What are the different types of headaches?

Whether it feels like a drill piercing the side of your forehead, or intense pressure right above your eye, the relentless pain of a headache is universally recognizable, no matter the type. There are many types of headaches — all painful — but each is associated with different triggers and attributes. Here, we cover the different types of headaches, their causes and common treatments.

Types of headaches

The third edition of the International Classification of Headache Disorders (ICHD-3) — published in 2018 in the journal Cephalalgia — splits headaches into three main categories, including so-called primary headaches, secondary headaches and “painful cranial neuropathies, other facial pain and other headaches.” The diagnostic manual also includes an appendix of additional headache disorders that, with more scientific backing, could one day be added to the manual’s three main sections.

“In the appendix there are some great examples of the kinds of headache that some doctors acknowledge and other physicians don’t recognize,” Dr. Nina Riggins, the director of the Headache and Traumatic Brain Injury Center at the University of California, San Diego, told Live Science in an email. Among these, one can find super-specific categories like “headache attributed to travel in space,” for instance.

Primary headaches

“Primary headaches” are named as such because the headache itself is the main problem, meaning these headaches do not emerge as a symptom of an underlying medical condition, such as an infection or physical trauma, according to Stanford Health Care. Instead, primary headaches arise from inflammation of the nerves, blood vessels or muscles in the head and neck, which then causes pain. The ICHD-3 classifies migraines, tension-type headaches and trigeminal autonomic cephalalgias (TACs), which include cluster headaches, as types of primary headache. 

Migraines

In the case of migraines, it’s important to note that a “migraine is not just a headache,” Riggins said. “It is a genetic neurological disease, and as multiple brain networks are involved, symptoms usually are not limited to headache alone.” 

For instance, patients with migraines may experience nausea, vomiting, dizziness, physical weakness and sensitivity to light and sound on top of their headaches, she said. The ICHD-3 also differentiates between migraines with and without different types of “aura;” an aura describes transient neurological symptoms that arise before and sometimes during a migraine. Auras can include visual hallucinations, where one sees bright geometrical shapes, spots or flashes, for instance, according to the Mayo Clinic. Auras can also cause physical sensations, such as tingling, numbness or weakness. Sometimes an aura can briefly affect a person’s ability to understand or produce speech.

Some people with migraines experience a “prodromal phase,” which occurs hours or days before a migraine, or a “postdromal phase,” which occurs after the headache resolves, according to the ICHD-3. These phases are often associated with symptoms of much higher or much lower than normal levels of activity, depression, food cravings, repetitive yawning, fatigue and neck stiffness or pain. Migraines typically last between two and 72 hours and often involve throbbing pain on just one side of the head (although not always), according to Stanford Health Care.

Tension-type headaches (TTHs)

Migraines can sometimes occur at the same time as tension-type headaches (TTH), another kind of primary headache; and sometimes, one of these headache types can act as a trigger for the other, and vice versa. TTHs are sometimes called “hatband” headaches because they are associated with a tight, painful pressure around the temples, forehead and back of the head, according to Stanford Health Care. The ICHD-3 categorizes TTHs as “infrequent episodic,” “frequent episodic” or “chronic,” based on their frequency and duration.

Trigeminal autonomic cephalalgias (TACs)

TACs, the third kind of primary headache, include cluster headaches, which cause pain on one side of the head, around the temple, eye or just above the eye, according to the ICHD-3. The headaches last between 15 minutes and three hours and can occur anywhere from once every other day to eight times a day. During TACs, other symptoms often crop up on the same side of the face; for instance, one might develop a stuffy nose, sweaty forehead or teary eye on their headache-side. 

“Attacks occur in series lasting for weeks or months (so-called cluster periods or bouts) separated by remission periods usually lasting months or years,” the manual notes.

TACs also include other headache disorders called paroxysmal hemicranias and hemicranias continua; these are also accompanied by additional symptoms, like tearing eyes and nasal congestion. 

