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17 Types
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Head pain can be classified as being one of three types: 1) primary headache, 2)
secondary headache, and 3) cranial neuralgias, facial pain, and other headaches.
Common primary headaches include tension, migraine, and cluster headaches.
Medication overuse headache (rebound headache) is a condition where frequent use of
pain medications can lead to persistent head pain. The headache may improve for a short
time after medication is taken and then recur. (The term "rebound headache" has been
replaced by the term "medication overuse headache.")
Home remedies for tension headaches, the most common type of primary headache,
include rest and over-the-counter (OTC) medications for pain.
Head pain can be classified as being one of three types: 1) primary headache, 2) secondary headache, and 3) cranial
neuralgias, facial pain, and other headaches.
Common primary headaches include tension, migraine, and cluster headaches. Other types of headaches include:
What is a headache?
Headache is defined as a pain arising from the head or upper neck of the body. The pain
originates from the tissues and structures that surround the skull or the brain because the brain
itself has no nerves that give rise to the sensation of pain (pain fibers). The thin layer of tissue
(periosteum) that surrounds bones, muscles that encase the skull, sinuses, eyes, and ears, as well
as thin tissues that cover the surface of the brain and spinal cord (meninges), arteries, veins, and
nerves, all can become inflamed or irritated and cause headache. The pain may be a dull ache,
sharp, throbbing, constant, intermittent, mild, or intense.
The guidelines are extensive, and the Headache Society recommends that health care
professionals consult the guidelines frequently to make certain of the diagnosis.
There are three major categories of headache based upon the source of the pain.
1. Primary headaches
2. Secondary headaches
3. Cranial neuralgias, facial pain, and other headaches
The guidelines also note that a patient may have symptoms that are consistent with more than
one type of headache, and that more than one type of headache may be present at the same time.
QUESTION
Who suffers more frequently from migraine headaches?See Answer
What are primary headaches?
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other
less common types of headaches.
Tension headaches are the most common type of primary headache. Tension headaches
occur more commonly among women than men. According to the World Health
Organization, 1 in 20 people in the developed world suffer with a daily tension
headache.
Migraine headaches are the second most common type of primary headache. Migraine
headaches affect children as well as adults. Before puberty, boys and girls are affected
equally by migraine headaches, but after puberty, more women than men are affected.
Cluster headaches are a rare type of primary headache. It more commonly affects men
in their late 20s, though women and children can also suffer from this type of headache.
Primary headaches can affect the quality of life. Some people have occasional headaches that
resolve quickly while others are debilitating. While these headaches are not life threatening, they
may be associated with symptoms that can mimic strokes.
Many patients equate severe headache with migraine, but the amount of pain does not determine
the diagnosis of migraine. Read our Migraine Headache article for more information about the
symptoms, causes, and treatment of migraines.
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This group of headaches also includes those headaches associated with substance abuse and
excess use of medications used to treat headaches (medication overuse headaches). "Hangover"
headaches fall into this category as well. People who drink too much alcohol may waken with a
well-established headache due to the effects of alcohol and dehydration.
SLIDESHOW
8. Primary cough headache
13. Hemicrania continua (headaches that are persistently on one side only, right or left
[unilateral])
14. New daily-persistent headache (NDPH) (a type of chronic headache)
15. Headache from exertion
16. Trigeminal neuralgia and other cranial nerve inflammation
17. Secondary headaches due to:
o Trauma
o Disorders
o Infection
o Structural problems with the bones of the face, teeth, eyes, ears, nose, sinuses or
other structures
o Substance abuse or withdrawal
Changes in brain chemistry may also be associated with headache: Medication reactions, drug
abuse and drug withdrawal can all cause pain.
Every person is different so the history of the headache is important. Recognizing patterns or
precipitating (foods eaten, stress, etc.) factors, in combination with the physical examination and
associated symptoms, can help identify the cause for each individual's specific headache.
