Major shift in Migraine Thought? (part 1)

There seems to be a major shift taking place in the medical world when it comes to migraine.  It’s actually been going on for many years, and it will probably continue for many years to come, but many people are still unaware of it.

At the heart of the shift is the question of just how widespread migraine is.  It’s not going to come as a shock that this is confusing to many people.  Some people still think of migraine as a bad headache.  Others don’t realize that it’s possible to have a mild migraine attack.  Others are still confused about basic terms, like cluster headache, migraine, sinus headache, and so on.

The "Common" Headache?

Before we talk any more about migraine, probably the best thing to do is go back and talk about the common headache.  Most people generally think of the most common type of headache as the tension headache (now more properly called the tension-type headache).

It might surprise you to know that we actually know very little about what a tension-type headache really is.

Wait a minute now – you just get tense, stressed, muscles get tense for one reason or another – you get a headache.  What can be simpler than that?

It seemed that simple, until researchers actually started to investigate the actual muscle tension in the so-called tension headache.  The surprise result was that a lot of people were getting the headache without any muscle tension at all!

Hence the name change.

Is it psychological?  Well, some psychological factors seem to influence some headaches, but there have been no consistent findings that show that the common headache is due to psychological factors.  In other words, people with fewer anxiety or mood problems do not get fewer headaches.

So in the end, we know even less about tension-type headache (TTH) than migraine!  And just like migraine, we don’t know what causes TTH.

So, could TTH be connected somehow to migraine?  Currently we’re usually looking at symptoms and ruling out other causes before we put a headache and other symptoms into a category of migraine or TTH.  But what if many of the migraine attacks and TTH attacks actually had the same root cause?

What if the common headache was actually migraine?

A shift of thought

Many specialists are becoming convinced that most of the headaches out there are actually coming from migraine.  And this changing opinion is showing up in popular literature about migraine.  Take for example:

I was taught – as most doctors were taught, and still believe – that tension headache accounts for the vast majority of chronic headaches … Migraine, not muscle contraction, is what causes headache ascribed to tension.  These mild-to-moderate, nonspecific headaches stem from low-level activation of the mechanism of migraine … it arises from a single mechanism, but since the degree of activation fluctuates, it is expressed to varying extents and in many different ways.

Dr. David Buchholz, Heal Your Headache

While it is true that an unlucky few have common migraine as well as hypnic headache, or both hemicrania continua and cluster headaches, such cases are extremely rare.  What most of us construe as "different headaches" are actually different presentations of one headache type, and that is usually migraine … The overwhelming majority of headache patients have one kind of headache and, usually, that is migraine.  Migraine is by far the most common kind of headache.

Dr. Robert Cowan, The Keeler Migraine Method

This shift in thought has huge implications for research, treatment … and for you.  And we’ll talk more about that in part 2.