What Are Headaches?
Illustration by Dennis Madamba for Health
Medically reviewed by Kashif J. Piracha, MD
Whether you have many headaches or not, you may wonder about the types of headaches and what they mean. There are four main types of headaches—migraine, tension, cluster, and secondary—and more than 15% of people worldwide experience a headache on any given day.
The exact cause of most headaches is unknown beyond secondary headaches. Scientists still believe that the neurological cause may involve the facial nerve, the neurotransmitter serotonin, and other brain chemicals.
The symptoms and severity of headaches depend on the headache type. A healthcare provider can prescribe additional treatment and help you find ways to reduce pain if you are experiencing severe or debilitating headaches.
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Types of Headaches
There are different kinds of headaches—all of which differ in their symptoms, duration, location, and severity. Here are four types of headaches and what they mean:
Cluster: Cluster headaches are a less common type of headache. People with cluster headaches experience pain in one side of the head, which can last anywhere from 15 minutes to three hours. People with this type of headache can have episodes daily or several times a month.
Migraine: A severe form of headache that usually affects one side of your head. Migraine attacks can last anywhere from four to 72 hours.
Secondary: Secondary headaches occur as a symptom of a different underlying condition, such as a sinus infection, head trauma or injury, or substance use or withdrawal. Symptoms of secondary headaches can differ depending on the underlying condition you are experiencing.
Tension: Tension-type headaches cause mild to moderate pain on both sides of the head. The headaches can be as short as a few minutes or last for several days. Tension headaches are the most common type of headache.
Symptoms
Headache symptoms can vary from person to person. The signs also depend on the type of headache that you have.
Migraine
Symptoms of migraine include:
Aura—a symptom that causes you to see flashing lights or zig-zag lines
Foggy vision
Light sensitivity
Nausea or vomiting
Noise sensitivity
Pulsing or throbbing head pain
Tension Headache
People with tension headaches may experience:
Difficulty sleeping
Neck and shoulder pain
Pain on both sides of the head
Pressure or tightness on the head
Cluster Headache
Cluster headaches tend to have more sudden and intense pain than tension headaches. Symptoms may include:
Eye symptoms such as drooping eyelid, tears, and redness
Pain on one side of the head
Restlessness
Sweating
Causes and Risk Factors
Experts know that secondary headaches are a symptom of another condition. Researchers aren’t sure what exactly causes headaches in general, however.
Headache researchers have been studying different theories about several brain chemicals and biological factors that could help explain why people experience headaches. Each type of headache has its own theories of causes and separate risk factors or triggers.
Migraine
Early research suggested that serotonin—a brain chemical messenger known as a neurotransmitter—might lead to migraine symptoms. Scientists believe that serotonin can release a protein called CGRP in some people that activates a facial nerve called the trigeminal nerve. The trigeminal nerve sends pain signals to the brain, resulting in migraine headaches.
Some people may be more likely to experience migraine than others. Risk factors for migraine include having a family history of migraine and experiencing other health conditions such as depression, anxiety, epilepsy, or a sleep disorder. Women are also three times more likely to get migraine than men.
Tension Headaches
Tension-type headaches occur when the muscles in the scalp and neck become tense. However, scientists don’t know the exact reason headache-related muscle tension occurs. Some research suggests that extreme stress, mood disorders, and head injury can increase the risk of muscle tension, which can result in a tension headache. Research on tension headaches remains ongoing.
Common risk factors for tension headaches include emotional stress, eye strain or fatigue, smoking, physically overexerting your body, and excessive use of caffeine. Similarly to migraine, people who have a family history of tension headaches and are assigned female at birth experience tension headaches at higher rates.
Cluster Headaches
There are two main theories that researchers have developed about the cause of cluster headaches. One theory is that a dysfunction in the hypothalamus (the part of the brain responsible for sleep, body temperature, hormone regulation, and blood pressure) could lead to cluster headache symptoms.
The other theory is related to the release of histamine. Histamine is a chemical released in response to an injury, allergy, or inflammation in the brain and may cause head pain and eye and nose-related symptoms.
There are several risk factors for cluster headaches. Those factors can include alcohol and tobacco use, exposure to bright lights, taking certain medications, physical overexertion, and heat (such as hot weather or hot baths).
Diagnosis
Receiving a correct diagnosis for the specific type of headache you have is important to determining the right treatment. If you begin to experience new symptoms or a change in your headache symptoms, it’s good practice to see a healthcare provider.
