Different Types of Primary Headaches: What You Need to Know

Are headaches getting in the way of your daily life? Are you struggling to identify types of headaches based on their clinical characteristics? If so, you are at the right place and this article is exactly what you need to read.

As quoted in the Atlas of Headache Disorders published by the World Health Organisation (WHO), Headache disorders are the most common type of neurological conditions, that are often under-recognized, under-diagnosed, and under-treated.

From tension headaches to migraines and cluster headaches, understanding the different headache types is key to finding the right treatment. In this article, we will understand the difference between primary and secondary headaches and the characteristics and triggers of primary headache types.  

I want to emphasize that the science behind headache disorders – pathophysiology, triggers, and treatments of primary and secondary headaches is a vast topic. Here, we have churned out published scientific literature to give you a simplistic version of primary headache types. Since it is a huge topic, we will cover each of the primary headaches and their subtypes separately in various blog articles.

Join us on this informative journey as we unravel the complexities of types of headache pain and equip you with the knowledge and tools to conquer them.

Remember, understanding your headache type is the first step towards finding relief. Let’s decode the headache puzzle together.

What are the common causes of headaches?

Headaches may be caused by several conditions. Some common causes of headaches are listed below:

• Disorders of neck, eyes, brain, jaw, teeth
• Emotional factors such as stress (family, marital, work, health related), depression, anxiety, frustration
• Dietary factors such as aged cheese, caffeine withdrawal, red wine, chocolate, processed meats containing nitrates
• Environmental factors such as change in weather conditions, strong odors, glare from sun or bright light
• Hormonal Events such as menstruation, oral contraceptives, hormone replacement therapies, menopause
• Physical factors such as getting too much or too little sleep, skipping meals, injuries, too much physical exertion

The international classification of primary headache types

• According to the third edition of the International Classification of Headache Disorders (ICHD-3) published in 2018, headaches can be divided into primary headaches, secondary headaches, neuropathies or facial pains, and other headaches. The updated headache classification of the International Headache Society (IHS) lists more than 200 different types of headaches that can be differentiated from each other on the basis of the history and physical examination alone (1).

ICHD-3 classifies primary headaches into four types:

• Migraines
• Tension-type headache (TTH)
• Trigeminal autonomic cephalalgias (TAC’s)
  • Cluster headache (most common type in TAC)
  • Paroxysmal hemicrania
  • Hemicrania continua
  • Probable trigeminal autonomic cephalalgia
• Other primary headache disorders

What is the difference between primary and secondary headaches?

A primary headache is a headache that is not caused by an underlying health problem or a disorder. Examples of primary headaches include migraines, cluster headaches, and tension-type headaches.  These types of headaches are more painful.

Secondary headaches on the other hand usually develop as secondary symptoms due to another underlying health disease or infection. Some examples include headaches as a result of brain tumor, cerebral haemorrhage, cranial or cervical vascular disorder, disorder of homeostasis, disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, other facial or cervical structure.

Clinical characteristics of primary headache types

Understanding the clinical characteristics of primary headaches is the key to identifying the type of headache and determining the appropriate treatment strategy.

Migraine Headaches:

• Migraine headache is a frequent neurobiological headache disorder characterized by increased CNS excitability. It is one of the world’s most disabling medical conditions (5).
• Migraine is the second most common form of headache that is described as pulsating, throbbing, pounding pain, often unilateral (one side of the brain)
• Untreated migraine headache typically lasts from 4-72 hours
• Moderate to intense pain affecting daily activity
• Some common symptoms include:
  • increased sensitivity to light (photophobia), noise (phonophobia) and odors
  • nausea or vomiting

• The most common triggers of migraine are (2, 3) :
  • Stress in 80% patients (probable factor)
  • Fasting
  • Certain foods and beverages such as freshly baked yeast products, sour cream, chocolates, cured meat, mono sodium glutamate (MSG)
  • Atmospheric changes
  • Hormonal fluctuations in 65% women (menstruation, ovulation, oral contraceptives, pregnancy, post partum and menopause)
  • Sleep deprivation, or excessive sleep
  • Exposure to sunlight or bright light in 38% patients (probable factor)
  • Heat intolerance
  • Sensitivity to odors
  • Neck pain
  • Alcohol ingestion and smoking
  • Dehydration

