Headaches

There are hundreds of various types of headaches.  The information provided here is for general information only and is not to be used as a substitute for a physician.  It is important to have all headaches diagnosed correctly by your physician. 

The International Classification of Headache Disorders (ICHD-III) describes 3 main categories. 

International Classification of Headache Disorders (ICHD-III) Headache Categories:
Primary Headaches: Examples include Migraine Headaches, Tension Type Headaches, Cluster Headaches and other Trigeminal Autonomic Cephalgias.
Secondary Headaches: Examples include headaches secondary to Head and Neck Trauma, Cervical and Cranial Vascular Disorders, Non Vascular Intracranial Disorders, Substance Withdrawal, Infections, and others.
Cranial Neuralgias, Central and Primary Facial Pain, and Other Headaches: Examples include headaches resultant of Central causes of Facial Pain, Other Headaches, Cranial Neuralgias, and Central or Primary Facial Pain.


Another type of classification is based more upon headache types and treatments.  Here, the headaches are classified into one of four general categories. These general categories are by no means exhaustive, and provide only a general overview of headache types. 


General Headache Categories

Migraine, Medication, Vascular, and Concussive Headaches:These include migraine and other vascular headaches, medication overuse and withdrawal headaches, headaches resultant of head injuries, and others. Headaches within this category are generally well treated by a combination of some medications, spinal manipulation, and physical medicine modalities. 

Tension Headaches: These include headaches secondary to whiplash, neck pain, arthritis, muscle spasms and others. Headaches in this category are generally well treated with spinal manipulation, physical medicine modalities, and only minimal amounts (if necessary) of medication.

Inflammatory Headaches: These include headaches secondary to infections such as a sinus infection. Headaches in this category are generally well treated with anti-infective agents and can generally be treated effectively by your primary care physician or infectious disease specialist.

Traction Headaches: These include headaches resultant of tumors and other masses which “traction” on parts of brain and/or the nervous system. Headaches of this type are best treated by a neurosurgeon, neurologist or other neurointerventional specialist.


Common Headache Terms
Episodic Headaches- Less than 15 Headache Days per month
Chronic Headaches – 15 HA days per month and of at least 4 hours duration per day, and Symptoms of at least 3 months
Daily – Daily Headaches
Chronic/Transformed Headaches – Episodic headaches which begin to occur more frequently until they become chronic.


