Doctor Elena Riva Amarante, director of the Headaches and Facial Pain Unit at Hospital Ruber Internacional in Madrid, emphasizes the importance of the patient explaining in detail their migraine episodes in order to be able to differentiate them from other types of headache.
As she specifies, "the diagnosis is based fundamentally on the symptoms that the patient describes to us," so "it is important to know how the pain appears, how long it lasts, what symptoms accompany it, and to what extent it limits their activities," and she recalls that "tension-type headache is the most frequent in the general population, while migraine is the one that generates greater disability and motivates more visits to neurologists".
Along these lines, Riva Amarante warns that "although it is often related to stress, fatigue, or lack of sleep, not all headaches are the same nor do they require the same treatment." "In fact, there are more than 200 types of headaches, among which tension-type headache and migraine stand out—two disorders with very different characteristics and impact," she has stated.
The specialist recalls that "migraine is a neurological disease, not a simple headache" and points out that "it can significantly affect family, social, and work life, especially when attacks are frequent or disabling." It is estimated that this condition affects approximately 12 percent of the population, with greater presence between the ages of 20 and 50.
Riva Amarante emphasizes that the disease is more common in women, who account for around 80 percent of those affected. To differentiate it from tension-type headache, she describes that the latter is usually felt as a pressure that surrounds the head, similar to wearing a helmet or a tight band, with a mild or moderate intensity that, in general, allows one to continue with everyday tasks.
Pain lasting between four and 72 hours and associated symptoms
By contrast, migraine manifests with episodes of moderate or severe pain that can last between four and 72 hours if treatments are not administered. Usually the pain is throbbing, affects one side of the head, worsens with physical activity, and may be accompanied by nausea, vomiting, and marked sensitivity to light and noise.
The neurologist indicates that "approximately, one out of every four people with migraine presents, in some attacks, transient neurological symptoms known as aura, which can include light flashes or other visual disturbances before the pain begins," and stresses that there are warning signs that require immediate medical attention, such as sudden and very intense pain, the appearance of problems speaking, loss of strength, confusion or seizures, in addition to fever and neck stiffness.
In her opinion, "when the pains repeat several times a month, stop responding to usual treatments or interfere with daily life, it is important to consult with a specialist." "We should not wait for the problem to become disabling," she has added, emphasizing that "it continues to be an underdiagnosed disease."
Regarding the therapeutic approach, she explains that currently, healthy lifestyle measures, drugs to stop the attacks, and preventive treatments aimed at reducing the frequency and intensity of the attacks are combined. "One of the fundamental aspects is to treat the attack from the beginning," because "delaying medication out of fear of taking too many painkillers can make it harder to control pain and cause the patient to need more doses," she has noted.
In people with frequent or very disabling attacks, preventive therapies contribute to better migraine control. In any case, she insists that "what matters is to individualize the approach and find the option most suitable for each patient," and recommends keeping a headache diary to note the frequency of episodes, their intensity, and the circumstances in which they are triggered.