Migraines typically cause moderate to severe throbbing pain, usually on one side of the head, often accompanied by nausea, vomiting, and sensitivity to light/sound. They may include aura (visual disturbances, tingling) before the headache. Tension headaches usually cause mild to moderate constant pressure or tightness, often described as a band around the head. They rarely cause nausea or sensitivity to stimuli. Migraines are often disabling, while tension headaches usually allow continuation of daily activities. However, some people experience mixed features, making diagnosis challenging without specialist evaluation.

Yes, cervicogenic headaches (headaches originating from the neck) are common. The upper cervical spine shares pain pathways with the head through the trigeminocervical complex. Conditions like osteoarthritis, disc degeneration, whiplash injuries, poor posture, or muscle tension in the neck can refer pain to the head. These headaches typically start in the neck/back of the head and radiate forward, worsen with certain neck movements or positions, and may be accompanied by reduced neck range of motion. Treatment involves addressing the underlying neck disorder through physical therapy, posture correction, medications, or interventional procedures.

Recent advances include: CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) – monthly or quarterly injections that block a key migraine pathway; Gepants (ubrogepant, rimegepant) – oral medications that block CGRP receptors for acute treatment; Ditans (lasmiditan) – acute treatment targeting serotonin receptors without blood vessel constriction; Neuromodulation devices – external devices that stimulate nerves (vagus nerve, supraorbital nerve) for acute or preventive treatment; OnabotulinumtoxinA (Botox) – FDA-approved for chronic migraine prevention. These new options offer alternatives when traditional medications are ineffective or cause side effects.

Medication overuse headaches (rebound headaches) occur when acute headache medications are used too frequently (typically >10-15 days/month for NSAIDs or >10 days/month for triptans/opioids). The brain becomes sensitized, leading to daily or near-daily headaches. Treatment involves: Patient education about the condition; Withdrawal of overused medications (may require inpatient care for opioids/barbiturates); Initiation of preventive medications during/after withdrawal; Non-pharmacological therapies; and Strict limits on future acute medication use (2-3 days/week maximum). With proper treatment, most patients improve within 1-3 months, though withdrawal symptoms can be challenging initially.

Several evidence-based complementary approaches can help: Supplements: Magnesium, riboflavin (B2), coenzyme Q10, feverfew, butterbur (PA-free); Acupuncture: Shown effective for migraine prevention and tension headaches; Biofeedback: Teaches control over physiological responses to stress/pain; Cognitive behavioral therapy: Addresses pain perception and coping; Physical therapy: For cervicogenic headaches and muscle tension; Relaxation techniques: Meditation, progressive muscle relaxation; Lifestyle modifications: Regular sleep, exercise, hydration. While these can be effective, they should complement (not replace) medical evaluation, especially for severe or worsening headaches. Discuss all supplements with your doctor, as they can interact with medications.