By Nicoletta Lanese - Live Science
Most of us know the pain of a headache, but do you know what types of headaches you get?
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.
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" 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.
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.
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.
