Learn your Headache type
Headaches can be broken down into two major categories: Primary Headache Disorders, and Secondary Headache Disorders.
- Primary Headache Disorders - WebMD suggests that Primary headaches are headaches that are not the result of another condition. In other words, there is no deeper underlying cause. These headache types are due to the headache condition itself. Examples of primary headaches include tension-type headaches, migraine or cluster headaches.
- Secondary Headache Disorders - Secondary headaches develop as a secondary symptom of an underlying condition. Doctors Young and Silberstein suggest that "quite often, a secondary headache can be ruled-out by a thorough history and physical examination." Examples include Sinus Headache (from sinusitis), infections of the head or neck, or stroke.
More Common Headaches
- Tension - Type Headache (TTH) - This is the most commonly experienced type of headache. This headache is bilateral (two-sided) and is usually pressing or squeezing in sensation (rather than throbbing). It is not accompanied by nausea – unlike migraine. It is mild-to-moderate in pain severity. Routine or exercise does not make a TTH worse (unlike migraine). This featureless headache has no vomiting or nausea. In its chronic form it is referred to as Chronic Tension-Type Headache.
- Medication Overuse Headache (MOH) - This headache was formerly referred to as Medication-Induced Headache and also Rebound Headache. MOH is a condition that wherein, over time, pain relievers and other acute medicines (eg. triptans) which are used to stop headaches and are taken too frequently - now cause more frequent or daily headaches. It is a concept of too much of a good thing. Medication overuse headache requires that the patient be withdrawn from the substance being overused. This can be done in several ways, depending on the type of medicine that is being withdrawn. Outpatient detoxification at home may work for some patients, while other patients requiring more aggressive detoxification might require a hospital setting, or a physician’s help.
- See a more complete article here (Brent give Chad article to link to)
Chronic & Sometimes Refractory (resistant to treatment) Types:
- Chronic Migraine (CM) - When people with migraine have headache on more than 15 days a month, they are diagnosed with chronic migraine. Chronic Migraine is one cause of very frequent headache, with some patients having headache almost every day or even every day. Some days patients may mistake the pain for a “tension-type headache” or even think the pain is coming from their sinuses when the pain is less severe. Many patients with chronic migraine also use acute headache pain medications on more than 10-15 days per month, and this can actually lead to even more frequent headache. Botox injections are treatments approved by Health Canada. You can also visit www.mychronicmigraine.ca Also visit the CM button on the middle-far-right of our homepage.
Note: Since CM has been known to be refractory to treatment at times, I have listed it in this section, as well as with other Migraine Types.
- Chronic Tension Type Headache (CTTH) - Chronic Tension Type Headaches frequently involve the posterior (back) part of the head and neck, and are often bi-lateral (2 sided). They are usually pressing or squeezing in quality. CTTH may be a daily, or near daily headache that may evolve from episodic tension-type headaches. Most features of migraine are generally absent and nausea is uncommon, but mild nausea may be present. This headache type can affect both genders.
- Hemicrania Continua (HC) - This is a chronic daily headache sub-type that is characterized by continuous, moderately severe, one-sided headache pain that varies in intensity. Hemicrania Continua can be accompanied by light or sound sensitivity, or nausea. Sometimes it may be associated with tearing or drooping of the eye. For this reason it is sometimes confused with cluster headache. Usually this headache is continuous but it can be remitting (comes and goes). Most patients have the chronic form; some have remitting form. The continuous form often occurs daily for years. It is known for its rapid response to a medication called Indomethacin.
