what migraine and various other diseases and symptoms really are.

As time goes by, classifications change. But we need to start somewhere. Also, remember that they're trying to help doctors to diagnose - a person walks into the clinic and says,"I have a headache". The doctor has to figure out if it's a migraine headache, tension headache, etc. A common place to start figuring out the problem is with the headache itself.

The authors say, for example, that genetic research is rewriting the rules, especially when it comes to migraine. We're learning that migraine has genetic factors. In a few years' time, we may recognize that migraine is much more like [such and such a disease] than it is like a common headache.

So the purpose is not to explain what a migraine or tension headache etc. is with certainty, but to find easy ways of diagnosing them so treatment will be easier to find, and so that we can better recognize diseases that don't fit in the category as well as we first thought.

So we have here a document that isn't perfect, and it's not my job to defend it. However, I do want to support the intent of the members of the committee to help us understand that all headaches (and treatments) are not created equal. And I think we need to understand what they have to say so that we can better understand our own treatment, and have the power to propel worldwide research forward.

You can investigate this document for yourself! Check out the The International Classification of Headache Disorders here, courtesy of the Migraine Aura Foundation.

Primary headaches: Migraine

Here's the first classification, migraine.  There are three kinds of primary headaches.  A primary headache is basically a headache that doesn't have an obvious other cause, like an infection or a head injury.  Sometimes migraine is considered secondary, if it seems to come as a result of another issue.  You'll notice that nothing is clear-cut here, people can have more than one headache at once, or it may not be clear which category they fit into in real life.  Read more about the cause of migraine here.

What's a migraine?

Generally, a migraine attack lasts 4-72 hours.  According to this document, there are common features of migraine - it's usually one-sided, pulsating, moderate to severe, made worse by physical activity, and often accompanied by nausea.  During a migraine attack, a person is also often sensitive to light and/or noise.

When should you be diagnosed with migraine?  Here's the suggestion.  First, you've had at least 5 attacks, and the attacks are not because of another disorder.  Next, your symptoms include either nausea or sensitivity to light or sound.  Finally, your symptoms have at least two characteristics:
  • one-sided headache
  • pulsating headache
  • moderate to severe pain
  • made worse by physical activity

  • There are many symptoms of migraine.  For a summary of some of migraine's major symptoms, read this article.  Here are some other quick ways to tell if it's a migraine attack.

    Now this is only the general migraine category.  There are many kinds of migraine - in this document, 6 sub-types, and more than a dozen different kinds under that.  Your treatment may be different depending on what category you seem to fit into.

    The huge impact of migraine on society is well documented.  The World Health Organization ranks the top causes of "life lost" due to a disability, and migraine is now #12 on the list.  If you're suffering, you're not alone.  Migraine is a major, world-wide, real, and serious issue.  It impacts everyone, not just sufferers.

    How many people have migraine, and other migraine statistics

    Say what?! unilateral

    This is an easy one - unilateral means one-sided. For example, migraine headaches (headaches which are a symptom of migraine) are commonly unilateral - on one side of the head. Commonly, but not always. Young children with migraine usually have bilateral (two-sided) headaches. When they get older, the headache may become one-sided again.

    One note about last month's word, interictal. One of our readers, Hawley, correctly pointed out that this term (and the term ictal) is most commonly used for seizures. Being an Emergency Medical Technician, Hawley emphasized that in an emergency situation terms like ictal need to be used in the most common way - for seizures.

    It's important for you to understand the concept as it relates to migraine, but don't go talking about it in the emergency room. In that case, the term should be used just for seizures. You wouldn't want to get treated for the wrong disease!

    Thanks for that, Hawley. Remember, if you have comments or questions to drop by the HeadWay MailRoom. Your password is nomoache.
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