Common Headache Types
Tension Headaches:  
Most common form of headache.  May be episodic or chronic.  Commonly described as dull, achey, non-throbbing.  It is frequently bilateral and wraps around the front of the head in a band distribution.  It is generally associated with neck tightness.
Migraine without Aura:  Generally a unilateral distribution of headache (one side of face).  Moderate to severe pain.  Has 2 of 3 PIN criteria: Photophobia, Inability to function, Nausea.  May have sound sensitivity.  Typically lasts 4-72 hours.
Migraine with Aura:  Similar to Migraine without Aura but with pre-headache symptoms.  These pre-headache symptoms are typically 5-60 minutes before the onset of headache.  Pre-headache symptoms may include visual disturbances, numbness in the extremities, or others.
Cluster Headaches:  Typically localized to a single eye and surrounding region. Excruciating Pain; Rapid Onset; Tearing; Eye Redness; Runny Nose; Congested Face. Pain typically lasts 15 minutes to 3 hours.  More common in men.  More commonly seen in ages 20-40.  May be seasonal.
Medication Overuse Headaches (MOH):  Previously called Rebound Headaches.  Secondary cause of Chronic Daily Headaches.  Often motivated by the desire to treat headaches or a fear of future headaches.  Occurrence and onset depends on the length of treatment and the type of medication used.  Overuse is defined in terms of days per month of treatment and depends on the drug used.  In general:
Ergots:  10 or more days per month for 3 months
Triptans: 10 or more days per month for 3 months
Opioid:  10 or more days per month for 3 months
Barbiturates:  2-3 days per week for 3 weeks
Simple Analgesics (NSAIDS, Acetaminophen):  15 or more days per month for 3 months
MOH Headaches are also a type of headache which can occur from taking multiple medications oo over dosing on certain medications.  Some of these headaches can be a symptom of a much more serious issue.  For example, taking more than 1 SSRI (antidepressant medication) at a time increases the risk of Seratonin Syndrome, which can demonstrate as a headache.  Seratonin Syndrome can often be a serious and sometimes life threatening issue.  The risk of Seratonin Syndrome also increases when taking an SSRI with and opioid, or taking an SSRI with certain headache medications, or from a combination or over dose of certain other medications.
Cervicogenic Headaches:  Secondary type of headache generally resulting from pain and tightness of the neck and upper back.  The headache pain is often noted at the base of the skull and there may also be pain at the front of the head similar to a Tension Headache.
Hypertension Headaches:  Seen in patients with hypertension. More severe in the morning and diminishes throughout the day.  Symptoms often correlate with timing of antihypertensive therapy and the efficacy of hypertension control.
Sinus Headaches:  Diffuse pain about the sinus regions of the face.  Associated with sinus infection or inflammation.
Tumor/Traction Headaches:  Headache caused by a tumor or other mass which compresses or tractions on the brain.  Symptoms may progressively worsen (as tumor size increases).  Localized pain that is aggravated by coughing or certain head movements (depending on the tumor or mass locale).  Pain from increased intracranial pressure may be diffuse and associated with nausea. May be chronic or infrequent with sharp increases.
Menstrual Migraines:  Migraine type headaches occuring shortly before or during menstruation.
Exertion Headaches:   Generalized head pain during or after physical exertion (exercising) or after passive exertion (sneezing, coughing).  Duration of 1 minute to 48 hours.  Headaches here should also be evaluated for other CNS issues.
Post Traumatic Headaches:  Headaches following a closed head injury.  My be accompanied by diziness, lightheadedness, gait disturbances, and others. May mimic migraine or tension type headaches. These headaches need to be further evaluated for other CNS issues.
Allergic Headaches:  Headaches with accompanying nasal discharge and/or congestion, watery eyes.  Associated with seasonal or other types of allergies.
TMJ Headaches:  Headaches associated with jaw pain. Clicking and/or lateral tracking of the jaw may occur.
Trigeminal Neuralgia Headaches (Tic Douloureau):  Sharp stabbing unilateral pain about the face and/or jaw. May be short duration or may be chronic. Unknown etiology.  Is often seen secondary to nerve damage of the face, vascular compression about the face, tumors, or Multiple Sclerosis.
Eyestrain Headaches:  Recurrent mild headache.  Frontal bilateral pain. Directly associated with eye strain.
Fasting Headaches:  Headaches associated with fasting. Generally localized to the frontal region with diffuse or pulsating pain.
Arthritis Headaches:  Similar to Tension Headache.  Associated with arthritis and worsens on movements.  Generally localized to the neck and suboccipital region.
Caffeine Withdrawal Headaches:  Bilateral pulsating headache.  Generally seen within 24 hours of caffeine withdrawal.
Aneurysm Rupture Headaches:  Sudden unbearable headache with additional symptoms of double vision, rigid neck, lightheadedness, and or others. Depending upon the location of the rupture, there may be gait disturbance, cognitive difficulties, visual changes, difficulty with speech and/or others. There is a congenital tendency and also associated with hypertension.
Hangover Headaches:  Bilateral pulsating headache aggravated by physical acivity.  Associated with excessive intake of alcohol.
Temporal Arteritis (Giant Cell Arteritis):  Stabbing, burning pain caused by inflammationof the temporal artery.  Pain about the temporal artery region, and may also be around the temple or the jaw.  Blurred vision or visual loss may be present.  Requires emergency treatment or permanent blindness may occur.
Low Pressure CSF Headache: Most frequently following lumbar puncture.  May occur from CSF leaks (spontaneous or otherwise). Symptoms also include orthostatic headache, nausea, vomiting, horizontal diplopia, unsteadiness or vertigo, altered hearing, neck pain/stiffness.
High Pressure CSF:  Volume of the CSF is increased either from increased production or reduced absorption. Idiopathic intracranial hypertension (pseudotumor cerebri)  describes an increase in CSF pressure without a space-occupying intracranial lesion or hydrocephalus.  Visual field defects are common.