- Hypnic Headache (HH) - Hypnic Headache has also been called the 'alarm clock headache', due to its nocturnal ability to wake patients from sleep at roughly the same time. It is a headache characterized by short-lived headaches that occur exclusively during sleep, are generalized and may be severe. Some patients suffer for decades before a proper diagnosis is made. Initially, caffeine at bedtime is recommended; Indomethacin can also be tried
- New Daily Persistent Headache (NDPH) - A sub-category of chronic daily headache in which the headache often begins abruptly and affects mostly women. Many patients will recall the exact day that these headaches began - sometimes for no apparent reason. Dr Werner Becker suggests that this headache is often bi-lateral (2 sided), it is mild-to-moderate in intensity,. and often patients experience a near constant headache. Interestingly, over 40% of sufferers say there is no reason as to why their headaches began. In some cases, they can be triggered by a flu-like illness or brought on by surgery. NDPH predominantly affects women and they can be refractory (resistant) to treatment.
- Post-Traumatic Headache (PTH) - Headaches that begin after a fall or injury are often referred to as Post-Traumatic Headaches. These headaches can occur after mild, moderate, or severe injury. This headache was formerly known as “Headaches After Head Injuries”. The diagnosis is controversial. At this time, the diagnosis of headache following injury needs to occur within 7 days of the injury. These headaches may clinically resemble migraine, tension type, occipital neuralgia and others. If the headache lingers after a head injury after 3 months, then the diagnosis of chronic post-traumatic headache is often made. A button on the upper-far-right of our homepage has an article on PTH.
- Access our poster on Chronic Daily Headache, that was medically edited by Dr. Werner Becker, from Calgary, Alberta by clicking HERE (send Chad CDH Poster)
Rare and Uncommon Headaches
- Cervicogenic Disorder (Headaches due to Neck Problems ) - A one-sided headache that may be associated with neck disorders such as arthritis and prior neck injuries. Neck triggers and reduced range of motion are typical. Some controversy exists among headache specialists, about the origin of this pain. Chiropractors often address neck problems.
- Cluster Headache (CH) - Usually a one-sided type of headache that affects males over females by approximately 3:1. The pain attacks can be very severe. Attacks come in “clusters”, then often take a holiday. The pain is very often on the same side. The pain sensation is often piercing in quality (like a red hot poker through the eyeball), quite intense and may be associated with redness or watering of the eye and stuffiness of the nose. Direct oxygen administered by face mask can sometimes be used to abort this headache. The chronic version is referred to as Chronic Cluster Headache. Cluster headaches can be an excruciating type of headache, and are sometimes referred to as "suicide headaches."
- Ice pick Headaches - are pretty self-explanatory. They feel like you’re getting stabbed in the head with an ice pick. They often come on suddenly, delivering an intense, sharp pain. They’re short–usually only lasting 5-30 seconds–but incredibly painful. These headaches occur on the orbit, temple, and parietal area of your head. That’s where your trigeminal nerve is, which is the nerve in your face that’s responsible for biting and chewing, as well as for sensation. The nerve is on the side of your head just past your eye and above your ear. If you get sharp pains in this area, chances are you’re getting ice pick headaches.
- Myofacial Pain - Myofacial Pain Syndrome is a chronic pain disorder. In Myofacial Pain pressure is placed on sensitive points - known as “trigger points”. Experts believe that the actual site of the injury or the strain begins the development of a trigger point that, in turn, causes pain in other areas; this situation is known as referred pain.
- Occipital Neuralgia (ON) is a relatively rare head pain disorder that is experienced on the back of the head, at the occipital region. It is thought to be provoked (triggered) by touching the face; brushing the hair; wearing a hat; lying on a pillow or some other sudden movement. The pain sensation is sharp, piercing, or stabbing in quality and severe in intensity. Attacks generally last from a few seconds to a few minutes. Migraine medicines, nerve blocks (freezing the nerve) and physiotherapy are recommended treatments
- Paroxysmal Hemicrania - This is a very rare headache type that is cluster-like in its presentation, that often begins in adulthood and is characterized by severe, throbbing pain that is boring, or drilling in nature and it usually affects one-side of the face, in and around the eye. The pain of PH is a red, tearing eye, a droopy or swollen eyelid, and nasal congestion. Interestingly enough these are features of cluster Headache - which affects more males than females. PH tends to affect more females than males. There are 2 types - a chronic type and an episodic type. The drug Indomethicin almost always brings resolution to this headache. Non-Drug treatments are not known
- Sinus Headache - Acute inflammation in one or more of the nasal sinuses by a viral or bacterial infection can cause acute headache. The pain is usually localized over the affected sinus, and may be associated with thick, yellow or yellow-green nasal mucous. The “headache” is usually a non-throbbing pressure felt over the affected sinus. There may be accompanying reduction or absence in sense of smell, and fever can be present.
