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We often think of a headache as one of the run-of-the-mill aches and pains life throws our way. Headaches are an annoyance and inconvenient, but simply a part of life for most people. And, for the most part, they are not a symptom of a more serious condition.

But, when might a headache be more than just run-of-the-mill? What is the difference between a migraine and a headache? What kind of headache may be symptomatic of something more?


The Common Headache

The most common form of a headache, which affects most of us from time to time, is a tension headache. Characterized by a dull aching sensation all over the head, tension headaches are caused by tight muscles in the shoulders, jaw, neck, and scalp. Stress, depression, and anxiety can provoke tension headaches.

Over-the-counter pain medications are generally effective in relieving tension headaches, although if you’re using medications more than approximately 15 days a month then you might run the risk of developing a medication-overuse headache.

Knowing your triggers is the first step to preventing headaches so that you can try to counteract them with regular sleep, exercise, and healthy food choices. Reducing stress through relaxation techniques such as yoga or meditation can also be effective in preventing headaches.



Migraines are disabling, intense, throbbing, and often present on one side of the head, such as the forehead, behind the eye, in the temple, or over the entire side of the head. Patients with migraines may experience sensitivity to light and sound, nausea, vomiting, or changes in taste or smell. Neurological or cognitive symptoms may occur as well, such as flashing lights, changes in sensation or even confusion.

Oftentimes, avoiding triggers is the easiest way to decrease frequency of migraines. Triggers may include certain foods, caffeine, alcohol, strong smelling perfumes, and weather changes.

Treatment is necessary if migraines can’t be managed with over-the-counter medications. The question is whether a daily preventative should be used or if the migraine should be treated as it occurs. Most of my patients suffer from 10 to 20 migraines a month and for them the only way to treat their migraines is with preventative medication. A number of prescription medications, which have traditionally been used for blood pressure, mood disorders, or seizure disorders, have been shown to reduce the frequency of migraines when used regularly.

For people who do not respond well to treatment with an oral medication, regular Botox injections every 3 months—the only FDA-approved preventative treatment for chronic migraines—may be effective. Treatment for one migraine sufferer may not work for another, and the treatment plan will depend on individual circumstances.


When to Call a Doctor

The most important thing for headache sufferers to remember is to remain cognizant of your body. You know what is normal for you. If your headaches change in severity or duration, or symptoms outside of pain accompany the headache, seek the help of a medical professional.

In addition, if you are over 50 and develop a new type of headache, either after a trauma or without a clear trigger, call a doctor as this can signal a more serious health issue.


Urgent medical evaluation is advised if you experience any of the following symptoms:

A headache accompanied by a stiff neck and fever

An intense headache developing within seconds (thunderclap headache)

Any accompanying neurological symptoms, including new visual changes, double vision, facial weakness, numbness or weakness in the body

Cognitive changes such as confusion, trouble with speech, or trouble performing easy tasks

Intractable, severe vomiting or vertigo


When your headaches are getting in the way of daily activities and interfere with enjoyment of life, you shouldn’t hesitate to see a physician. Your doctor can help you design a plan to prevent and treat your headaches so you can get back to living life.


Dr. Daniel Vardeh, neurologist and pain specialist, Lahey Hospital & Medical Center