[Headache] Headache and Migraine: Symptoms to recognize them

[Headache] Headache and Migraine: Symptoms to recognize them

  • Introduction
  • Classification of headaches
  • Migraine
  • Tension headache (or tension muscle)
  • Cluster headache
  • Secondary headaches
  • Other headaches
  • Headache and nausea

Sources and bibliography


According to the World Health Organization,  almost 50% of the population has suffered from at least one episode of headaches in the last year and the majority, while taking medications to find relief from symptoms, never went to a doctor even in case of repeated episodes.

So let’s start by defining headache , which is a disease that manifests itself mainly as head pain; again according to the WHO, migraine is among the top 20 health problems that can significantly worsen the quality of life, due to its invalidating characteristics.

To effectively treat a headache, a specific diagnosis of the type is indispensable in order to intervene correctly with drugs or other targeted therapeutic approaches.

[Headache] Headache and Migraine: Symptoms to recognize them

Classification of headaches

The classification made by the International Headache Society is currently considered the official reference to distinguish the different types of headache and migraine, classified on the basis of symptoms.

First of all, they stand out

  • primary headaches (without specific factors, causes or diseases that may have caused headaches)
  • secondary headaches (following a specific cause which, if removed, would cause the pain to cease; for example, a decayed tooth, a tumor, )

Among the primary headaches we distinguish then:

  1. migraine,
  2. muscle-tension headache
  3. Cluster headache
  4. other headaches


Tension headache

Cluster headache






Female: Male

3: 1

2: 1

1: 4








One-sided on the eye






4-72 hours

30 minutes-7 days

15-180 minutes




Recurrence in cluster periods, attacks are concentrated in certain hours of the day or night.

Aggravation with routine activities




Other symptoms

Worsening from light and / or noise, nausea and / or vomiting

Worsening from light or noise, mild nausea in the chronic form

Tearing, pupil size, nasal congestion and runny nose


Th migraine is a recurrent disorder whose duration is generally comprised in a range between 4 and 72 hours (3 days); it is more common in women and generally begins to manifest itself in young adulthood.

The symptoms of migraine are:

  • pain on one side, which worsens with normal physical activity associated with daily movements,
  • pain is throbbing,
  • nausea and/or vomiting,
  • nuisance induced by sound or light.

The diagnosis of migraine is made on the basis of 5 criteria that must all be met:

Unless treatment occurs, the duration of the illness should be between 4 and 72 hours.

It has at least 2 of the following characteristics:

  • Presence on only one side of the head (migraine means half-skull),
  • throbbing pain,
  • moderate to severe intensity,
  • worsening with normal routine activities (bending over, climbing stairs, making small efforts, etc.)
  • Presence of nausea / vomiting or noise / light disturbance,
  1. The symptoms cannot be traced back to other diseases,
  2. At least 5 attacks characterized by criteria 1 and 3 must have been experienced.

There are some symptoms that can herald the imminent arrival of a migraine attack, namely:

  • Exciting symptoms
  • irritability,
  • hyperactivity,
  • insomnia,
  • euphoria,
  • yawning,
  • thirst
  • Inhibitory symptoms
  • fatigue,
  • tiredness,
  • weakness,
  • depression,
  • difficulty concentrating.

The factors that could trigger the attack vary between different subjects, but the most common are:

  • Environmental factors:
    • wind,
    • excessive temperatures (hot or cold),
    • changes in the weather,
    • rain,
    • change of season,
    • altitude,
    • sun exposure,
    • noises,
    • intense smells,
    • cigarette smoke.

Farm food:

  • alcohol,
  • sausages,
  • pretreated meat (hot dog headache),
  • peppers,
  • canned meats, sauces and soups,
  • chips,
  • condiments and spices (Chinese restaurant headache)
  • aged cheeses,
  • liver,
  • yogurt,
  • figs,
  • bananas,
  • citrus fruits, vinegar,
  • the,
  • coffee,
  • caffeinated drinks ,
  • aspartame.

Emotional factors:

  • emotions,
  • stress,
  • relaxation after a tiring period (often called “adrenaline rush“).