• Most migraine attacks consist of four phases (2, 3):
  • Premonitory phase: Premonitory phase is associated with hypothalamus activation. Common symptoms include yawning, mood change, lethargy, light and sound sensitivity, excess energy, thirst and edema
  • Aura: Migraine aura refers to visual, sensory or motor disturbances just before a migraine attack. This condition usually lasts for 30-60 min before headache pain
  • Headache: Headache is often unilateral, generally described as pulsating throbbing pain.  Some common symptoms include  nausea, vomiting, aversion to light (photophobia), sound (phonophobia), rhinorrhea, secretion of tears (lachrymation) , touch (allodynia), and smell (osmophobia)
  • Postdrome: Commonly referred as migraine hangover, it is the last stage of migraine. Symptoms include mental fog, difficulty concentrating, tiredness, and drowsiness. The greater the intensity of the headache pain, the more prolonged these symptoms are.

• Many migraine patients find headache improvement with relaxation and other self-care techniques. Rest in a darkened room, cool compresses, and massage are found to alleviate headache pain.
• Avoid fasting and drink plenty of fluids to avoid dehydration.

Some studies have shown that the gut-brain axis may have an impact on migraine, however the underlying mechanisms are not totally known. Multiple factors influence this connection, including inflammatory mediators (IL-1β, IL-6, IL-8, and TNF-α), gut bacteria, neuropeptides, serotonin pathway, stress hormones, and dietary nutrients (4).

It has also been proposed that dietary approaches with beneficial effects on gut microbiota and gut-brain axis, such as adequate fiber consumption per day, adhering to a low glycemic index diet, supplementation with vitamin D, omega-3, and probiotics, and weight loss dietary plans for overweight and obese patients, may improve migraine (4).

Seeking medical attention is also important for individuals who experience frequent or severe migraines. Healthcare professionals can provide a range of treatment options, including prescription medications, lifestyle modifications, and alternative therapies, to help manage the symptoms and prevent future migraine episodes.

Tension-Type Headaches (TTH):

• Tension headache is the most common primary headache disorder, with a global prevalence of 46% to 78% (6)
• TTH is characterized by recurrent mild to moderate intensity headaches that are of bilateral location, which are of pressing or tightening quality, dull with sensation of tight band around head. These type of headaches have no aggravation by routine physical activities such as walking or climbing stairs (7)
• TTH causes greater disability and missed worked days than migraines
• The cause of TTH is multifaceted involving hereditary and environmental factors (6)
• The primary cause of tension headaches is muscle tension or contractions in the head, neck, and shoulder areas. This muscle tension can be triggered by various factors, including stress, poor posture, eye strain, and even clenching or grinding of the teeth. When these muscles become tense, they can pressure the nerves and blood vessels, leading to the characteristic dull, aching pain of a tension headache.
• There are three subtypes of TTH (8):
  • Infrequent episodic with headache once a month
  • Frequent episodic with headaches 1-14 days a month
  • Chronic episodic with headaches occuring 15 or more days in a month
• Behavioral Treatments include (8)
  • Regulation of exercise and meal
  • Cognitive behavioral programs such as stress management
  • Relaxation techniques
  • Biofeedback
• Physical therapy include exercise programs, hot and cold packs, massage
• Identifying and addressing the underlying causes of tension headaches is crucial for finding relief. Stress management techniques, such as relaxation exercises, meditation, and deep breathing, can be effective in reducing muscle tension and preventing future episodes. Additionally, improving posture, taking regular breaks from computer or smartphone use, and practicing good sleep hygiene can all help to alleviate the symptoms of tension headaches.

Over-the-counter pain medications, such as ibuprofen or acetaminophen, can also provide temporary relief for tension headaches. However, it’s important to use these medications sparingly and to address the root causes of the headaches to prevent them from becoming a chronic issue.

