11 How is migraine different from a tension headache?
A tension headache has some distinguishing features from migraine. It occurs on both sides of the head, often across the forehead. It is non-pulsating in nature and is not aggravated by routine physical activity. It usually isn’t associated with nausea.
12 What is menstrual migraine?
Migraine may be menstrually related. This is tied to the oestrogen withdrawal that occurs just before menstrual periods. If periods are regular and predictable, patients can take abortive medications regularly for the few days preceding – and the first few days of – menstruation.
13 Are there symptoms that would warrant further investigation?
When you have a chronic daily headache that is possibly chronic migraine, there can be certain “red flags” in your medical history and examination that may suggest an alternative cause for the headache. Sudden onset of headache, headache associated with fever and neck stiffness, headache triggered by cough, exertion or orgasm, and headaches that occur during pregnancy – or just after giving birth – are all factors which will require further investigation.
14 What other tests should be done and when?
An MRI brain scan can’t diagnose migraines,but it can help doctors rule out other medical conditions that may cause your symptoms. Your doctor might send you for an MRI, for example, if your symptoms occur during exercise or if you have a rapid onset of either pain or aura symptoms. In addition, an MRI should be undertaken in patients who are under the age of 10 or over the age of 50 at onset, if there’s a change in the migraine’s frequency or intensity, or if the headache feels different to the typical migraine.
Patients with a prolonged aura, or an aura in the context of starting the oral contraceptive pill should also be sent for a scan. Other symptoms your doctor will look out for in this context can include fever or abnormalities on the physical examination.
15 What if migraine occurs during exercise?
If migraine occurs exclusively during exercise, and this has already been adequately investigated by your doctor, then treating with anti-inflammatory medication (such as indomethacin) before exercise may help eliminate the symptoms.