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While tension headaches are the most frequently occurring type of headache, their cause is not
known. The most likely cause is contraction of the muscles that cover the skull. When the
muscles covering the skull are stressed, they may become inflamed, go into spasm, and cause
pain. Common sites include the base of the skull where the trapezius muscles of the neck insert,
the temples where muscles that move the jaw are located, and the forehead.
There is little research to confirm the exact cause of tension headaches. Some believe that
tension headaches occur because of physical stress on the muscles of the head. For example,
these stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm.
Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer
concentrating for long periods. Emotional stress also might cause tension headaches by causing
the muscles surrounding the skull to contract.
Pain that begins in the back of the head and upper neck and is often described as a band-
like tightness or pressure. It may spread to encircle the head.
The most intense pressure may be felt at the temples or over the eyebrows where the
temporalis and frontal muscles are located.
The pain may vary in intensity but usually is not disabling, meaning that the sufferer may
continue with daily activities. The pain usually is bilateral (affecting both sides of the
head).
The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to
light and sound.
The pain occurs sporadically (infrequently and without a pattern) but can occur
frequently and even daily in some people.
The pain allows most people to function normally, despite the headache.
The physical examination, particularly the neurologic portion of the examination, is important in
tension headaches because to make the diagnosis, it should be normal. However, there may be
some tenderness of the scalp or neck muscles. If the health care professional finds an
abnormality on neurologic exam, then the diagnosis of tension headache should be put on hold
until the potential for other causes of headaches has been investigated.
Tension headaches are painful, and patients may be upset that the diagnosis is "only" a tension
headache. Even though it is not life threatening, a tension headache can make daily activities
more difficult to accomplish. Most people successfully treat themselves with over-the-counter
(OTC) pain medications to control tension headaches. The following work well for most people:
aspirin,
ibuprofen (Motrin, Advil),
acetaminophen (Tylenol, Panadol) and
naproxen (Aleve).
If these fail, other supportive treatments are available. Recurrent headaches should be a signal to
seek medical help. Physical therapy, massage, biofeedback, and stress management can all be
used as adjuncts to help control tension headaches.
It is important to remember that OTC medications, while safe, are medications and may have
side effects and potential interactions with prescription medications. It always is wise to ask a
health care professional or pharmacist if one has questions about OTC medications and their use.
This is especially important with OTC pain medications, because they are used so frequently.
It is important to read the listing of ingredients in OTC pain medications. Often an OTC
medication is a combination of ingredients, and the second or third listed ingredient may have
the potential of interfering with the action of other drugs based upon a patient's other medical
issues. For example:
Some OTC medications include caffeine, which may trigger rapid heartbeats in some
patients.
In nighttime preparations, diphenhydramine (Benadryl) may be added. This may cause
sedation, and driving or using heavy machinery may not be appropriate when taking a
sedative medication.
Some OTC cold medications have pseudoephedrine mixed in with the pain medication.
This drug can cause elevated blood pressure and palpitations.
Aspirin should not be used in children and teenagers because of the risk of Reye's
syndrome, a life threatening complication that may occur when a viral infection is present
and aspirin is taken.
Aspirin, ibuprofen, and naproxen are anti-inflammatory medications that can be irritating
to the stomach and may cause intestinal bleeding. They should be used with caution in
patients who have peptic ulcer disease.
Most anti-inflammatory medicines also cause the potential for bleeding elsewhere in the
body, and you should not take them if you also take blood thinners. Talk with your doctor
or other health care professional about the benefits and risks of anti-inflamatory drugs.
Blood thinners include warfarin (Coumadin), heparin (Lovenox), dabigatran
(Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa), clopidogrel
bisulfate (Plavix), ticagrelor (Brilinta), and prasugrel (Effient).
Overuse of aspirin, ibuprofen, and naproxen also may cause kidney damage.
