Bearing With a Sore Head

What hurts in your skull - and why

- By Dr Katy Munro

What's the difference between a headache and a migraine?

A headache is a neurological symptom, and the underlying cause needs to be established. A migraine is a genetic, neurological condition often causing headaches, but is also associated with many other symptoms including heightened sensitivity to light, sound, movement, and smells, as well as dizziness, brain fog, abdominal pain, speech difficulties, visual disturbances, nausea, vomiting, fatigue, and irritability. But this list is not exhaustive. Migraine is a spectrum condition, so some people have infrequent, mild attacks, while others have more severe, frequent episodes. Some suffer daily impact from the effects of migraine on their brain.

What happens during a migraine?

During migraine attacks, neurochemicals trigger a wave of electrical depolarization at cell surfaces, known as 'cortical spreading depression, which spreads out over the brain. The effects of neurochemical disturbances may vary from person to person, from attack to attack, and throughout a person's life.

'Aura' is a neurological disturbance during the hour before the headache hits and affects about a third of sufferers. Aura is often visual with zigzag lines, flashing lights, blurred vision, or blind spots. In the next phase, symptoms such as headache, brain fog, and fatigue can occur.

Cognitive problems are common. The vagus nerve, which runs from the brain to the gut, is also affected. This slows down the emptying of the stomach, which can lead to nausea and sometimes vomiting, delays absorption of helpful medications, and may prolong attacks.