Cluster headaches (CH):

Cluster headaches are classified as trigeminal autonomic cephalgia, characterized by severe unilateral pain on the head and face.

It is a unique and often debilitating type of headache that affects a relatively small percentage of the population with a life-time prevalence of 1,24/1000 and typical age of onset is 20-40 years (11). These headaches are characterized by intense, stabbing pain that is typically localized to one side of the head and can be accompanied by autonomic cranial symptoms, such as eye redness, lacrimation (tearing), and rhinorrhea (nasal mucus dripping) and nasal congestion (9).

These headaches are characterized by their cyclical nature: periods of weeks to months of experiencing severe pain followed by remission. Remissions can last months to years, with some reporting no return of their symptoms (9,10). The pain associated with cluster headaches is often described as one of the most severe types of pain that a person can experience. The pain can be so intense that it can cause individuals to become restless, pacing, and even rocking back and forth in an attempt to find relief. This pain can last for anywhere from 15 minutes to several hours and can occur in clusters, with multiple headaches occurring over the course of a day or even a week.

The exact cause of cluster headaches is not fully understood, but it is believed to be related to a combination of factors, including genetic predisposition, changes in the body’s internal clock, and the activation of specific areas of the brain. Certain triggers, such as alcohol consumption, changes in sleep patterns, and exposure to certain environmental factors, can also contribute to the development of cluster headaches.

Treating cluster headaches can be challenging, as they can be resistant to many of the traditional headache treatments. However, there are a variety of treatment options available, including prescription medications, oxygen therapy, and even surgical interventions in some cases. Working closely with a healthcare provider is essential for developing an effective treatment plan that can help to alleviate the symptoms and prevent future episodes.

Understanding the unique nature of cluster headaches and the intense pain associated with them is important for individuals who are affected by this condition. By seeking appropriate medical care and exploring a range of treatment options, individuals with cluster headaches can find relief and regain control over their lives.

Natural home remedies for headache relief

While over-the-counter and prescription medications can be effective in providing relief for headaches, many patients like to explore natural and holistic approaches to managing their symptoms. These natural remedies can be a complementary or alternative option for those who prefer to avoid or minimize the use of pharmaceutical drugs.

One of the most popular natural remedies for headache relief is use of essential oils. Certain essential oils, such as peppermint, lavender, and eucalyptus, have been shown to possess anti-inflammatory and analgesic properties that can help alleviate the symptoms of headaches. These oils can be applied topically to the temples, forehead, or back of the neck, or can be diffused into the air to be inhaled.

Another natural approach to headache relief is the use of herbs and supplements. Herbs like feverfew, butterbur, and ginger have been used for centuries to treat various types of headaches, and some studies have suggested that they may be effective in reducing the frequency and severity of migraines and other headache types. Supplements like magnesium, vitamin B2, and CoQ10 have also been explored for their potential headache-relieving properties.

In addition to essential oils and herbal remedies, there are also a variety of other natural approaches that can be effective in managing headaches. These include practices like acupuncture, massage therapy, and relaxation techniques, such as meditation and deep breathing. These approaches can help to reduce muscle tension, improve blood flow, and promote overall relaxation, which can be beneficial in preventing and alleviating headache symptoms.

While natural remedies can be a valuable addition to a headache management plan, it’s important to remember that they should not be used as a replacement for traditional medical treatment.

TOP TIP: It’s always best to consult with a healthcare provider before incorporating any new natural remedies into your routine, especially if you are taking prescription medications or have any underlying health conditions.

Over-the-counter medications for headache relief

When it comes to finding relief for headaches, over-the-counter (OTC) medications can be a convenient and accessible option. These headache medicines are readily available without a prescription and can provide quick, temporary relief for a variety of headache types.

One of the most common OTC medications for headache relief is acetaminophen, an active ingredient in products like Tylenol. Acetaminophen reduces the production of prostaglandins, which contribute to inflammation and pain. It is often effective in relieving the symptoms of tension headaches and mild to moderate migraines.

Another popular headache medicine is ibuprofen, an active ingredient in products like Advil and Motrin. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help to reduce inflammation and alleviate the pain associated with headaches. It is often effective in treating tension headaches, migraines, and sinus headaches.

