Distinguishing Migraines From it’s More Serious Imitators: Migraine Mimicking Headaches

• Not All Severe Headaches Are Migraines
  • Cluster headache
  • Tension-type headache
  • Secondary headaches
  • Medication Overuse Headache (MOH)
• Summary

Not All Severe Headaches Are Migraines

While migraines are the most common type of severe headache, other less common varieties must be distinguished from them. It is essential to determine the correct type of headache you are experiencing so that it can be appropriately treated. Before you brand your new onset severe headache as a migraine, be sure to confirm with your doctor that you do not have any of these less common but more severe conditions.

1. Cluster headache

Compared to migraines, this is rare and affects less than 1% of adults, primarily males. While this headache is usually just on one side, it is of shorter duration than a migraine headache and occurs in bursts.

The pain of a cluster headache is excruciating and located around your eyes or temples. Most people with cluster headaches feel restless or agitated, whereas, with migraines, most people usually want to lie down in a dark room.

Cluster headache attacks last 15 minutes to 3 hours and occur 1–8 times a day. They can last one week to 12 consecutive months. The headache is on the same side for the whole cycle of cluster attacks until it goes into remission. This is different from migraines.

With migraines, while the pain may predominate on one side in a single attack, it can switch sides in another episode. For instance, you may have a migraine headache that predominates on your right side in your current episode. With your next episode, it could predominate on the left. This is different from cluster headaches, where the pain predominates on one side consistently until it goes into remission.

For most people with cluster headaches, remission lasts for up to 12 months before it reoccurs. Another feature you will likely experience with a cluster headache is some combination of watery eyes, eyelid drooping, dilated pupils, red eyes, and runny/stuffy nose- all on the side of the headache.

While migraine patients can also experience these symptoms, they are less common and generally milder. While we know the trigeminal nerve, a nerve from the brain that goes to the part of the face affected by cluster headaches, is involved in these headaches, we still do not know what causes them entirely.

2. Tension-type headache

This is the most common type of headache in the general population. Compared to migraines, these headaches are less severe and do not usually get past moderate severity. They are usually on both sides of the head. While we used to think this type of headache was caused by muscle tension in the head and neck, that is no longer the case, and we do not know the exact cause of this common problem.

3. Secondary headaches

Migraine, cluster, and tension-type headaches are all known as primary headaches. This means that they are, first and foremost, a headache disorder. A secondary headache is when some other condition causes a headache, such as a brain tumor, trauma, substance use or withdrawal, or infection in or around your brain. Other causes of secondary headaches can be bleeding into the brain, vasculitis (inflammation in the arteries that go to the head), other blood vessel abnormalities, or medication overuse headaches.

These conditions are serious, life-threatening events. If you suspect you have any of them, you must seek immediate medical attention.

10 Signs Some Other Serious Medical Condition Is Causing Your Headache

Questions your doctor may ask to determine if your headache is signaling a more serious condition.

• Is this the worst headache of your life?
• Do you have weakness, numbness, or other neurological abnormalities that are not typical for a migraine aura?
• Is your headache triggered by coughing, exertion, or sexual activity?
• Are you confused, lethargic, or having personality changes along with a headache? (You may not realize this, but friends or family might notice).
• Do you have a fever with your headache?
• Are you pregnant?
• Did your headaches begin after the age of 50?
• Did your headache develop suddenly with strenuous exercise or activity?
• Did your headache develop suddenly and become severe within a few seconds or minutes?
• Is your headache increasing in frequency or intensity over time?

Answering yes to any of these questions does not guarantee you have a serious or life-threatening secondary headache. Still, it does mean that you need urgent or immediate evaluation by a doctor. If you answered “yes” to any of the questions above, you should seek care immediately. Call your doctor or visit the emergency department to be seen.

4. Medication Overuse Headache (MOH)

Medication overuse headache is a type of secondary headache that is usually a complication of another primary headache disorder. You need to know about MOH if you have migraine or any headache disorder.

For example, if you get frequent migraine headaches and take medicines for treatment, you may develop a medication overuse headache (MOH). We do not fully understand what causes this, but in patients with headaches, taking medications to relieve headaches (both prescription and over-the-counter) more than 2 days a week for 2 months (on average) can lead to this dreaded complication.

A common pattern with MOH is that you find your medication isn’t working as well as it did before. You find yourself taking higher doses or more frequently. While we are not clear on why this happens, the frequent use of pain medications actually increases headache frequency. Research has shown changes in brain scans such as MRI in people who have medication-overuse headaches. Fortunately, this returns to normal when the medicine is discontinued.

So far, the only treatment that works for MOH is to stop taking the medication that caused it. This can be a complicated process because when you stop, your headaches may get worse before it gets better. Hospitalization may be required in severe cases or in cases where you are stopping a habit-forming medication such as opioids or benzodiazepines.

Headaches requiring you to take pain medicine more than two days per week need further evaluation. You may need a different medication that will provide more effective treatment. You may also need further evaluation to ensure you have the correct diagnosis. Continuing to take more meds more frequently is ineffective and will harm you.

Summary

Headaches are common and can be annoying. Most headaches can be cured by using over-the-counter medicines, increasing rest and hydration, and reducing stress. Severe persistent headaches are often branded as migraines. While migraines are the most common type of severe headache, other conditions can mimic migraines. It is important that your severe headache be diagnosed correctly so you can receive the correct treatment. Seek immediate medical care if you are concerned that you may have any of these serious conditions.

Written by: myObMD writing team | Editor: Jennifer Abayowa and Dayna Smith, MD | Reviewed October18,2024 | Copyright: myObMD Media, Inc 2024.