Paroxysmal hemicranias typically arise in adulthood and involve a “throbbing, claw-like or boring pain” on one side of the face, according to the National Institute of Neurological Disorders and Stroke (NINDS). Attacks can occur from five to 40 times per day and last two to 30 minutes each. Individuals may experience these attacks daily or else experience periods of remission between attacks that last months or years. 

Hemicranias continua, on the other hand, is a condition characterized by continuous pain intermixed with occasional bouts of more severe pain, according to NINDS. Most people with hemicranias continua experience pain on just one side of the head, but very rarely, the pain can manifest on both sides. “A headache is considered hemicrania continua if the person has had a one-sided daily or continuous headache of moderate intensity with occasional short, piercing head pain for more than three months without shifting sides or pain-free periods,” the NINDS website states. 

In addition to these three main types of primary headache — migraine, TTHs and TACs — the ICHD-3 lists a few miscellaneous primary headaches, including primary cough, exercise, cold-stimulus and sexual activity headache, which are named for their various triggers. A few other headaches are named for the nature of the pain they cause, such as “thunderclap” and “stabbing” headaches.

Secondary headaches

Unlike primary headaches, secondary headaches arise as a symptom of other diseases or medical conditions, rather than being stand-alone disorders, according to the ICHD-3. For example, secondary headaches can stem from: 

• Trauma or injury to the head and/or neck 
• Vascular disorders that affect the head and/or neck 
• Non-vascular disorders that affect the inside of the head
• Substance use disorders or withdrawal 
• Disorders of homeostasis, such as sleep apnea, lack of oxygen or poor thyroid function 
• Pain attributed to a disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth or mouth 
• Infections  
• Psychiatric disorders

Secondary headaches can be a warning sign for serious medical conditions, such as brain tumors, aneurysms or meningitis, an infection that causes inflammation in the brain, according to Stanford Health Care. 

In the context of psychiatric disorders, on the other hand, “Evidence supporting psychiatric causes of headache remains scarce,” the ICHD-3 states. Because of this, most of the criteria for psychiatric disorder-related headaches are in the manual’s appendix, with the exception of headaches related to psychotic disorders or somatic symptom disorder (SSD), where a person experiences one or more disruptive physical symptoms (like headaches) and then have excessive thoughts or health concerns about those symptoms.

Secondary headaches can resemble primary headache types; in other words, they might be described as resembling a tension-type or migraine headache. To meet the description of a secondary headache, however, a headache must occur for the first time shortly after the onset of another disorder, the ICHD-3 states. In the event that a pre-existing primary headache grows substantially worse due to a new medical condition, like a brain tumor, “both the primary and the secondary headache diagnoses should be given,” the manual states.

Other headache disorders

The third category of headache in the ICHD-3 includes painful cranial neuropathies and other facial pain; neuropathy refers to disease or dysfunction of the peripheral nerves, or nerves that lie outside the brain and spinal cord. 

For example, various cranial nerves belong to the peripheral nervous system and convey pain signals to the brain. These nerves can become damaged due to disease, such as shingles or multiple sclerosis, the ICHD-3 states. Alternatively, the nerves sometimes get compressed by surrounding anatomical structures and cause facial pain in that way, too. 

The precise location and quality of the pain depends on the nerves involved; for instance, damage to the so-called glossopharyngeal nerve is associated with continuous pain in the ear, under the lower jaw, and/or at the back of the throat or tongue. This pain is “commonly described as burning or squeezing, or likened to pins and needles.”

Common headache triggers and treatments

Common triggers for primary headaches include dehydration, medications and changing hormone levels, according to Stanford Health Care. Sometimes, they can be set off by bright or flashing lights; stress; changing sleep patterns; and certains foods, including red wine, chocolate, aged cheeses and substances containing caffeine. In general, alcohol consumption is often a strong trigger for those with cluster headaches during a bout, Riggins noted. 

