Not all severe headaches are migraines and not all migraines are severe headaches. In fact, tension-type headaches are much more common than migraine. Nevertheless, migraine certainly is not rare. In fact, it affects 18% of all women and 6% of all men. It is estimated that the loss of productivity caused by migraine is $13 billion annually!

In order to be classified as migraine, a headache syndrome must fulfill certain diagnostic criteria established by the International Headache Society (IHS). Generally speaking, there are two varieties of migraine headache: migraine without aura and migraine with aura. An aura is a neurological symptom that occurs in association with a migraine headache. Examples of auras include changes in vision, numbness, tingling sensations, weakness, and, rarely, difficulty speaking. It is possible for both headaches varieties to occur in the same patient. The vast majority of migraine headaches, however, are migraines without aura.

Criteria for the diagnosis of migraine without aura include the following:

A. At least five headache attacks.
B. Each headache attack lasts from 4-72 hours.
C. Each headache has at least two of the following four characteristics:

1. The pain is on one side of the head.
2. The pain is pulsating or throbbing in quality.
3. The pain is severe enough to interfere with daily activities.
4. The pain is aggravated by physical activity (ie, walking up stairs).

D. During the headache, at least on of the following two symptoms is present:

1. Nausea and/or vomiting.
2. Bright light or loud sounds makes the headache worse.

E. The headaches are not secondary to specific brain problem such as a stroke or a brain tumor.

Criteria for the diagnosis of migraine with aura include the following:

A. At least two headache attacks.
B. Each headache has at least three of the following four characteristics:

1. One or more fully reversible aura symptoms.
2. At least one aura symptom occurs gradually over more than four minutes, or two or more symptoms occur in succession.
3. No single aura symptom lasts for more than 60 minutes.
4. Headache follows aura within 60 minutes. Note, however, that the headache also may begin before or simultaneously with the aura.

C. The headaches are not secondary to specific brain problem such as a stroke or a brain tumor.