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Headache Headache Basics

It's Not All in Your Head: Difficulty Diagnosing Headache


Medically Reviewed On: September 18, 2003

Migraine attacks typically last four to 72 hours. They usually interfere with routine function, and almost everyone with migraine takes some medication, though most people take over-the-counter medications. Migraine also runs in families, so any given relative of a person with migraine is twice as likely to have migraine as the general population. For some subtypes of migraine, we know the specific gene that causes it.

What kind of pain do tension headaches cause?
Tension-type headaches are defined in contrast to migraine. Where migraine pain is one-sided, tension-type headache pain is on both sides of the head. Where migraine pain is throbbing, tension headache pain is a pressure pain. Where migraine is moderate or severe, tension headache pain is usually mild or moderate. Where movement makes migraine pain worse, and migraine sufferers like to hibernate and in a dark, quiet room not moving, tension headache sufferers do not experience pain exacerbation with movement in general. And where migraine is always associated with at least aura, nausea, or sensitivity to light and sensitivity to sound, tension headache isn't associated with any of those features.

What characterizes chronic daily headaches?
There are four types of the primary chronic daily headaches. One is called chronic or transformed migraine, and that's a disorder where a person starts out with episodic migraine, and their migraine gets worse over time.

The second one is called chronic tension-type headache, and that's a disorder where a person starts out with episodic tension-type headache, and their headaches get worse and comes more frequently over time.

The third disorder is called new daily persistent headache, where people out of the blue go from basically not been headache people at all to having headaches that never go away. So you wake up one morning with a headache, and that's it. It's there all the time for months or years. And that's a very difficult disorder to treat.

The final kind of chronic daily headache is a disorder called hemicrania continua, which is characterized by pain on one side of the head that waxes and wanes in severity. When the pain gets severe, very often people report that their eye tears, their eyelid droops, their nose gets stuffy, or their eye gets red.

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