In addition to acetaminophen and ibuprofen, other OTC medications combine multiple active ingredients to provide more comprehensive relief. The first line of pharmacotherapy for tension type and migraine headaches includes NSAIDs, aspirin, acetaminophen, and perhaps a combination with caffeine to alleviate acute flares (9).

Venlafaxine or amitriptyline are two possible medications for patients with major depressive disorder (MDD) or other mood disorders. Additionally, valproate or topiramate may be beneficial for those with epileptic disorders (9).

It’s important to note that while OTC medications can be a convenient option for headache relief, they should be used with caution and in moderation. Overuse or misuse of these medications can lead to side effects, such as stomach irritation, liver damage, or even rebound headaches.

PRO TIP: It’s always best to follow the dosage instructions on the label and consult with your family physician if symptoms persist or worsen.

Effective strategies for preventing headaches

While finding relief for headaches is important, it’s equally crucial to focus on strategies for preventing them in the first place. By addressing the underlying causes of headaches and implementing lifestyle changes, patients can take a proactive approach to managing their symptoms and reducing the frequency and severity of future episodes.

One of the most effective strategies for preventing headaches is stress management. As we’ve discussed earlier, stress is a common trigger for a variety of headache types, including tension headaches and migraines.

PRO TIP: Incorporating stress-reducing activities, such as meditation, yoga, or deep breathing exercises, into your daily routine can help to alleviate muscle tension and improve overall well-being.

Maintaining a healthy sleep schedule is another important strategy for preventing headaches. Lack of sleep or disruptions in sleep patterns can contribute to the development of headaches, so it’s crucial to prioritize getting enough high-quality sleep each night.

PRO TIP: Establishing a consistent bedtime routine, limiting screen time before bed, and creating a comfortable sleep environment can all help to improve sleep quality and reduce the risk of headaches.

Proper hydration is also essential for preventing headaches. Dehydration can lead to the constriction of blood vessels and the release of certain chemicals that can trigger headaches.

PRO TIP: Drinking plenty of water throughout the day, especially during periods of physical activity or exposure to hot weather, can help keep the body hydrated and reduce the risk of dehydration-related headaches.

In addition to lifestyle factors, dietary choices play a role in preventing headaches. Individuals may find it helpful to identify and avoid personal food triggers, such as certain types of cheese, chocolates, processed meats, or alcoholic beverages.

PRO TIP: Maintaining a balanced, nutrient-rich diet and incorporating foods that are rich in magnesium, riboflavin, and CoQ10 may also be beneficial in reducing the frequency and severity of headaches.

By implementing a combination of these strategies, patients can take a proactive approach to managing their headaches and improving their overall quality of life. Remember, prevention is key, and the more you can do to address the underlying causes of your headaches, the better you’ll be able to find long-term relief.

Conclusion: Finding the right approach for headache management

Headaches can be a frustrating and debilitating experience, but with the right knowledge and strategies, it is possible to find relief and regain control over your health. By understanding the various types of headaches and their underlying causes, you can develop a personalized plan for managing your symptoms and preventing future episodes.

Whether you’re dealing with tension headaches, migraines, or cluster headaches, there are a variety of treatment options available, from over-the-counter medications to natural remedies and lifestyle changes. By working closely with your family physician, you can explore the most effective strategies for your individual needs and preferences.

It is important to get a careful assessment of medical history and physical examination done to avoid misdiagnosis. Neuroimaging and CSF/serum testing can assist in a more accurate diagnosis and subsequent selection of treatment in chronic recurring headaches.

PRO TIP: Maintain a headache diary to identify patterns and triggers of your headache, such as certain foods, stress, sleep disorders. By documenting the severity, frequency and duration of your headache, it will assist your healthcare provider for more effective treatments and therapies.

Remember, headache management is not a one-size-fits-all approach. What works for one person may not work for another, so it’s important to be patient, persistent, and open to trying different methods until you find the right solution. With the right tools and support, you can take control of your headaches and live a healthier, more fulfilling life.

