by Nesreen Suwan, M.D.
Migraine is a common neurological disorder that often walks a fine line between being under diagnosed and being used as a scapegoat diagnosis leaving serious underlying medical conditions overlooked and disregarded. For this reason, it is increasingly important to empower patients with some of the differentiations that separate migraines from other kinds of headaches, as well as the warning signs to look for that may indicate underlying medical conditions.
Red flags that may point to underlying serious medical conditions include, but are not limited to: new onset headaches in mid or late life, progressive worsening in frequency or intensity of chronic headaches, history of being awakened by headaches, headaches that are aggravated by cough, sexual activity, exercise or changing positions, headaches that are associated with weakness, numbness, blurring, loss of vision, alteration or loss of consciousness, headaches that are associated with fever, neck stiffness, or mental status changes. Further red flags include headaches associated with a history of a recent head trauma or fall, drug abuse or HIV risk factors or that are associated with alteration or loss of consciousness with or without history of recent head trauma.
The above noted are just examples of some indications that there may be an underlying condition that needs to be diagnosed and treated beyond the migraine-like presentation. For example, an infection in the brain or brain coverings could appear as a headache with neck stiffness and fever. Headaches that are caused by coughing may point to underlying brain abnormalities. While, headaches caused by sexual activity might suggest abnormal vessels in the brain or low pressure in the fluid around the brain. Elderly patients who experience headaches that are associated with blurring of vision and diminished visual acuity should be evaluated immediately for a condition that may involve inflammation of blood vessels and may lead to blindness.
Headaches could also be signs of brain tumors.
Some headaches have been related to neck arthritis or disc bulging.
This is not to say that all headaches are indications of underlying conditions. However, it is to say that patients and physicians should work together and take into account the associated symptoms that come with the headache and not use "migraines" as a sweeping diagnosis to explain all head aches. Furthermore, many types of headaches may coexist in the same patient. It is not unusual for patients to have a combination of tension headaches and migraine.
On the other hand, a patient with chronic tension headache and/or migraine may develop any of the above noted medical conditions such as brain bleeding, infection, tumor…..etc. Which is why determining if the patient is suffering from one type or multiple types of headaches is very crucial, and identifying where the headache is coming from is the first step in any successful headache management. The most important step in any headache management is the accurate diagnosis. This is obtained by full and thorough evaluation by a specialist. After establishing the accurate diagnosis, headache management would never be obtained by consuming analgesics and painkillers.
If you are a headache sufferer, you deserve compassionate and competent care that seeks to treat you as a whole person, not just as a patient or a walking headache. This is the kind of care I strive to provide at many locations conveniently located in the Chicagoland area.
Migraine or Not a Migraine: That is the question
As Featured In Glancer Magazine, November 2010