Chronic sinus disease is rarely, if ever associated with headache. Patients with recurrent headaches associated with nasal stuffiness and watery nasal discharge, without fever are much more likely to have chronic migraine. Vasodilation (expansion of blood vessels) in the sinuses and nasal passages can lead to nasal stuffiness and watery nasal discharge, associated with the migraine headache, and these symptoms often respond to “sinus headache” compounds that contain a pain reliever and a decongestant—leading patients and primary care physicians alike to make a diagnosis of chronic sinus headache.
If you have had an MRI or CT scan that is normal, you DO NOT have sinus headache. Dr. Stewart Tepper (a renowned Headache Neurologist) found that over 90% of self-diagnosed and primary care physician-diagnosed sinus headaches met International Headache Society criteria for migraine.
- Temporomandibular Joint (TMJ), (TMD) - The temporomandibular joint is the joint between the lower jaw (mandible) and the skull. Excessive wear - damage to this joint or inflammation can cause pain. Clicking, or popping sounds are sometimes noted. There is a strong correlation between clenching or grinding of the teeth and headache pain. Bite-Plates should be a discussed with your dentist. Experts recommend TMJ patients NOT chew gum. Stress is often a factor. Lifestyle changes are effective treatments. Self-help tips can be found at www.tmj.org
- Trigeminal Neuralgia (TN) this headache is considered quite rare and it is characterized by sharp, short jabbing pains to the face. This intense pain may last from a few seconds to one minute, striking many times during the day. These headaches are most commonly found in women over 55. Treatment usually involves anticonvulsants, neurosurgery (freezing of the nerve) and some might benefit from a ‘TN Diet'.
According to OUCH UK: As few as 0.2% (two in a thousand) of the population suffer from CH, approximately the same number as for multiple sclerosis. CH can begin at any age, but most sufferers are more likely to start suffering in their 30s or 40s. Visit OUCHUK at https://ouchuk.org/
A Common but Benign Headache that tends to be more frequent in Migraine Sufferers
Cold Stimulus Headache (formerly known as an Ice Cream Headache) A cold stimulus headache was once called an Ice Cream Headache. At times, when headache sufferers put cold ice cream on the roof of their tongue the cold stimulus can produce a headache. The same term is used for a headache arising from a cold object in the back of the throat near or by the soft palate. Ice cream is simply one food item that can cause this headache type. Again, avoiding that trigger would be the fastest solution to living a pain-free life.
Note: Rare primary headaches include SUNCT Syndrome, Primary Cough Headache, Primary Exertional Headache, Primary Thunderclap Headache, Primary Headache Associated with Sexual Activity, others.
Chronic cluster headache is also extremely rare.
For an extensive list of all classifiable headache types visit www.ichd-3.org
Learn your Migraine type
Types of Migraine
- Abdominal Migraine - Abdominal migraine is a form of migraine seen mainly in children, however it is seen in older adults on occasion. As children with this condition grow older, about half of them will ‘grow out’ of abdominal migraines, into the teenage years. Typical features include abdominal pain, nausea and/or vomiting and sometimes pallor (lack of healthy colour of the skin). The pain is often felt as moderate to severe in intensity.
- Aura Without Headache (formerly Migraine Without Headache) - Also called a Silent or Acephalgic Migraine, this type of migraine can be very alarming as you experience dizzying aura and other visual disturbances, nausea, and other phases of migraine, but no head pain. It can be triggered by any of a person’s regular triggers, and those who get them are likely to experience other types of migraine, too. The International Headache Society classifies this type as Typical Aura without Headache.