For patients where the clinical presentation is complex (multiple types of headaches present) or where clinical symptoms do not clearly fit any one primary headache type, please consult a specialist for proper diagnosis and treatment.

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Muscle tension can be a major culprit behind headaches. The [TheraFlow Dual Foot Massager](Amazon link) is designed to release stress from your feet and promote relaxation, which can help reduce the frequency of tension headaches.

Natural Remedies:

If you’re looking for a natural approach, the [MigraSoothe Roll-On](Amazon link) uses essential oils like peppermint and lavender to deliver calming relief right at the source of pain. Perfect for those who prefer to avoid medications!

Over-the-Counter Solutions:

Don’t forget to stock up on trusted pain relief medications like [Excedrin Migraine](Amazon link), proven to provide fast-acting relief for severe headaches.

Pro Tip: Keep a [Headache Diary](Amazon link) to track triggers, symptoms, and effectiveness of treatments to better manage and prevent headaches.

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REFERENCES:

1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia, 38(1), 1–211. https://doi.org/10.1177/0333102417738202
2. Aguilar-Shea, A. L., Membrilla, J. A., MD, & Diaz-De-Teran, J. (2022). Migraine review for general practice. Atención Primaria, 54(2), 102208. https://doi.org/10.1016/j.aprim.2021.102208
3. Pescador Ruschel MA, De Jesus O. Migraine Headache. [Updated 2023 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560787/
4. Arzani M, Jahromi SR, Ghorbani Z, Vahabizad F, Martelletti P, Ghaemi A, Sacco S, Togha M; School of Advanced Studies of the European Headache Federation (EHF-SAS). Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain. 2020 Feb 13;21(1):15. doi: 10.1186/s10194-020-1078-9
5. Silberstein, S. D. (2004). Migraine. Lancet, 363(9406), 381–391. https://doi.org/10.1016/s0140-6736(04)15440-8
6. Scripter C. (2018). Headache: Tension-Type Headache. FP essentials, 473, 17–20.
7. Ashina, S., Mitsikostas, D. D., Lee, M. J., Yamani, N., Wang, S., Messina, R., Ashina, H., Buse, D. C., Pozo-Rosich, P., Jensen, R. H., Diener, H., & Lipton, R. B. (2021). Tension-type headache. Nature Reviews. Disease Primers, 7(1). https://doi.org/10.1038/s41572-021-00257-2
8. Bhoi, S., Jha, M., & Chowdhury, D. (2021). Advances in the Understanding of Pathophysiology of TTH and its Management. Neurology India, 69(7), 116. https://doi.org/10.4103/0028-3886.315986
9. Hernandez, J., Molina, E., Rodriguez, A., Woodford, S., Nguyen, A., Parker, G., & Lucke-Wold, B. (2024). Headache Disorders: Differentiating primary and secondary etiologies. Journal of Integrative Neuroscience, 23(2), 43. https://doi.org/10.31083/j.jin2302043
10. De Coo, I. F., Van Oosterhout, W. P. J., Wilbrink, L. A., Van Zwet, E. W., Ferrari, M. D., & Fronczek, R. (2019). Chronobiology and sleep in cluster headache. Headache the Journal of Head and Face Pain, 59(7), 1032–1041. https://doi.org/10.1111/head.13567
11. Lund, N. L. T., Petersen, A. S., Fronczek, R., Tfelt-Hansen, J., Belin, A. C., Meisingset, T., Tronvik, E., Steinberg, A., Gaul, C., & Jensen, R. H. (2023). Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments—a consensus article. The Journal of Headache and Pain, 24(1). https://doi.org/10.1186/s10194-023-01660-8

USEFUL LINKS

• https://www.healthquality.va.gov/guidelines/pain/headache/HA-Provider-Tool-final-12Jan2024.pdf
• https://www.health.harvard.edu/blog/have-a-headache-the-top-7-triggers-2020033019330
• https://www.ninds.nih.gov/health-information/disorders/headache
• https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/headache/types/migraine-headache.html
• https://uhs.berkeley.edu/sites/default/files/HeadachesMigraines.pdf