Understanding Different Types of Headaches

Headaches are one of the most common types of pain, affecting millions of people worldwide. They can range from mild and infrequent to severe and debilitating and can significantly impact a person's quality of life.

There are over 150 known types of headaches, each with unique triggers, symptoms, and treatments. Understanding the different types of headaches can help you better manage your headaches and know when to seek medical attention.

Primary Headaches

Primary headaches are headaches that are not caused by another underlying medical condition. You have this disorder if you have experienced headaches for more than 15 days a month over the last three months. They are the most common type of headache, and they include:

• Chronic daily headaches: “Chronic daily headache” is an umbrella term for several persistent headaches, occurring daily over long periods. Often, chronic daily headaches interfere with your work, disturb your sleep, and decrease the quality of your life. A primary chronic headache may be further divided into short-duration headaches that last under four hours or long-duration headaches that last over four hours.
• Tension headaches (or stress headaches): The most common type of primary headache, tension headaches are characterized by a dull, aching pain that feels like a tight band around the head. They can be caused by stress, muscle tension, poor posture, and lack of sleep.
• Migraines: Migraines are severe headaches that can cause throbbing pain, often on one side of the head. They can also be accompanied by nausea, vomiting, sensitivity to light and sound, and aura (visual disturbances). Stress, hormonal changes, certain foods, and lack of sleep can trigger migraines.
• Cluster headaches: Cluster headaches are severe, one-sided headaches that occur in clusters. They are often described as a burning or piercing pain around the eye. Alcohol, smoking, and changes in sleep patterns can trigger cluster headaches.
• New daily persistent headaches: New daily persistent headaches (NDPH) are headaches that occur every day for at least three months. They have a “vice-like” quality and start on both sides of the head. Like migraines, they may cause nausea and sensitivity to light and sounds. The cause of NDPH is unknown, but it is thought to be related to changes in the brain's pain-processing pathways.

Secondary Headaches

Sometimes, a headache is a red flag that something else is wrong. Secondary headaches are headaches that are caused by another underlying medical condition. They can be caused by a variety of conditions, including:

• Sinus infections: Sinus infections can cause headaches, facial pain, and pressure.
• Dehydration: Dehydration can cause headaches, fatigue, and dizziness.
• Caffeine withdrawal: People who regularly consume caffeine can experience headaches if they suddenly stop.
• Medication overuse: The overuse of pain medications may actually lead to rebound headaches. Rebound headaches start as your body withdraws from the effects of medication that may have initially helped treat your headache. Therefore, medication overuse may be a secondary cause of your headaches. In this situation, your doctor may stop the medications you use for acute (sudden-onset) headaches and eventually replace them with prophylactic medications (medications that prevent headaches). This can determine if medication overuse is increasing your headaches.
• Hormones: Also known as a menstrual migraine, hormone headaches can result from the changes in estrogen levels associated with menstruation.
• High blood pressure: High blood pressure can cause headaches, especially in the morning.
• Cervicogenic headaches: Cervicogenic headaches start on one side of the neck and spread to the head. Neck (cervical spine) injuries often cause them. In young females, they may start when overly loose ligaments cause friction in the neck joints. In older people, they may start when arthritis damages the neck joints.
• Occipital neuralgia: Occipital neuralgia is an ache or stabbing pain in the back of the head. It starts when the occipital nerves that run in the scalp at the back of the head are pinched.
• Nerve compression: Nerve compression headaches result from pressure on a nerve in the face or head. An example is trigeminal neuralgia.
• Spinal headaches: Spinal headaches, also known as postdural puncture headaches, are intense headaches caused by a leak of cerebrospinal fluid (CSF), the protective liquid surrounding your brain and spinal cord. This leak can occur through a tiny puncture in the dura mater, the membrane enclosing the CSF, during procedures like a spinal tap or epidural, causing the pressure around your brain to drop.
• Brain tumors: Brain tumors can cause headaches, but this is a rare cause.