- Basilar Migraine - A rare type of migraine where the sufferer can experience an aura consisting of two or more of the following: slurred speech, a spinning sensation, ringing of the ears, heightened sense of hearing, double vision, aura symptoms in both eyes, reeling/lurching walking, decreased level of consciousness or bi-lateral (2-sided) sensory symptoms.
- Chronic Migraine (CM) - When people with migraine have headache on more than 14 days a month, they are diagnosed with chronic migraine. Chronic Migraine is one cause of very frequent headache, with some patients having headache almost every day or even every day. Some days patients may mistake the pain for a “tension-type headache” or even think the pain is coming from their sinuses when the pain is less severe. Many patients with chronic migraine also use acute headache pain medications on more than 10-15 days per month, and this can actually lead to even more frequent headache. Botox injections are treatments approved by Health Canada. You can also visit www.mychronicmigraine.ca Additionally, you can access links to our Chronic Migraine page that is filled with resources. http://www.headache-help.org/chronic-migraine
- Hemiplegic Migraine (HM) - If you have ever had a migraine that felt more like a stroke, it was probably a Hemiplegic Migraine. HM is a rare type of migraine with aura that is accompanied by motor weakness (paralysis) that is fully reversible, but may last for weeks. There are two types of HM that are often experienced in childhood, and cease in adulthood. Paralysis, fever, headache, nausea and/or vomiting are symptoms, there are others. HM can be confused with a TIA or Stroke, or some other neurological disorder, so having a full neurological work-up is important to confirm the diagnosis of HM and to rule-out other serious ailments.
- Menstrually Associated Migraine (MAM) - This migraine type was previously referred to as "Menstrual Migraine". In prepupertal children, the incidence of migraine is equal to boys and girls. However, with menarche and throughout childbearing years, the incidence of migraine in women becomes two to three times that of men. Up to 60% of female migraineurs experience migraines around the Menses. The link between migraine and female sex hormone is well established. The International Headache Society defines this headache as having two subtypes. The most common type is referred to as Menstrually Related Migraine without Aura which must have an onset during the pre-menstrual time period (2 days before to 3 days after the onset of menstruation).
- Migraine with Aura - Migraine with aura represents the least common form of migraine affecting less than 10% of migraine sufferers. Experts suggest that approximately one third of patients with migraine have an aura with some of their headaches, and about half of these patients will have an aura with every headache. The aura usually precedes the headache, but it may occur during the headache also. The symptoms are variable and can include visual disturbances such as black dots, zig zag lines or flashing lights, sensory disturbances, numbness or tingling sensations, motor weaknesses. Auras usually last 15 – 30 minutes, however, in some cases, the aura may occur with no headache - see Aura Without Headache.
- Migraine Without Aura (formerly Common Migraine) - This is the most common type of migraine that is typically experienced on one side of the head, but occasionally presents itself on both sides. It generally consists of moderate to severe throbbing pain. It is commonly associated with light or sound sensitivity. Nausea and vomiting may be present. The majority of sufferers are female and the aura, consisting of neurological sensations (listed above) is absent during this type of migraine attack. Approximately 90% of migraine patients suffer from “migraine without aura”. Diagnosing migraine without aura can be difficult because the symptoms are similar to several other types of migraine. The key differentiator is that Migraine Without Aura lacks the warning phases (prodrome and aura) that other types of migraine have.
- Retinal Migraine - When a headache causes you to temporarily lose vision in one eye, it is a Retinal Migraine. Most common in women during their childbearing years, the blindness can last anywhere from a minute to months, but is usually fully reversible. This is a specific type of aura that accompanies a migraine, and it’s a condition we know very little about. What we do know is that Retinal Migraine may be a sign of a more serious issue, and those who experience it should make a point to see a specialist such as an Optometrist.
