Headache & Migraine: An Introduction

Headache is one of the most common symptoms encountered in clinical practice, but it is not a single condition. It may represent a primary headache disorder, such as migraine or tension-type headache, or occur secondary to another medical, neurological, vascular, musculoskeletal or systemic problem.

Migraine is a complex neurological disorder that can affect sensory processing, cognition, balance, digestion and energy as well as producing head pain. Symptoms vary considerably between individuals and may also change at different stages of life.

At The Health Equation, we recognise that persistent headache and migraine are often multifactorial. Careful assessment is therefore needed to establish the most likely diagnosis, identify any need for further medical investigation and understand the factors influencing each patient’s symptom pattern.

The Range of Headache Presentations

Patients may attend with an established diagnosis or with symptoms that have not yet been clearly classified. Presentations commonly assessed include:

  • Migraine with or without aura
  • Chronic migraine
  • Tension-type headache
  • Cluster headache and related trigeminal autonomic headache disorders
  • Cervicogenic headache associated with dysfunction of the neck
  • New daily persistent headache
  • Primary stabbing, exertional or sexual-activity headache
  • Medication-overuse headache
  • Headache associated with hormonal change, sleep disruption or systemic illness
  • Facial, jaw or cranial pain that may overlap with headache symptoms
  • Headache potentially secondary to another medical condition

These terms describe recognised symptom patterns, but similar symptoms may occur in more than one disorder. Some patients also experience overlapping headache types. A diagnostic label should therefore follow an appropriate clinical assessment rather than being based on one symptom alone.

Diagnosis, Causes and Contributing Factors

A primary headache disorder is not necessarily caused by an external problem. Migraine, for example, is a neurological condition in its own right. However, the threshold for an attack may be influenced by a combination of internal and external factors.

These may include:

  • Sleep disruption or altered daily routines
  • Hormonal change
  • Stress and emotional load
  • Dehydration, missed meals or alcohol
  • Medication use or withdrawal
  • Neck, jaw or musculoskeletal dysfunction
  • Respiratory and breathing-pattern disturbance
  • Visual strain, sensory overload or environmental triggers
  • Other medical or metabolic factors

It is important to distinguish between an underlying headache disorder, a factor that increases susceptibility and a trigger associated with an individual attack. Treatment is therefore directed not only towards symptom relief, but also towards reducing the frequency, severity and wider impact of episodes wherever possible.

Migraine Is a Neurological Disorder

Migraine is not simply a severe headache. It is a recurrent neurological disorder involving altered sensory processing and changes within several brain networks. Head pain is common, but some people experience aura, dizziness, nausea or other neurological symptoms with little or no headache.

Migraine affects approximately 14–15% of the global population and is two to three times more common in women than in men. Hormonal influences are important for many patients, but migraine can affect people of any sex and at almost any age.

The condition varies considerably between individuals. Attacks may be occasional or frequent, predictable or apparently spontaneous. In some patients, episodic migraine can become chronic, particularly when several biological, medical and lifestyle factors overlap.

These figures are consistent with current World Health Organization information on migraine and headache disorders.

The Phases and Symptoms of Migraine

A migraine attack may involve several phases, although not everyone experiences every phase and the order can vary.

Prodrome

Hours or occasionally days before the main attack, some people notice:

  • Fatigue or altered energy
  • Difficulty concentrating
  • Mood change or irritability
  • Neck stiffness
  • Food cravings
  • Increased yawning
  • Sensitivity to light, sound or smell

Aura

Around one-third of people with migraine experience aura. This usually involves temporary visual symptoms, but may also affect sensation, speech or language. Aura typically develops gradually and resolves, but a first or unusual episode requires appropriate medical assessment because similar symptoms can occur in other neurological conditions.

Headache Phase

The pain may be one-sided or bilateral and can be throbbing, pressing or variable in character. It may be accompanied by:

  • Nausea or vomiting
  • Sensitivity to light, sound, smell or movement
  • Dizziness or altered balance
  • Neck and facial discomfort
  • Cognitive slowing or difficulty concentrating

Postdrome

After the principal symptoms settle, fatigue, reduced concentration, muscular sensitivity or a general feeling of being unwell may persist for several hours or longer.

Recognising the full sequence can help patients identify the earliest features of an attack and use appropriate management strategies sooner.

The Wider Impact of Migraine

Migraine can affect much more than the hours in which head pain is present. Frequent or unpredictable attacks may interfere with work, education, exercise, family life, social activity and emotional wellbeing. Some patients also restrict activities between attacks because they fear triggering another episode.

Migraine may coexist with other conditions, including:

  • Anxiety or depression
  • Sleep disorders
  • Fibromyalgia and persistent pain
  • Dizziness or vestibular disorders
  • Postural orthostatic tachycardia syndrome (PoTS)
  • Gastrointestinal and hormonal symptoms

These associations do not necessarily mean that one condition directly causes another, but they may influence clinical assessment and treatment planning.

Frequent use of acute headache medication can also contribute to medication-overuse headache, in which treatment intended to relieve attacks begins to increase headache frequency. This possibility should be considered whenever painkillers, triptans or combination headache medicines are being used regularly.

Our Clinical Perspective

The diagnosis of migraine should be based on the recognised pattern of symptoms while also considering whether another headache disorder or medical condition could better explain the presentation.

At The Health Equation, assessment extends beyond identifying triggers. Using the Integrated Regulatory Systems Framework (IRSF), we consider how respiratory, neural, circulatory, endocrine, immune and inflammatory, metabolic and musculoskeletal factors may influence the patient’s migraine threshold and capacity to recover from attacks.

This approach complements conventional migraine care and may include osteopathic treatment, breathing re-training, nutritional and lifestyle strategies, appropriate investigations and collaboration with medical specialists.

Book a Diagnostic Consultation

All new patients seeking assessment for headache or migraine should book a 60-minute Diagnostic Consultation with Gerry Gajadharsingh DO.

This provides time to review the complete headache history, previous investigations and treatment responses; perform an appropriate clinical examination; and explain the likely diagnosis and recommended management plan.

Patients are encouraged to send relevant medical correspondence, imaging reports and blood-test results before the appointment. A comprehensive written report is included.

Migraine and Associated Conditions

Migraine is associated with a wide range of neurological, sensory, pain, sleep and regulatory conditions. These associations do not mean that every person with migraine will develop them, or that migraine necessarily causes them. However, they help demonstrate why a broad clinical history can be important when symptoms are complex.

The image below, produced by the Association of Migraine Disorders, illustrates some of these recognised associations.

Conditions associated with migraine – Association of Migraine Disorders

Continue Exploring Headache and Migraine

Our supporting pages provide further information about headache and migraine: