Major shift in Migraine Thought? (part 2)

Last time we were talking about a major shift in migraine thought which may come as a surprise to many people.  The shift is this – instead of thinking that most people get "normal" headaches, and a few get migraine attacks, a growing number of experts are suggesting that most headaches are actually from migraine, and that most people with chronic headaches in particular are actually migraineurs.  (read Major shift in Migraine Thought? (part 1)

A shift in Migraine thought?

There are a number of reasons this shift has come about.  First, new research has shown that your basic "tension headache" is not usually based on muscle tension at all, but is actually something much more complex.  Next, a growing understanding of migraine and the mechanism of the migraine chain reaction.  And, of course, recent studies have suggested that most people who think they have a sinus headache also have migraine.

Finally, simply a clinical discovery.  Many people were walking into the doctor’s office because they were getting severe migraine attacks, but they also had nondescript, basic headaches.  When they started being treated for the migraine attacks, they were surprised (and in many cases the doctor no doubt was too!) to discover that the other headaches vanished as well!

So many are coming to the conclusion that both are coming from the same source, and have the same cause.

Of course, you could still say that most headaches are tension-type headaches, but you need to realize that this is a description of what the headache is like, and perhaps how it’s generally treated.  Once again, we don’t have a definitive answer when it comes to what actually causes these headaches any more than what causes migraine – and it may be the same thing in both cases.

Why does this shift matter?

So what does this mean to those of us here on the ground?  Here are some thoughts, and maybe you’d like to add your own in the comments as well:

  • This is an important reminder not to ignore those "other" headaches.  Many people are just concerned about that migraine attack, which may be rare, and so they just put up with more frequent headaches that are actually diminishing their quality of life quite a bit.  They may seem insignificant next to a blazing migraine attack, but they do add up.  You may be able to get treatment for them if you only pay attention and find a doctor that will pay attention as well.
  • Equally important, I think that this shift could really help many, many people who have been stuck with chronic headaches but have not been getting what could be successful treatment because they don’t have "typical" migraine symptoms.  If you’ve spent any time reading this site, you know that migraine symptoms are not so typical.  Even some doctors think you need to be screaming in agony before you’re really having a migraine attack.  The truth is that many people suffer for years, lose jobs and have strained relationships due to so-called "lesser" headaches.  Treatment is available!  Maybe we just need to change the way we think about it.
  • On the research side, this could really open our eyes to new possibilities.  It could give added momentum to migraine research as people begin to realize just how widespread the problem really is.
  • Finally, it could help in one specific area of research – the research that helps us understand why people’s symptoms are so different.  If migraine really is so widespread, why is it that it leaves one person bedridden, unable even to drink a sip of water, while for another person there’s just a nagging headache?  Why is one person dizzy, and another has stomach pain?  Are there truly similar but distinct diseases here, or is it the same disease that shows itself in different ways?  It’s very likely that migraine is something that almost everyone experiences as a "natural" response, but that it gets out of control with some people – but why?  And could those differences lead to better treatment for certain types of migraine?  I think this will be a key to solving the migraine problem.

What do you think?  Is this a good development?  How could it help, or what are the dangers?  Share your thoughts!

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8 comments… add one
  • Btesy Jun 15, 2009

    It’s certainly all food for thought — and it’s never a bad thing to consider anything from another perspective. Interesting, because a lot of people describe their tension-type headaches as starting in their neck and shoulders, but I hear many migraineurs describing their migraines as starting the same way!

    Maybe it’s all just more evidence of how desperately we need additional research and understanding of migraine disease and headache disorders for the millions and millions of people affected!

  • Sandy Jun 18, 2009

    Very interesting information. I used to get terrible migraines but the symptoms varied from attack to attack. It was always very puzzling. I did notice that the neck tension came on after the initial gut symptoms started. I read somewhere that the chemicals released as a result of a reaction to food in the gut caused the neck and shoulder tension. After doing a lot of work on myself through detox and nutrition the migraines just vanished.

  • Heidi Gunderson Jun 22, 2009

    I am so glad that the medical profession is starting to look at migraine in this way. It helps doctors see us as individuals and gives them more options for treatment. I love your blog. You are helping open migraine sufferer’s eyes to the fact that grouping headaches into one category helps doctors treat us better, not worse. Some migraine sufferers have been afraid they won’t find out what “type” of migraines they have, when the better option is to find the best way to treat their personal overall migraine disease. I’m pretty sure Dr. David Buchholz from Johns Hopkins led the thinking in that direction with his book “Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain.” It is a great read for anyone with headaches. Thanks again for your wonderful blog entry. I enjoyed reading it.

  • James Jun 23, 2009

    Thanks for your comments.

    No, this thinking came long before Dr Buchholz’s book. In some ways, it’s a return to the past – we’ve gotten very specific in our categories, and now we’re realizing the relationships between the many different diseases.

    But I don’t think this is the end of “different types of headache and migraine”. The categories are still useful, and we still may find many different diseases here, even if they end up being related. The categories are helping us find shortcuts to better treatment, because people with certain symptoms tend to do better with certain types of treatment.

  • Heidi Gunderson Jun 23, 2009

    Okay. Thanks for your reply. I don’t think I was completely clear. I’m not sure doing completely away with the different types is the answer either, and that’s not really what I meant. I don’t know. I’m not a doctor. And I’m not sure, after reading Dr. Buchholz’s book, if that’s what he meant either. I don’t mean to put words in anybody’s mouth. I just think everyone should be treated as an individual. It seems like grouping them into different types may have been too much of a problem for awhile. Someone may have symptoms from several different types of migraine, so that person’s personal migraine progression needs to be looked at on an individual basis instead of as a type of migraine. That’s all I meant. I’m sorry if the way I worded it was confusing. Thanks for your answer. I appreciate your thoughts.

  • DJ Jun 24, 2009

    Good article. The biggest problem with getting migraine or headache treatment is a doctor not believing in it which is pretty endemic in Australia. The article itself says “The truth is that many people suffer for years, lose jobs and have strained relationships due to so-called “lesser” headaches.” which is only one justifiable reason out of many why affected patients should get a much better deal from their doctors.

    Anyhow hints on how to successfully approach and convince doctors that migraine/headache treatment is necessary would be great.

  • James Jun 24, 2009

    Heidi – sorry, that wasn’t meant as a refutation of something terrible you said! I agree with you – I was just adding some balance and further thoughts to the discussion. Don’t worry! 🙂

    DJ, thanks for your further thoughts. It is disappointing to hear that so many people have bad experiences with doctors. We’re going to talk more about this next week. We did talk a little about how to approach your doctor in this issue of Headway.

  • jeisea Sep 14, 2009

    Hi James
    Informative, interesting article. All the more evidence for considering prevention of headache rather than dealing with the consequences. There are various preventative measures. Some neurologists specialize in this area. One of my specialists pointed me to the research about B2 (Riboflavin) as a prevention. It works for me and at less than the dose suggested in research.

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