Headache Types - which do you have?

What do the different headache types mean?

The type of headache is a key step in working out what is causing your headache.

This in turn gets to a headache diagnosis, which then provides the answer to your burning question: What can I do to relieve my headache?

Most doctors when asked about headache types will jump straight to talking about a diagnosis, without explaining the reason why such a diagnosis is possible.

It is better to think types of pain, types of accompanying symptom and types of activity that are associated with headache.

Links to more detailed description of these symptoms are at the bottom of the page.

Headache Types: What the Head Pain Feels Like

Sharp Head Pains (like those caused by "Ice-pick Headache") are very common and not usually serious if they are sharp and short-lived. They are a nuisance if they occur many times per day, but most people will cope with them if they know that they are not serious

Pounding Headache or Throbbing Headache - will usually be the common type of pain experienced by people with migraine headache. In migraine there is also "sensory sensitivity"

A Pressure type of Headache is most commonly due to Tension-type Headache, which is not at all serious.
People with cluster headache will often describe their pain as an intense pressure around the eye or nose, but they will also have other symptoms of "autonomic activation (see below)".
A pressure type feeling in the head can sometimes be due to raised fluid pressure within the head, and this is especially true in people who are very overweight with constant severe headaches of recent onset.
People who know they have migraine will sometimes start to complain of pressure-type or heavy discomfort in their head. If you have migraine and are starting to get a heavy, pressure discomfort pain in your head you may be developing into Chronic Migraine.

The medical term "Neuralgia" means an extremely intense sharp pain, which can be triggered by touch or movement. The diagnosis of neuralgia depends on the site of the pain and what triggers the pain.
There are several common types of neuralgia which is usually a much more intense experience than ice-pick pains. People with severe neuralgia will often require admission to hospital to control their pain

The Timing or Duration of the Headache

Constant Headache - which can last all day every day or for a good part of every day, is most often seen in people with Chronic Migraine.
In Chronic Migraine episodes of headache have been replaced by a daily dull headache that never goes away. On top of these daily headaches are more typical migraine symptoms at least once per week.

A Sudden Severe Headache that hits you out of the blue will require urgent medical attention. About 10% of people with an out-of-the-blue sudden severe headache will have had a brain haemorrhage. These people will have gone from no headache to the worst headache of their life in the space of about 2 seconds. In brain haemorrhage the pain usually lasts for hours to days, and brain scans are necessary

A First Ever Headache that is not sudden in onset can be due to a long list of causes, although most are in fact a first episode of migraine headache. However, infections such as sphenoid sinus infection, temporal arteritis, high or low pressure in the head could cause a headache like this.

What You Are Doing When the Headache Starts

If a headache only starts during Exercise, it will need to be investigated to rule out Chiari Malformation. In older people Cardiac Cephalalgia is a rare, but treatable cause. Most cases (>80%) do not have any cause and are called Primary Exercise Headache

A Headache when you Cough is not usually due to any identifiable problem on a brain scan. The most common cause seen is also Chiari Malformation.

A headache at Orgasm or during Sexual Activity can cause a lot of distress. A small number of these will be due to something serious such as a brain haemorrhage. However, people with repeated episodes will usually have no cause identified or be found to have the Reversible Cerebral Vasoconstriction Syndrome.

Headaches During Pregnancy are almost always due to migraine. However, there are a small number of complications affecting the arteries or veins in the head that may need to be investigated before making a conclusion of migraine

These Other Symptoms are Important to know when describing Headache Types

As well as the type of pain, these lists of accompanying symptoms are very important when trying to make sense of headache types:

Is Sensory Sensitivity present?

At least one, preferably two, of these symptoms must be present to end up with a diagnosis of migraine headache:

Nausea
Intolerance of light or preference for dark (photophobia)
Intolerance of noise or preference for quiet (sonophobia or phonophobia)
Intolerance of smell (osmophobia)
Intolerance of movement - preference to lie down
Vomiting
Some people also do not want to be touched or have anything in contact with their head

Sensory Sensitivity is the hallmark of migraine, and at least two of the sensory sensitivity symptoms are present in definite migraine.

Autonomic Activation

These symptoms may make you think you have a problem with one of your sinuses, but migraine can sometimes cause these symptoms too! Cluster Headache is the most severe cause of bouts of headache with autonomic activation.

Watering of the eye - lacrimation
Nasal congestion
Running of the nose - rhinorrhoea
Drooping of the eyelid - ptosis
Reddening of the eye - conjunctival injection
Swelling around the eye

There are also some very rare headaches that respond to Indomethacin called Paroxysmal Hemicrania that can have autonomic activation as a strong feature of this headache type.

Other symptoms

Syncope or loss of consciousness at onset of headache Someone who faints at the onset of a thunderclap headache has an increased risk of subarachnoid haemorrhage.

A Headache with Pulsatile Tinnitus may mean raised intracranial pressure such as from Idiopathic Intracranial Hypertension or Cerebral venous Sinus Thrombosis.
Pulsatile Tinnitus sounds like a whooshing noise inside the head or ear that keeps the same beat as your pulse

A temporary difficulty with speech followed by headache, can occur in migraine

Difficulty with vision, also can occur in migraine, but Pituitary Apoplexy can present with acute headache and visual disturbance, as can Temporal Arteritis.

Flashing lights or visual aura followed by headache - is migraine related in the overwhelming majority of cases. About 20% of people with migraine will experience migraine visual aura