Tweedle Dee

People with migraine have particular brains that may be prone to develop other types of headaches. Here are a few examples. 

Post-traumatic headache

A person with migraine who has a concussion has more risk of developing persistent headaches. Migraines may also deteriorate after a trauma. In this case, the person could have two diagnoses. 

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Primary stabbing headache or «ice pick headaches»

This is a very common problem, usually benign. The headache is sharp, intense, brief. It comes in flurries and may vary in location. It’s not always easy to differentiate from a neuralgia. 

Cold stimulus evoked headache (ice-cream headache)

This is the intense but short lasting headache some people get when they eat or drink something cold. We believe that a hypersensitivity to cold triggers a painful reaction. 

Tension Type headache

By definition, Tension Type Headache (TTH) has no «migraine features» like nausea and sensory hypersensitivity. People with chronic migraine often have days with TTH. We now think that they are part of the migraine problem, but in Europe there is still a view that they are two different problems. 

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Cluster migraine

This is NOT an official diagnosis but you will see it online and some physicians use it. It often describes a situation where a person has characteristics of both migraine and cluster headache.  The person can have the autonomic symptoms of cluster (droopy eyes, tearing, runny nose), a cyclical aspect of attacks (at the same hour, in bouts of a few weeks) or other traits evoking cluster (fast onset of attack, exquisite alcohol sensitivity, excruciating pain, restlessness). 

Ping Pong Theory situations

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Cervicogenic headache 

The association of neck pain and migraine is extremely common in the clinic and there are many controversies on its definition. Also, many neck problems may be caused by a concussion or whiplash, adding up to the migraine pile. 

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Sinus headaches

This is often a wrong diagnosis in a person with migraine either triggered by sinus irritants or with sinus symptoms. It’s important to treat the migraines and be careful of avoiding antibiotics or steroids unless there is truly a bacterial sinusitis. 

Sleep apnea headaches

Sleep apnea can definitely trigger headaches that may occur in the morning and abate after a few hours. No surprise, people with migraine can deteriorate if sleep apnea is present. 

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Medication-overuse headache

This famous vicious circle happens mostly in people with migraine brains. More headache, more pills, more headache. People who use regular analgesics (acetaminophen, opioids, NSAIDs) for other pains but do not have a history of migraine are less likely to develop a chronic headache. 

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In summary, people with migraine can be prone to other types of headaches, probably because their brains have a low threshold for headache pain. It is not always easy to tear apart the different headache types and to determine a treatment for each. On the other side, addressing a leading factor in a chronic migraine situation may lead to success. 

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