Acetaminophen, if used in amounts greater than recommended, can cause liver damage
or failure. It also should be used with caution in patients who drink significant amounts of
alcohol or who have liver disease because even lesser doses than are normally
recommended may be dangerous.
Medication overuse headache can be mistaken for chronic tension headaches. When pain
medications are used for a prolonged period, headaches may recur because the effects of
the medication wear off. (This type of headache was referred to as a "rebound headache,"
and is classified as a secondary headache.)
The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals
histamine and serotonin in the brain. The hypothalamus, an area located at the base of the brain,
is responsible for the body's biologic clock and may be the source for this type of headache.
When brain scans are performed on patients who are in the midst of a cluster headache, abnormal
activity has been found in the hypothalamus.
Cluster headaches are headaches that come in groups (clusters) separated by pain-free periods of
months or years. A patient may experience a headache on a daily basis for weeks or months and
then be pain-free for years. This type of headache affects men more frequently. They often begin
in adolescence but can extend into middle age.
During the period in which the cluster headaches occur, pain typically occurs once or
twice daily, but some patients may experience pain more than twice daily.
Each episode of pain lasts from 30 to 90 minutes.
Attacks tend to occur at about the same time every day and often awaken the patient at
night from a sound sleep.
The pain typically is excruciating and located around or behind one eye.
Some patients describe the pain as feeling like a hot poker in the eye. The affected eye
may become red, inflamed, and watery.
The nose on the affected side may become congested and runny.
Unlike people with migraine headaches, those with cluster headaches tend to be restless. They
often pace the floor and/or bang their heads against a wall. People with cluster headaches can be
driven to desperate measures, including suicidal thoughts.
If examined in the midst of an attack, the patient usually is in a painful crisis and may have the
eye and nose watering as described previously. If the patient is seen when the pain is not present,
the physical examination is normal and the diagnosis will depend upon the history.
Cluster headaches may be very difficult to treat, and it may take trial and error to find the
specific treatment regimen that will work for each patient. Since the headache recurs daily, there
are two treatment needs. The pain of the first episode needs to be controlled, and the headaches
that follow need to be prevented.
inhalation of high concentrations of oxygen (though this will not work if the headache is
well established);
injection of triptan medications, like, sumatriptan (Imitrex), zolmitriptan (Zomig),
and rizatriptan (Maxalt) which are common migraine medications;
spraying or dripping lidocaine, a local anesthetic, into the nostril;
dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict;
and
caffeine.
Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and
minimizing alcohol may prevent future episodes of cluster headache.
The International Headache Society lists eight categories of secondary headache. A few
examples in each category are noted (This is not a complete list.).
Injuries to the head may cause bleeding in the spaces between the meninges, the layers of
tissue that surround the brain (subdural, epidural, and subarachnoid spaces) or within the
brain tissue itself (intracerebral hemorrhage: intra=within + cerebral=brain,
hemorrhage=bleeding).
Edema or swelling within the brain, not associated with bleeding, may cause pain and a
change in mental function.
Concussions, where head injury occurs without bleeding. Headache is one of the
hallmarks of post-concussion syndrome.
Whiplash and neck injury also cause head pain.
Brain tumors, either primary, originating in the brain, or metastatic from a cancer that
began in another organ
Seizures
Idiopathic intracranial hypertension, historically called pseudotumor cerebri, where
pressure within the spinal canal increases. The cause is unknown and while it can occur
in all ages, it often affects young, obese females. Idiopathic intracranial
hypertension can cause significant headache and if left untreated may, on occasion, lead
to blindness.
Infection
Meningitis
Encephalitis
HIV/AIDS
Systemic infections (for example, pneumonia or influenza)
Problems with the eyes, ears, nose throat, teeth, sinuses, and neck
Sinus infection
Dental pain
Glaucoma
Iritis
However, some patients present in crisis with a decreased level of consciousness or unstable vital
signs due to the underlying cause of the headache. In these situations, the health care
professional may decide to treat a specific cause without waiting for tests to confirm the
diagnosis.