Riggins said that she recommends that anyone with headaches should discuss them with their primary care physician. Some clinicians specialize in headache medicine, like Riggins, but it’s a fairly small field; most of these specialists are neurologists, but some family physicians also participate in the practice, she said. For primary care physicians looking to learn more about headache care, Riggins and others in the American Healthcare Society have created various online resources that can help. “We are developing content constantly to make sure that any doctor has a toolbox there for headache question they have,” she said.

For patients seeking care for their headaches, it’s helpful if they keep a diary of their headaches and prepare a list of past and current medications, Riggins said. (Check out the Stanford Health Care “Headache Trigger Tracker” and “Headache Diary” pages for examples.)

In addition to assessing your headache triggers and medical history, a doctor might call for various tests to better characterize the headache, according to Stanford Health Care. For example, they might call for an MRI or CT scan; other tests can be used to measure inflammation, produce pictures of blood vessels in the brain and check for bleeding in the brain or signs of an active infection. These tools help doctors determine whether a headache is primary or secondary.

Treatments for headaches include acute treatments, to use “as needed” during a headache, and preventative treatments, to reduce the frequency and intensity of headaches, Riggins said. Some treatments can be used for both purposes, she added. 

Some preventative strategies include lifestyle modifications, to help a person avoid potential headache triggers, Riggins said. In terms of drugs for migraine prevention, doctors can prescribe antidepressant or antiepileptic medications; beta blockers; botox injections; or medications that decrease blood pressure, among others, she said. Some patients benefit from transcranial magnetic stimulation, which stimulates nerve cells in the brain, according to Stanford Health Care.

Acute treatments for migraine include various drugs, like so-called triptans, ditans and gepants, that work by reducing the pain signals sent out by sensory nerves in the body; each class of drug works through a slightly different mechanism. Other acute medications include over-the-counter pain relievers, like naproxen; antihistamine drugs like hydroxyzine; and antiemetics, which help with vomiting and nausea, Riggins said. 

Beyond medication, resting in a quiet, dark room; using hot or cold compresses; and getting a massage can sometimes help relieve migraines, according to Stanford Health Care. 

Physical therapy, muscle relaxants and over-the-counter pain relievers often help those with cluster headaches, Stanford Health Care states. Physical therapy can also help those with a kind of secondary headache called “cervicogenic headaches,” which stem from disorders of the bones, discs or soft tissues of the upper spine, according to the American Migraine Foundation.

Some treatments for cluster headaches include injectable medications, prescription nasal sprays and oxygen therapy, where you breathe in oxygen from a mask, according to Stanford Health Care. Hypnic headaches — a rare primary headache disorder that wakes people up from their sleep — can be treated with lithium and calcium channel blockers, which increase the heart’s supply of blood and oxygen. Melatonin and the anti-inflammatory drug indomethacin are also effective for some people with hypnic headaches, the American Migraine Foundation states.

In the future, Riggins said she hopes that doctors will be better able to determine whether a given patient will benefit from a treatment, ahead of time. As of now, there’s often some trial-and-error in finding the right treatments for each patient, according to Stanford Health Care. “We would love to have biomarkers which would tell us that this patient is likely to have no side effects and will have benefit from this particular therapy,” she said.

Additional resources

• Watch a short video about why skipping coffee might cause headaches, from SciShow. 
• Identify what causes your headaches with Stanford Health Care’s Headache Trigger Tracker. 
• Find tips from the Mayo Clinic on how to prevent and manage migraines. 

This article is for informational purposes only, and is not intended to provide medical advice.

Nicoletta Lanese

Staff Writer

Nicoletta Lanese is a staff writer for Live Science covering health and medicine, along with an assortment of biology, animal, environment and climate stories. She holds degrees in neuroscience and dance from the University of Florida and a graduate certificate in science communication from the University of California, Santa Cruz. Her work has appeared in The Scientist Magazine, Science News, The San Jose Mercury News and Mongabay, among other outlets.

Source: Read Full Article