Different Types of Headaches: Is It Migraine?

Migraine?

Hello, Dr.
Lin.
Over the past two days, I've experienced two types of headaches.
On the first day, I had a throbbing pain on both sides of my temples and surrounding areas that lasted all day, which only subsided in the evening after taking over-the-counter acetaminophen.
On the second day, I noticed a small area on the upper left side near my forehead that was painful, approximately 2x2 cm in size.
There was no external injury, and I don't recall any trauma (no swelling), but pressing on that area is painful.
This pain started around noon.
Neither type of pain is unbearable.
Could this be a migraine or something else?

Zhou, 10~19 year old female. Ask Date: 2009/05/01

Dr. Lin Zijing reply Neurology

Migraine is a type of recurrent headache caused by changes in neurotransmitters in the brain, with each episode lasting from four to seventy-two hours.
The characteristics of the headache include unilateral pain, which can be throbbing or pulsating, often accompanied by a heartbeat sensation.
Severe pain may lead to nausea and vomiting, as well as sensitivity to light and sound.
Additionally, activities such as moving around, climbing stairs, or shaking the head can exacerbate the headache.

Tension-type headache is caused by excessive contraction of the muscles covering the skull, resulting in a sensation as if the head is being tightly banded or pressed down, leading to persistent pain.
This type of headache is often triggered by mental or physical stress or prolonged poor posture.
Tenderness is more likely to be found when pressing on the head muscles, and nausea and vomiting are less common.

Your condition appears to be more consistent with tension-type headache.
It is recommended to engage in regular exercise, relieve physical or mental stress, promote relaxation, and avoid maintaining the same posture for extended periods to help alleviate the headache.

Reply Date: 2009/05/01

More Info

Based on your description, it seems you are experiencing two distinct types of headaches, which may indicate different underlying causes. The first headache, characterized by a throbbing pain around the temples that lasted throughout the day and was relieved by over-the-counter medication (like Tylenol), could be indicative of a tension-type headache or possibly a mild migraine. Tension-type headaches are often described as a tight band around the head and can be triggered by stress, fatigue, or muscle tension. They typically do not present with additional symptoms such as nausea or sensitivity to light, which are more common in migraines.

The second headache, which you described as a localized pain in a small area near the forehead that is tender to touch, raises some different considerations. This could potentially be a tension headache as well, but the localized nature of the pain might suggest a different issue, such as a muscle strain or even a trigger point in the muscles of the scalp or neck. It is also possible that this could be a form of a cluster headache, although cluster headaches usually present with more severe, unilateral pain and are often accompanied by autonomic symptoms like tearing or nasal congestion.

To differentiate between these types of headaches, consider the following characteristics:
1. Migraine: Typically unilateral (one-sided), pulsating in nature, moderate to severe intensity, and often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines can also have an aura, which includes visual disturbances or other neurological symptoms before the headache begins.

2. Tension-Type Headache: Usually bilateral (both sides), described as a pressing or tightening sensation, mild to moderate intensity, and does not usually include nausea or vomiting. It can be triggered by stress, anxiety, or poor posture.

3. Cluster Headache: Severe, unilateral pain often around the eye, occurring in clusters or cycles, and associated with autonomic symptoms like nasal congestion or eye tearing.

Given your symptoms, it would be beneficial to keep a headache diary to track the frequency, duration, intensity, and any associated symptoms of your headaches. This information can be invaluable for your healthcare provider in making a diagnosis.

As for treatment, since you found relief with over-the-counter medication, it may be effective for managing your current symptoms. However, if your headaches persist or worsen, or if you experience new symptoms (such as visual disturbances, significant changes in headache patterns, or neurological symptoms), it would be prudent to consult a healthcare professional. They may recommend imaging studies like a CT or MRI to rule out any serious underlying conditions, especially if there are concerning features in your headache pattern.

In summary, while your symptoms could suggest either tension-type headaches or migraines, the localized pain near the forehead may warrant further investigation. It is essential to discuss your symptoms with a healthcare provider who can provide a thorough evaluation and appropriate management tailored to your specific situation.

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