When to See a Doctor for Headaches

Occasional headaches are common and usually do not require medical attention. However, you may need to see a doctor if:

• You have more than two headaches each week
• You take an over-the-counter pain reliever for your headaches on most days
• Your over-the-counter pain medicine does not improve your headaches
• Headaches become more frequent or more intense
• The headaches interfere with your concentration or sleep

Diagnosis for Chronic Headaches

It is essential to first rule out infections, tumors, or other urgent issues that can lead to headaches. During diagnosis, a pain specialist will typically:

• Perform a neurologic exam.
• Review head/neck X-rays, CT scans, MRIs, and past medical records.
• Use diagnostic injections (blocks) to find the source of pain.

Depending on the cause, headaches may improve with medications, neck bracing, referrals to physical therapy, and chiropractic colleagues.

Treatment for Headaches

The treatment for headaches will vary depending on the type of headache. For primary headaches, such as tension headaches and migraines, over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be helpful. Triptans — a family of tryptamine-based drugs can also be used to stop migraines and cluster headaches. Some people may also find relief from relaxation techniques, such as yoga or meditation.

For secondary headaches, the treatment will focus on the underlying medical condition. For example, if your headaches are caused by a sinus infection, you will need antibiotics. If your headaches are caused by dehydration, you will need to drink plenty of fluids.

Botox Injections for Migraines

For years, Botox injections have been used to relax spastic muscles in children with cerebral palsy and patients with spasticity in their limbs after stroke or spinal cord injury. Similarly, Botox relieves migraine pain by relaxing the muscles in the face and head. As an added benefit, studies have shown Botox has a possible anti-inflammatory effect. It may even play a role in blocking pain signals from reaching the brain.

• How often can it be used, and how long does it last? Administered at an affiliated NSPC office, Botox injections for migraine headaches can be repeated every 12 weeks if necessary. The effects, however, can last up to six months.
• Do the injections hurt? No, Botox injections do not typically cause any significant soreness. Some noted side effects include temporary flu-like symptoms, which is relatively rare. There have been some reported issues regarding Botox spreading minimally from the area of injection, but the effects are temporary.
• Is Botox right for me? Proper evaluation and diagnosis are crucial and always the first step for patients.

Additional Headache Treatments Available

• Cervical Epidural Steroid Injections
• Occipital Nerve Blocks
• Occipital Nerve Stimulation
• Trigeminal Nerve Blocks
• Stellate Ganglion Blocks
• Medial Nerve Blocks
• Medial Nerve RFA
• Sphenopalatine Ganglion Block (SPG)
• Joint Injections
• Trigger Point Injections
• Botox Injections
• Prolotherapy
• Platelet Rich Plasma (PRP Therapy)
• Peripheral Nerve Stimulation (PNS)
• Spinal Cord Stimulation (SCS)

Headache Prevention

There are a number of things you can do to try to prevent headaches, including:

• Manage stress
• Get enough sleep
• Eat a healthy diet
• Stay hydrated
• Avoid triggers, such as certain foods or alcohol

Medications That Prevent Headaches

There are multiple medications that reduce the frequency of chronic daily headaches. Consult an NSPC-affiliated pain specialist for a personalized regimen to prevent headaches.

• Amitriptyline (Elavil) is an antidepressant that reduces the duration of headaches as well as their severity. It is used for chronic tension-type headaches.
• Tizanidine (Zanaflex) is an alpha-adrenergic agonist that is effective for chronic migraine and chronic tension-type headaches. It reduces headache severity, frequency, and duration.
• Gabapentin (Neurontin), a gamma-aminobutyric acid analog, increases the number of headache-free days compared with a placebo in patients who have chronic daily headaches.
• Valproate (Depacon) and topiramate (Topamax) are anticonvulsants that can reduce the frequency of chronic migraines by 50%.
• Propranolol is a beta-blocker (a medication that is often used to control high heart rates) that also reduces the frequency of migraines. Its effectiveness for chronic migraine treatment is unclear.

Headaches are a common problem, but there are many different types of headaches, each with its own unique set of symptoms, triggers, and treatments. If you are experiencing headaches, seeing a doctor such as a pain management physician is important to determine the cause and get the right treatment. You can often manage your headaches and live a pain-free life with proper treatment and lifestyle changes.

Ease headaches and seek treatment from our network of pain specialists. Find a location near you and begin finding relief today!