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It's hard to tell the difference between a migraine and an ‘ordinary' headache

(HealthDay News) – If you feel like someone has split your head open with an axe, is that kind of pain always associated with a migraine headache?

Physicians often really can't tell you if what you're experiencing is a migraine, bad sinus headache, or a headache brought on by tension or some other factor.

But the doctor should know the difference, a leading expert in diagnosing migraines says. One reason says Dr. Robert Kaniecki, is that sinus headaches are comparatively rare, and tension headaches aren't painful enough to cause a visit to the doctor's office.

What most of those patients actually have are migraines, says Kaniecki, director of the University of Pittsburgh Medical Center's Headache Center and an assistant professor of neurology.

They are misdiagnosed, he contends, because many family doctors -- and even a number of neurologists -- just don't know enough about headache diagnosis. Misdiagnosis leads to treatment that doesn't work and may create problems, he adds.

For example, a sinus headache is supposed to be caused by an infection of the sinuses, and so it is treated by antibiotics and decongestants. However, a study in 2002 showed that only eight of 3,038 people who reported sinus headaches actually had infections, Kaniecki says. The massive doses of antibiotics many received helped create resistant strains of bacteria, he says.

The tension headaches reported by 38 percent of Americans rarely require medical attention, Kaniecki adds.

Both are far different from migraines, which are defined as episodic, disabling headaches that last from four to 72 hours, are one-sided or throbbing and are accompanied by sensitivity to light or noise. In some cases, there can be neck pain or sinus congestion.

Kaniecki says effective treatments that can bring relief from correctly diagnosed migraines include: combinations of ordinary aspirin and other over-the counter painkillers; prescription anti-inflammatory drugs; and triptans (e.g. Imitrex), a family of migraine-specific medications considered to be the most effective on the market.

The National Migraine Study, done in 1999, found that more than 50 percent of migraine patients were misdiagnosed. In that misdiagnosed group, 42 percent were told they had sinus headaches and 32 percent were diagnosed as having tension headaches.

A survey of doctors showed why:

"Only 48 percent of internal medicine physicians and 62 percent of family practice residency graduates report being very prepared to treat headaches," Kaniecki says.

His experience over the past decade leads him to believe that a large number of neurologists are simply overwhelmed by the challenge of diagnosing and treating headaches properly, he adds.

"Good treatment starts with good diagnosis," Kaniecki says, adding that patients and doctors must work together to achieve that. The first step is to determine whether there is a serious physical problem, such as a tumor. That ruled out, the next step is to get detailed information about the frequency and exact type of headaches.

Just over four percent of American adults suffer from chronic headaches, some of them having attacks every day or near-daily.

It's only been in the last decade or so that research has developed a coherent picture of chronic headaches that puts migraine at the center, says Dr. Roger K. Cady, who heads the Headache Care Center in Springfield , Mo. and also acts as a spokesman for the American Headache Society.

It's a picture of the chronic headache as "a consequence of what goes on in the brain, and all of these differing diagnoses are facets of the underlying condition," says Cady, director of the Headache Care Center in Springfield , Mo.

Even specialists are still adjusting to "this huge change in the understanding of migraine," he adds.

Most family doctors, who see relatively few chronic headache patients, have understandingly had "a hard time in catching up" with this advance, Cady says, but he notes the situation is improving.

On the Web

A volume of information about headaches is offered by the National Institute of Neurological Disorders and Stroke.

SOURCES: Robert Kaniecki, M.D., assistant professor, neurology and director, Headache Center , University of Pittsburgh Medical Center; Roger K. Cady, M.D., director, Headache Care Center , Springfield , Mo. ; Journal of the American Medical Association, March 19, 2003
Author: Ed Edelson, HealthDay Reporter
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