For example, a patient with headache, fever, stiff neck, and confusion may have meningitis.
Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and
a lumbar puncture are performed to confirm the diagnosis. It may be that another diagnosis
ultimately is found, for example, a brain tumor or subarachnoid hemorrhage, but the benefit of
early antibiotics outweighs the risk of not giving them promptly.
blood tests;
computerized tomography (CT scan) of the neck;
magnetic resonance imaging (MRI) scans of the head; and
lumbar puncture (spinal tap).
Specific tests will depend upon what potential issues the health care professional and patient
want to address.
Blood tests
Blood tests provide helpful information in association with the history and physical examination
in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise
in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive
protein (CRP). These two tests are very nonspecific; that is, they may be abnormal with any
infection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of
the infection or inflammation. The ESR is often used to make the tentative diagnosis of temporal
arteritis, a condition that affects an older patient, usually over the age of 65, who presents with a
sharp, stabbing temporal headache, due to inflammation of the arteries on one side of the head.
Computerized tomography (CT scan) is able to detect bleeding, swelling, and some tumors
within the skull and brain. It also can show evidence of a previous stroke. With intravenous
contrast injection (angiogram), it may also be used to look at the arteries of the brain for
aneurysms.
MRI is able to show the anatomy of the brain and the layers that cover the brain and the spinal
cord (meninges). It is more precise than computerized tomography. This type of scan is not
available at all hospitals. Moreover, it takes much longer to perform, requires the patient to
cooperate by holding still, and requires that the patients have no metal in their body (for
example, a heart pacemaker or metal foreign objects in the eye).
Lumbar puncture
Cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a
needle that is inserted into the spine in the lower back. Examination of the fluid looks for
infection (such as meningitis due to bacteria, virus, fungus, or tuberculosis) or blood from
hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to
make certain there is no bleeding, swelling, or tumor within the brain. Pressure within the space
can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the
diagnosis of idiopathic intracranial hypertension (previously known as pseudotumor cerebri)
in combination with the appropriate history and physical examination.
When should I seek medical care for a
headache?
Readers Comments 6
Share Your Story
The "worst headache of your life." This is the wording often used in textbooks as a cue
for medical practitioners to consider the diagnosis of a subarachnoid hemorrhage due to a
ruptured cerebral aneurysm. The amount of pain will often be taken in context with the
appearance of the patient and other associated signs and symptoms. Too often, patients
are prompted to use this expression by a health care professional and do not routinely
volunteer the phrase.
Different than your usual headaches
Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity
Associated with persistent nausea and vomiting
Associated with fever or stiff neck. A stiff neck may be due to meningitis or blood from a
ruptured aneurysm. However, most patients who complain of a stiff neck have muscle
spasm and inflammation as the cause.
Associated with seizures
Associated with recent head trauma or a fall
Associated with changes in vision, speech, or behavior
Associated with weakness or change in sensation on one side of the body that may be a
sign of stroke
Not responding to treatment or is getting worse
Requires more than the recommended dose of over-the-counter medications for pain
Disabling and interfering with work and quality of life
How do you get rid of a headache? Are
home remedies effective for headaches?
It is important to consider that an unusual headache may need to be evaluated by a health care
professional, but in most instances, primary tension headaches may be initially treated at home.
Those with migraine headaches often have a treatment plan that will allow treatment at home.
Prescription medications are available to abort or stop the headache. Other medications are
available to treat the nausea and vomiting. Most patients with migraine headaches get much
relief after resting in a dark room and falling asleep.
Patients who have secondary headaches will often need to seek medical care.
Anemia is a disease marked by low numbers of red blood cells. Low iron or underlying disease, like cancer, may be
to blame. Treatment can resolve anemia.
Are elevated C-reactive protein (CRP) levels dangerous? C-reactive protein (CRP) is a blood test that doctors can
use to detect risk of heart disease, heart attack, stroke, and peripheral arterial disease. CRP is a highly reactive
protein that is found when there is general inflammation within the body. CRP levels seem to be able to predict
cardiovascular risk at least, and cholesterol levels.
