How To Know The Type of Your Headache?

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1. Tension-type headache (commonest):

People always think that migraine is the most common type of headache. However, tension-type headache (TTH) is the most widespread cause of both occasional and chronic headaches.

According to Uptodate.Com, about 90% of primary headaches are Tension-type headaches (TTH). In addition, TTH is the world’s second-most prevalent disease (reference).

The remaining 10% of primary headaches are due to other types such as migraine and cluster headaches.

Types of TTH (according to frequency):

To help you understand the causes and the symptoms, we divide TTH into three main subcategories according to headache frequency:

  1. Episodic, infrequent TTH: Episodes less than one day a month
  2. Episodic, Frequent TTH: Episodes from one to 14 days a month.
  3. Chronic TTH: Episodes 15 or more days a mo)nth.

Causes of TTH:

The primary mechanism of tension-type headaches is contraction and spasm of the muscles of the face and the neck (reference).

The exact cause is unknown; the episodic forms of TTH (especially the infrequent episodic type) are often related to triggers such as wrong head or neck postures for long periods leading to muscle strains.

With the chronic variant of TTH, Genetic factors with altered brain sensation of bain may be the cause. The role of muscle strain and physical stress in chronic TTH is not essential.

Also, some reports link TTH to nutritional deficiency of specific vitamins such as Vitamin B-12 and Vitamin D.

Symptoms (How to know?):

  • Unlike migraine and cluster headaches, The characteristics of TTH are generally non-specific (Called the dull headache).
  • Location: Often bilateral and diffuse in nature (surround the head or neck as a cap.
  • Severity: Mild to moderate (often not severe as migraine and cluster headache.
  • Character: Dull constant ache in the head (not throbbing or pulsating).
  • Duration of the single episode: It is highly variable, but it is often at a lead of 30 minutes duration and may last for several days (in a single episode).
  • Frequency of episodes: described above for the different subtypes of TTH (episodic frequent, episodic infrequent, and chronic types).
  • Associated symptoms such as nausea, vomiting, intolerance to light, or sounds are absent or very minimal.
  • Tenderness over the head or neck muscles at the headache location is common.
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2. Migraine headache.

Migraine headache is another common type of chronic headache with more severe symptoms. Migraine affects about 15% of people worldwide (reference).

Migraine is usually a severe type of headache felt as throbbing or pulsation pain on one side of the head (30% felt bilateral).

The cause of migraine headaches is also not well understood. However, it is thought to be related to temporary changes inside your brain (brain chemicals, nerve cells, or blood vessels).

Symptoms (how to know it is a migraine?):

Migraine has more distinctive features that separate it from tension-type headaches. Migraine tends to be more severe, unilateral, pulsating, and associated with an aura (see below).

The typical migraine episode passes into four stages:

1. Migraine prodrome:

  • Occurs in most patients (77% of patients with migraine pass through the prodrome stage).
  • Prodrome symptoms are a group of affective or mood symptoms that proceeds with the headache.
  • Common symptoms include repeated yawning, euphoria, depression, irritability, food cravings, neck stiffness, and sometimes constipation.

2. Migraine Aura:

  • Affects about 25% of patients with migraine.
  • They are a group of neurological symptoms and are characteristic of migraine; they include:
  • Visual symptoms (bright lines, shapes, objects, or visual loss).
  • Hearing symptoms (tinnitus, hearing noises, music, or loss of hearing).
  • Abnormal movements or inability to move a part of your body.
  • Patients can experience one or more symptoms at the same time.
  • Duration: the symptoms develop gradually but disappear rapidly in no longer than an hour.

3. The migraine headache stage.

  • Starts after or during the aura stage.
  • It is often unilateral (70%), but it can be bilateral (30%).
  • Pulsation or throbbing in character is felt in the front and sides of the head.
  • The episode’s duration is at least 4 hours, and it can last for several days if left untreated.
  • Headache is often exacerbated by daily activities such as walking or climbing stairs (impairing the quality of life).
  • It can be associated with other symptoms such as nausea and vomiting.

4. Migraine postdrome.

  • Starts after the resolution of the headache.
  • The patient may feel pain when he turns his head or neck.
  • Exhaustion and fatigue.

