Many of us use the terms headache and migraine interchangeably. However, in reality, they are different conditions, even though it’s often quite difficult to distinguish between them.

Headache or migraine?

If your headache is on both sides of the head, and is not made worse by going about your normal activities, it’s likely to be an ordinary headache.

On the other hand, if it throbs, is on one side of the head, is made worse by going about your normal activities, and is accompanied by nausea, vomiting or sensitivity to light and noise, then it’s more likely to be a migraine.

In addition, if it’s a migraine, the headache may be preceded or accompanied by an ‘aura’. The symptoms of an aura include seeing lights or spots, losing your vision, or suffering pins and needles, numbness or speech disturbances.

If you suffer frequent or persistent headaches, it’s important that you see a doctor. Don’t be tempted to self-treat them by taking more than the recommended dosage of painkillers. Your headaches may not be ordinary headaches: they may be due to an underlying condition, or they may need specific treatment.

In addition, paradoxically, if you’re using painkillers frequently, your headaches may be caused by the painkillers, particularly if they occur on most days or every day. These medication overuse headaches can be caused by any of the painkillers used to treat headache and migraine, but they’re more likely when using combination painkillers (see box below).

Treating headache

Occasional headaches can be alleviated with simple painkillers, such as paracetamol, ibuprofen and aspirin. Avoid preparations containing codeine.

Massaging and stretching the head and neck muscles may alleviate occasional headaches. There is also some evidence that spinal manipulation by a physiotherapist, chiropractor or osteopath can reduce headache pain.

Preventing headache

Reducing stress and managing stress better using relaxation techniques and specialised counselling may help prevent headaches.

Treating migraine

It generally takes time to work out the best way to control migraine attacks. Simple painkillers, such as aspirin or ibuprofen, are usually tried first. In many cases, these medicines eliminate mild to moderate migraine headaches, or reduce their severity. If you can’t use aspirin or ibuprofen, try paracetamol. If you have any nausea or vomiting, think about using tablets that can be dissolved in water.

If you’re using painkillers frequently, your headaches may be caused by the painkillers,
particularly if they occur on most days or every day.

If your migraines are severe or disabling, or if you find that simple painkillers don’t work, talk to your GP about trying a specific migraine medication. Several preparations are available, so you will need to work with your GP until you find the best medication and dose for you.

If you use a specific migraine medication, use it as soon as you feel the migraine headache coming on. Using the medication that works for you right from the start means that you’re more likely to alleviate the migraine before it becomes severe.

If your medication doesn’t work, it’s probably best to retreat to bed in a quiet and darkened room.

Preventing migraine

Some people can reduce their frequency of migraine attacks by recognising and avoiding the things that trigger them. The most common triggers appear to be stress, irregular sleep, skipping meals, smoking, and some foods, such as chocolate, cheese, citrus fruits and wine.

While it’s generally not possible to avoid stress completely, you may be able to manage it better by undertaking relaxation training or specialised counselling. Other techniques that may be useful include yoga, massage and exercise.

Keeping a pain diary each time you have a migraine may help you recognise the things that trigger and resolve them. Later, you can use the diary to monitor the success of your treatment. A pain diary can be found at www.clininfo.health.nsw.gov.au/nswtag/guidelines.html.

If you suffer more than three severe migraines a month, your doctor may suggest taking a medicine to reduce their frequency. These medicines often cause side effects, so you and your GP will need to weigh up the benefits and side effects before making a decision whether or not to try one.

Further information on the internet

The Winter 2004 issue of MedicinesTalk (No. 10) has information about the safe use of simple painkillers. 

The Better Health Channel website has a series of fact sheets on headache and migraine. Go to www.betterhealth.vic.gov.au, and type headache or migraine in the search box.

Avoid codeine preparations

Avoid painkillers containing more than one medicine, especially those containing aspirin, ibuprofen or paracetamol plus codeine. These painkillers are often called combination painkillers. The codeine in combination painkillers can slow down the absorption of other medications being used, and  may make any nausea and/or vomiting worse. Combination painkillers are also often implicated in cases of medication overuse. Instead, use painkillers that contain only one medicine, such as paracetamol, ibuprofen or aspirin, to alleviate headache. These painkillers are often called simple painkillers.