At your appointment, the provider will ask you about your symptoms, learn about your family history and lifestyle, and perform a physical exam. In some cases, they may also order diagnostic tests to rule out other conditions and confirm a diagnosis.
These tests may include:
Blood tests: It is standard practice for healthcare providers to take a sample of your blood to test it for a complete blood cell count, or CBC test. The CBC test evaluates the current status of your red and white blood cells. In some cases, your provider can also order a C-reactive protein test—a test that can determine if you have inflammation in your body and brain.
Cerebrospinal fluid sample: Cerebrospinal fluid is a body fluid that appears in the brain and spinal tissue. Taking a sample of this fluid and testing it can help a provider learn whether the cause of your symptoms is due to a brain bleed, tumor, infectious disease, or autoimmune condition.
Computer tomography (CT) scan: If you recently experienced a head injury, your provider may order this diagnostic test to see any signs of trauma and assess potential brain damage.
Magnetic resonance imaging (MRI) scan: This scan takes images of the brain and can look for potential suspects of head-related symptoms, such as tumors, bleeding, or fluid retention.
Using this information, a primary care provider or neurologist—a doctor who specializes in the brain and spinal cord—can understand the type of headache you have and how to proceed with treatment.
Treatment
The goal of treatment is to lower your symptoms, prevent the onset of severe symptoms, and improve your quality of life. Over-the-counter treatments are available to manage the headache pain associated with most headache disorders.
For severe pain, a provider may prescribe you certain medications to reduce the frequency and severity of your symptoms. In some cases, drug-free treatments can also help you manage your condition. Treatments for headaches include:
Over-the-counter (OTC) medications: Typically the first line of treatment, OTC painkillers commonly include Tylenol (acetaminophen) and non-steroidal anti-inflammatory drugs such as Advil (ibuprofen).
Serotonin receptors: If OTC medications don’t help, your provider can prescribe you serotonin receptor drugs to help you reduce inflammation and ease symptoms. The most common type of serotonin receptor is Triptans, a class of medications to improve headache pain.
Lifestyle changes: Alongside medication, you might find that lifestyle changes also help improve your symptoms. Some drug-free pain relief methods include staying hydrated with fluids, getting sleep, resting your eyes in a dark and quiet room, and placing a cold compress or ice pack on your forehead.
Preventing Headache Episodes
There is no surefire way to prevent all headaches. However, some prevention tips can help you lower the severity of your headaches and reduce how often headache episodes or attacks occur. Some techniques include:
Drinking enough fluids throughout the day to stay hydrated
Getting 30 minutes of exercise five days a week
Learning stress management techniques such as meditation, breathing exercises, or spending time with your loved ones
Limiting your caffeine intake
Not missing meals and eating nutritious foods
Seeing a mental health professional if you need emotional support or want help with implementing lifestyle changes
Setting a consistent sleep schedule by waking up and going to sleep at the same time each day
Using a journal to write down information about your headache episodes and potential triggers that can lead to symptoms
Related Conditions
In some cases, a headache disorder can co-occur with other health conditions. During your diagnostic process, a healthcare provider may also choose to test you for other diseases—especially if they are concerned that you might be at risk for them. These conditions include:
Chronic pain conditions: People with fibromyalgia (a condition that causes body pain, fatigue, and trouble sleeping) may be twice as likely to develop a headache disorder.
Heart conditions: High blood pressure, diabetes, and stroke commonly co-occur with migraine. These conditions can change how your blood flows to the brain which can lead to headache symptoms.
Psychiatric disorders: Having major depression, bipolar disorder, or anxiety increases your risk of developing migraine.
Restless legs syndrome: As many as one in three people with restless legs syndrome also have migraines. Research suggests that a chemical imbalance in your brain can contribute to migraine and restless legs syndrome symptoms.
A Quick Review
The different types of headaches can produce symptoms such as throbbing head pain, light and sound sensitivity, and nausea. While there is no outright cure for headaches, the good news is that several treatment options are available to help you manage symptoms and prevent future headache episodes. Medication and lifestyle changes are the two most common types of treatment.
If you notice that you are experiencing symptoms or that your headache symptoms have changed, it’s a good idea to see a healthcare provider. They can test you for headache disorder and co-occurring conditions and prescribe stronger medications to help you reduce symptoms and improve your quality of life.
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