The table below illustrates the main differences between TTH and migraine.

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TypeTension-type Headache
Migraine

Prevalence
More common, affecting up to 86% of peopleCommon, affecting up to 15% of people.
uni- or bilateralOften bilateralAdults: 70% unilateral, 30% bilateral.
Children & Adolescents: often bilateral
LocationDiffuse (as a cap or tight band surrounding the head).Front and sides of the head, around the eye.
CharacterDull, non-throbbing.Throbbing or pulsation.
Severity++ or ++++++ or +++++
Duration.
At least 30 minutes, up to seven days in a single episode.At least 4 hours, up to several days.
Associated symptoms
Less prevalent.Common, visual changes, photophobia, phonophobia, decreased appetite, exhaustion, etc.
physical activity
No effect (often doesn’t interfere with daily activity).Worsens the headache (such as walking or climbing stairs).
Nausea or vomiting
rareCommon
Tenderness over facial or neck muscles
Common.Rare.

Migraine triggers (and their frequency):

  • Emotional stress (80%).
  • Hormonal disturbances in women (65%).
  • Not eating (fasting or skipping meals) (57%).
  • Wheather changes (53%).
  • Sleep disturbances (50%).
  • Certain odors (44%).
  • Neck pain (38%).
  • Bright light (38).
  • AIcohol (38%).
  • Smoke (36%).
  • Heat (30%).
  • Certain foods (27%).
  • Exercise (22%).

3. Cluster headaches.

Cluster headache is a group of headaches called (Trigeminal Autonomic Cephalalgias). This group of headache syndrome has two distinct characteristics:

  • First, they affect one side of the head.
  • They are associated with autonomic symptoms at the same site, such as teaing, dropping of the eyelid, etc. (see later).

Cluster headache is rare relative to other headaches such as TTH and migraine. It represents less than 1% of chronic headaches and affects primarily males (reference).

Symptoms (how to know it?):

  • Location: Periorbital (around the eye) and temples (the area between the eye and the ear).
  • Side: strictly unilateral (cluster headache never affects both sides at the same episode). The symptoms always remain on the same side.
  • Character: Sharp, stabbing, or excruciating (one of the worst headaches).
  • Episode duration: shorter than migraine (from 15 minutes to 3 hours).
  • Frequency of episodes: anywhere between once every other day up to eight times a day.
  • Autonomic symptoms typically occur only during the attack and on the same side of the headache. They include dropped eyelid, tearing, red eye, runny nose, nasal congestion, sweating, and flushing on the same side.

4. Secondary headache syndromes:

Secondary headache is a term that describes a headache that occurs due to disease, tumor, or a condition. Headache in such a condition is not the primary disease, and it is only a sign of another condition.

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The conditions and diseases that cause secondary headaches are innumerable. Some of them are serious such as brain cancers, while the majority are simple such as common cold, toothaches, etc.

In one study, about 39% of patients who presented with a headache were diagnosed as secondary headaches.

The three most common causes of secondary headaches are:

  • Acute hypertension (elevated blood pressure).
  • Sinus headache.
  • Fever (as with common cold, influenza, etc.).

Secondary headaches are also common with neurologic diseases such as:

  • Post-traumatic headache (after severe trauma to the head).
  • Brain tumors.
  • Cervical spine diseases (neck spines).

The features and symptoms of the secondary headache vary widely according to the cause.

Moreover, there are always other symptoms and signs of the original disease.

Danger signs of headache that may raise the suspicion of headache secondary to a severe diseases include (reference):

  • Systemic symptoms include fever
  • Neurologic deficit (including decreased consciousness)
  • Onset is sudden or abrupt
  • Older age (onset after age 50 years)
  • Pattern change or recent onset of new headache
  • Positional headache
  • Precipitated by sneezing, coughing, or exercise
  • Papilledema
  • Progressive headache and atypical presentations
  • Pregnancy or puerperium
  • Painful eye with autonomic features
  • Post-traumatic onset of headache
  • Pathology of the immune system such as HIV
  • Painkiller (analgesic) overuse (e.g., medication overuse headache) or new drug at onset of headache

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