Caffeine Quiz
If you can't function without your morning cup of java or your afternoon caffeine jolt, this quiz is for you. Learn
about your caffeine addiction with the Caffeine Quiz.
Chronic rhinitis and post-nasal drip symptoms include an itchy, runny nose, sneezing, itchy ears, eyes, and throat.
Seasonal allergic rhinitis (also called hay fever) usually is caused by pollen in the air. Perennial allergic rhinitis is a
type of chronic rhinitis and is a year-round problem, often caused by indoor allergens, such as dust, animal dander,
and pollens that may exist at the time. Treatment of chronic rhinitis and post nasal drip are dependent upon the type
of rhinitis condition.
o ANED: Alive no evidence of disease. The patient arrived in the ER alive with no evidence of
disease.
o ARF: Acute renal (kidney) failure
o cap: Capsule.
o HA: Headache
o IBD: Inflammatory bowel disease. A name for two disorders of the gastrointestinal (BI) tract,
Crohn's disease and ulcerative colitis
o JT: Joint
o T: Temperature. Temperature is recorded as part of the physical examination. It is one of the "vital
signs."
Complete Blood Count (CBC)
A complete blood count (CBC) is a calculation of the cellular makeup of blood. A CBC measures the concentration
of white blood cells, red blood cells, platelets in the blood, and aids in diagnosing conditions and disease such as
malignancy, anemia, or blood clotting problems.
MRI (magnetic resonance imaging) is a procedure that uses strong magnetic fields and radiofrequency energy to
make images of parts of the body, particularly, the organs and soft tissues like tendons and cartilage.
Both CT and MRI are painless, however, MRI can be more bothersome to some individuals who are claustrophobic,
or suffer from anxiety or panic disorders due to the enclosed space and noise the machine makes.
MRI costs more than CT, while CT is a quicker and more comfortable test for the patient.
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Headaches Quiz
If you're plagued with headaches, our Headaches Quiz may help you identify causes, triggers, symptoms, and
treatments for headache pain caused by different types of headaches such as migraines, sinus, cluster, tension, or
stress.
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C. See a picture of Influenza Virus and learn more about the health topic.
Migraines Slideshow
What does a migraine headache feel like compared to a tension headache? Learn to spot migraine symptoms early,
how to identify your triggers, and get more information on migraine headache medications and treatments. Learn to
tell migraine from other types of headaches.
Pregnancy symptoms can vary from woman to woman, and not all women experience the same symptoms. When
women do experience pregnancy symptoms they may include symptoms include missed menstrual period, mood
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pregnancy include leg swelling and shortness of breath. Options for relief of pregnancy symptoms include exercise,
diet, and other lifestyle changes.
Root Canal
A root canal is a dental procedure that's used to save an infected tooth. Treatment involves removing the tooth's
nerve and pulp and then cleaning and sealing the tooth. Symptoms and signs that indicate a root canal is needed
include toothache, discoloration, swelling, tenderness, prolonged sensitivity to hot or cold, and a persistent pimple
on the gums. Typically, a root canal is no more painful than having a filling placed.
Stroke Slideshow
What is a stroke? Learn about stroke symptoms like sudden numbness or weakness, confusion, vision problems, or
problems with coordination. Discover causes and recovery of a stroke.
Testicular Pain
Testicular pain, or pain in the testicle or testicles are caused by a variety of diseases or conditions such as testicular
trauma, testicular torsion, varicoceles, testicular cancer, epididymitis caused by infections such as STDs, and
orchitis.
Common symptoms of pain in the testicle or testicles are abdominal pain, urinary pain or incontinence, fever,
nausea, vomiting, and pain in the scrotum or testicle. Treatment depends on the cause of the testicular pain or pain in
the testicles.
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