Headache Headache Basics

It's Not All in Your Head: Difficulty Diagnosing Headache

Medically Reviewed On: September 18, 2003

By Christine Haran

There's probably not a person on the planet who hasn't had at least one headache in their lifetime. In most cases, a headache is a minor and passing problem, but more than 45 million Americans have recurring headaches and 28 million have migraines. Such headaches cost the US economy billions of dollars each year because they routinely keep people home from work, sending them instead off to their doctors and pharmacies.

But are people needlessly suffering from their headache disorders? Some experts argue that recurrent debilitating headaches are often due to inadequate diagnosis and treatment, and even overuse of medications taken to relieve headache.

"The real gap is between the treatment that is available and the treatment that is delivered," says Dr. Richard B. Lipton, professor and vice chair of neurology at Albert Einstein College of Medicine in Bronx, New York.

For people who are diagnosed properly, there are usually a number of behavioral and drug treatment options. Below, Dr. Lipton reviews different headaches types, and factors that can contribute to misdiagnosis.

What types of headaches usually bring people to the doctor?
The two most common types of headache that bring people to the doctor are migraine and tension-type headaches. Migraine affects 12 percent of the population and episodic tension-type headaches affect 40 percent of the population. The most common headache type that brings people to the headache specialist is called chronic daily headache.

Both migraine and tension headaches usually occur once or twice a week, once a month, and they may occur only once a year. Chronic daily headaches occur 15 or more days per month, and a full 5 percent of the US population has headaches more days than not.

What characterizes migraine headaches?
Migraine headaches are characterized by pain and associated symptoms. The pain of migraine is typically on one side of the head. It's typically throbbing or pulsating. It's typically moderate or severe, and very often people report that routine physical activity makes the pain worse. So climbing stairs, bending over, coughing and sneezing can all make the pain worse.

The pain of migraine is always associated with some other feature. Most commonly it's associated with nausea or vomiting, or unusual sensitivity to light and heightened sensitivity to sound. Sometimes it's associated with something called aura, which is a visual display that consists of graying out of vision or spots, seeing spots, lines and heat waves, often beginning just on one side of the visual field, and then expanding to encompass a greater and greater area.

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