Hormonal factors:

  • menstruation,
  • ovulation,
  • birth control pills.


  • nitroglycerine
  • reserpine,
  • fenfluramine,
  • estrogen (such as birth control pills).


  • insomnia,
  • excess rest,
  • hypoglycaemia,
  • physical fatigue,
  • fever,
  • do you travel,
  • changes in meal intake (delay or skip a meal for example).

The knowledge of these risk factors, combined with one’s past experience, are an excellent tool for preventing new migraine attacks.

Tension headache (or tension muscle)

The tension-type headache is undoubtedly the form of sore most common and widespread head and can be in the form episodic or chronic; in the past it was referred to as muscle tension, but today it is preferred to avoid this terminology.

The attacks can last from a few minutes to several days and the pain is described as gravitational-constricting, of mild or moderate intensity, localized on both sides of the head and distributing itself as a band or as a helmet.

It is quite simple to distinguish tension headache from migraine because in this case

  • Physical activity does not worsen the symptoms ,
  • nausea and/or vomiting are rarely present, and only mildly.

The factors that can trigger the attack are:

  • stress,
  • depression,
  • anxiety,
  • drug abuse,
  • wrong postures,

This form of headache can also be classified according to the frequency of appearance,

  • a total of about 12 days a year is considered infrequent,
  • is considered frequent if it affects between 12 and 179 days a year,
  • it is considered chronic if it affects for at least 180 days a year.

The diagnostic criteria for the correct detection of episodic tension headache include:

  • Headache lasts from 30 minutes to 7 days,
  • Pain has at least 2 of the following characteristics:
  • bilateral (both sides of the head),
  • not pulsating, but gravative-constructive,
  • mild or medium intensity (does not prevent normal daily activities),
  • it is not worsened by routine physical activity (climbing stairs, walking, moving, …)
  • Nausea and vomiting are absent and possibly the symptoms worsened only by noise or light.
  • There are no other diseases that can cause the headache.
  • Instead, chronic tension headache requires that:

Be present for more than 15 days per month for at least 3 months,

  • It should last at least several hours,
  • Pain has at least 2 of the following characteristics:
  • bilateral,
  • not pulsating, but gravative-constructive,
  • mild or medium intensity (does not prevent normal daily activities),
  • it is not worsened by routine physical activity (climbing stairs, walking, moving, …)
  • Severe nausea and vomiting are absent and possibly the symptoms worsened only by noise or light.
  • There are no other diseases that can cause the headache.

In the case of patients affected by chronic forms, a drastic deterioration in the quality of life is observed, as well as a significant consumption of analgesics.

Chronic headache

Chronic tension headache is diagnosed when the headache is almost daily, although perhaps with a mild or moderate intensity but still capable of interfering with the life of the affected patient; it is often linked to an underlying depression, which must be resolved in order to limit attacks.

Often this type of headache also takes the name of drug abuse headache , as it is caused by the continuous intake of painkillers to find pain relief; by their very nature these forms are rather difficult to treat and require the intervention of an anti-headache center.

Cluster headache

It is a form of headache that mainly affects the male sex (from 70% to 90% of cases) and occurs both in episodic and chronic form: the name derives from the observation that attacks occur in active periods (clusters) alternating with periods without headaches. On the basis of these periods we distinguish episodic cluster headache (attacks concentrated in long periods between 7 days and 1 year, with pause periods of at least 14 days) and chronic cluster headache (periods of at least 1 year or with lower suspensions to 14 days).

An attack is characterized by the following symptoms:

  • severe pain,
  • which appears very quickly,
  • and which lasts from 15 minutes to 3 hours,
  • but often several times a day; in active periods 1 to 3 attacks can be counted per day, often at night.
  • Pain is concentrated on one side of the head, usually around the eye,
  • tearing,
  • nasal congestion and runny nose,
  • shrinkage of the pupils ( miosis),
  • increased sweating in the face.

The patient suffering from cluster headache shows restlessness and inability to sit still; in some cases the attack can be triggered by external factors such as alcohol, stress or stressful events, sleep, etc.

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