Precipitating and aggravating factors of migraine versus tension-type headache

Objective.-We conducted the present study to determine whether there are headache precipitating and aggravating factors that differentiate migraine from tension-type headache and headache precipitating and aggravating factors that differentiate tension-type headache from migraine. Methods.-We interviewed 38 patients with migraine and 17 patients with tension-type headache (diagnosed using International Headache Society criteria) by telephone, using a questionnaire. The questionnaire inquired about the following precipitating and aggravating headache factors: (1) physical activity, (2) straining, (3) bending over, (4) stress/tension, (5) coughing/sneezing, (6) fatigue, (7) reading, (8) driving, (9) lack of sleep, (10) specific foods/drinks, (11) alcohol, (12) not eating on time, (13) smoke, (14) smell, (15) light, (16) noise, (17) menstruation, and (18) weather. Results.-The most common precipitating factors acknowledged by both groups of patients were stress/tension, not eating on time, fatigue, and lack of sleep, Weather, smell, smoke, and light were the precipitating factors that differentiated migraine from tension-type headache. Excluding those factors that are part of the International Headache Society migraine diagnosis, the aggravating factors were straining, bending over, and smell, We found no precipitating or aggravating factors differentiating tension-type headache from migraine. Conclusion.-Apparently there are precipitating and aggravating factors differentiating migraine from tension-type headache but not vice versa. It is interesting that three of the migraine-specific precipitating factors tie, weather, smell, and smoke) involve the nose/sinus system, suggesting a greater significance of this system in headache than is generally considered.