Migraines and Headaches

Migraine is a neurological condition, not just a bad headache. An attack usually brings moderate to severe head pain along with nausea and sensitivity to light, sound or smell, and it can last from a few hours to a few days. Tension-type headache, cluster headache and medication-overuse headache are separate conditions with their own patterns, and telling them apart is what shapes the care you are offered.

Migraine and tension-type headache are not the same thing

In migraine, the brain’s pain and sensory processing is temporarily disrupted. That is why an attack so often arrives with nausea and a need for a dark, quiet room, why some people notice warning signs such as yawning, food cravings, neck stiffness or mood changes in the hours beforehand, and why a day of feeling drained and foggy can follow. The World Health Organization ranks migraine as the third highest cause of disability-adjusted life years worldwide.

Tension-type headache feels different: a steady, band-like pressure on both sides of the head, without the nausea and without pain that worsens sharply when you move. Cluster headache is different again. Medication-overuse headache can develop when acute headache treatments are taken on many days each month over a long period, and the World Health Organization describes it as the most common secondary headache disorder, affecting up to 5% of some populations. This is why clinicians pay more attention to the pattern of your headaches over weeks than to how bad any single one was.

Signs and symptoms

• Throbbing or pounding head pain, often on one side, that gets worse with movement
• Nausea, vomiting or loss of appetite during an attack
• Sensitivity to light, sound or smells, so you want a dark quiet room
• Aura before or during an attack in some people, such as flashing lights, zigzag lines, blind spots, or tingling in the face or hand
• Warning signs in the hours or day before, such as yawning, food cravings, neck stiffness or mood changes
• Feeling drained, foggy or washed out for a day afterwards
• Tension-type headache feels different: steady band-like pressure on both sides, without nausea

Attack frequency varies widely, from a few times a year to most days of the month, and the pattern can change over a lifetime, particularly around hormonal changes.

What raises the risk

Some risk factors cannot be changed:

• Family history, since migraine often runs in families
• Being female, which is linked to more than double the reported rate in Canada
• Hormonal changes across the menstrual cycle, pregnancy and menopause
• Age, with prevalence peaking between 30 and 49

Others can often be worked on, usually with support from a health care team:

• Irregular sleep, skipped meals, dehydration and high stress, which are common attack triggers
• Frequent use of acute headache medicines, which is linked to medication-overuse headache
• Untreated depression, anxiety or sleep disorders, which travel with more frequent attacks

How migraine is diagnosed in Canada

Migraine is diagnosed clinically, usually by a family doctor or nurse practitioner, based on the pattern of your attacks rather than a scan or blood test. Your clinician will ask how often headaches happen, how long they last, what the pain is like, what comes with it, and what makes it better or worse. A headache diary, or a questionnaire such as the MIDAS or HIT-6, is often used to track frequency and impact over time. Imaging is generally reserved for people whose headaches have warning features or an unusual pattern, and some people are referred to a neurologist or a headache clinic.

Treatment and day-to-day management

Clinical research for Migraines and Headaches is enrolling. See the current studies ↓

Care usually has two halves: something to take during an attack, and, for people with frequent attacks, something taken regularly to make attacks less frequent. Depending on your pattern and your other health conditions, a health care team may discuss:

• Acute or as-needed treatments taken at the start of an attack, including simple analgesics, anti-inflammatory medicines, triptans and newer targeted acute medicines, with attention to how many days per month they are used
• Preventive medicines taken regularly to lower attack frequency, including certain blood pressure medicines, antidepressants, anticonvulsants, and treatments that target the CGRP pathway
• Procedures and devices, including botulinum toxin injections for chronic migraine, nerve blocks, and neuromodulation devices
• Non-drug approaches, including cognitive behavioural therapy, relaxation and biofeedback, regular sleep and meal routines, physiotherapy for neck-related symptoms, and headache diaries to identify patterns
• Care for conditions that travel with migraine, such as depression, anxiety and insomnia, and a review for medication-overuse headache where acute treatments are being used frequently

Which preventive suits a given person is not predictable in advance, and finding a workable plan often takes more than one attempt. These are decisions for you and your own clinician rather than something this page can settle.

When to talk to a doctor

• Call 911 or go to an emergency department immediately for a thunderclap headache, meaning a sudden severe headache that reaches its worst intensity within about a minute. This can signal bleeding in or around the brain.
• Call 911 for a headache with new weakness or numbness on one side, a drooping face, trouble speaking or understanding, vision loss, confusion or a seizure, or for a headache after a significant head injury.
• Seek urgent care for a headache with fever and a stiff neck or a new rash, for a headache that steadily worsens over days or weeks, for a new headache pattern after age 50, or for a headache that is much worse when you cough, strain or lie down.

Why clinical research matters for migraine

Migraine is common and disabling, yet many people in Canada wait years for a diagnosis, and access to headache specialists and to newer preventive treatments varies by province and by drug plan. Researchers still cannot predict which preventive treatment will work for a given person, and a meaningful share of people do not respond well to the options available. Trials under way include newer CGRP-targeting and other mechanism-specific medicines for both acute treatment and prevention, neuromodulation devices, treatments for cluster headache and medication-overuse headache, digital cognitive behavioural therapy and behavioural programs, and studies in groups that have been under-represented in past research.

Clinical studies are how those questions get settled. Most ask you to keep a headache diary for a period before and during the trial. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. No one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Migraine Canada: education, headache diary, specialist directory and support
• Statistics Canada: prevalence of migraine in the Canadian household population
• Health Canada: Canadian Pain Task Force reports
• Pain BC: pain support line and self-management programs