- Vestibular Migraine - Vestibular Migraine is a type of migraine during which a sufferer experiences dizziness, or an off-balance or spinning (vertigo) feeling, along with or just before their migraine headache. For some, the headache may not be as debilitating as the vestibular symptoms. In addition to the dizzy feeling, sometimes people experience neck stiffness, sensitivity to light/sound, mental fogginess, and occasionally anxiety/panic. Medicinal treatments include standard migraine preventative therapies such as anti-depressants, beta blockers or calcium channel blockers, and acute therapies for the attack itself. Non-drug treatments include a specific form of physiotherapy that involves exercises and movement, that can be quite helpful.
Stages of Migraine
There are typically 4 stages to a migraine attack and they are the Migraine Prodrome, the Migraine Aura, the Headache Phase, and the Migraine Postrome.
Please note that not all stages are experienced by all who experience migraine.
- Migraine Prodrome - This phase of migraine warns migraineurs that an attack is imminent. Around 60% of sufferers experience various warning signs that an attack in approaching - which include:
- concentration problems
- food cravings
- sleep disturbances
A simple Google search for Migraine Prodrome symptoms would include a comprehensive list of physical, and psychological symptoms.
- Migraine Aura - An aura experienced before the attack, is experienced by less than 10% of all migraine suffers. As Dr. Werner Becker, Neuroscience Professor from Calgary notes: - "Experts suggest that approximately one third of patients with migraine have an aura with some of their headaches, and about half of these patients will have an aura with every headache. The aura usually precedes the headache, but it may occur during the headache also.
The symptoms are variable and can include visual disturbances such as black dots, zig zag lines or flashing lights, sensory disturbances, numbness or tingling sensations, motor weaknesses. Auras usually last 15 – 30 minutes."
- Headache Phase - Generally know as the Attack Phase, these symptoms and characteristics may include:
- throbbing one-sided headache (can be two-sided)
- nausea and vomiting may occur
- sensitivities to light or sound
- dizziness is sometimes present
- neck pain is experienced by some
Migraine.com suggests: "Because the trigeminal nerve becomes inflamed during a migraine, and because of its location, pain may occur around eyes, in the sinus area, and the teeth and jaw."
Migraine Postrome - The Postrome is considered the resolution, or recovery stage that is experienced after the attack. Experts suggest that this phase that follows the headache phase can last up to 48 hours. Some researchers divide this into 2 categories, which are:
Resolution - Typically, at this stage the headache is going away. Some feel better after being sick or from laying down, or from sleep. Symptoms include:
- impaired concentration
- sleep helps
Recovery - Many patients feel being hung-over after a migraine. This is normal. Characteristics can include:
- a feeling of tiredness, or weakness
- a hangover feeling
- usually rest is needed (also recommended by experts)
- altered mood levels such as depression, or euphoria
For an extensive list of all classifiable headache types visit www.ichd-3.org
- Migraine Canada - www.migrainecanada.org
- American Migraine Foundation - www.americanmigrainefoundation.org
- Ouch UK - Organisation for the Understanding of Cluster Headache www.ouchuk.org
- Brent Lucas, Headache Researcher, Executive Director, Help for Headaches, London, Ontario
- Dr. Werner Becker, MD, FRCPC Professor Emeritus, University of Calgary, Calgary, Alberta
- Dr. Elizabeth Leroux, MD, FRCPC, Clinical Associate Professor, Neurology, Headache Clinic, Calgary, Alberta
- Dr. Joel Saper, M.D., F.A.C.P., F.A.A.N. Neurologist - Headache Specialty, Michigan Headache & Neurological Institute, Ann Arbor, Michigan
- Dr. Paul E. Cooper, MD, FRCPC, FAAN, Chief of Clinical Neurological Sciences, London Health Sciences Centre and St. Joseph’s Health Care, London, Ontario
- Dr. Rose Giammarco, M.D., F.R.C.P. (C) Neurologist with Special Interest in Headache, Hamilton Headache Clinic, McMaster University, Hamilton, Ontario
- Irene Worthington, Pharmacist and published author on the acute and prophylactic guidelines for migraine, Sunnybrook Hospital (retired), Toronto, Ontario