Facts You Should Know About Headaches
Picture of a woman with a migraine
- While many people may think that every severe headache is a “migraine,” this label is actually reserved for headaches that meet specific criteria.
- There are many different types of common headaches.
- And, although some of the symptoms associated with each type may overlap, recognizing the distinct features of the headaches can help the patient and doctor determine the best treatment strategy.
1. Migraine Headache
Symptoms of migraine headaches are pain that awakens the individual from sleep.
Migraine headaches are commonly one-sided (unilateral). The pain is described as throbbing or pulsing, and worsens with routine physical activity, such as climbing a flight of stairs. The pain is typically moderate to severe.
Other symptoms include:
- nausea and/or vomiting;
- sensitivity to light, sound, or smells; and
- pain that awakens the individual from sleep.
A migraine headache may last from several hours to 3 days.
2. Sinus Headache
Sinus headache pain is generally around or behind the eyes, across the cheeks and bridge of the nose, along the forehead, or along the top teeth.
The pain associated with sinus headaches is generally located around or behind the eyes, across the cheeks and bridge of the nose, along the forehead, or along the top teeth. The pain is often described as a pressure-like sensation and is constant. Leaning forward or upside down, sudden activity, or exercise can make the pain worse.
Symptoms of an upper respiratory infection, including
- the discolored nasal mucus,
- nasal congestion,
- plugged ears,
- swelling of the face, and
- a fever may accompany sinus headache.
3. Tension Headache
Tension headaches are a pressure or tight sensation, often described as “vice-like” in quality. The pain is typically mild to moderate, but can become severe.
Some characteristics of a tension headache:
- There is no associated throbbing or pulsing to the pain of a tension headache.
- There is no exacerbation or increase in the pain with exercise.
- Nausea and vomiting are not associated with tension headaches.
- Some patients do occasionally describe either light sensitivity or noise sensitivity.
4. Cluster Headache
Cluster headache is another very distinct type of head pain. The pain is always one-sided during the cluster attack. However, the side that is affected can vary from headache to headache.
- The pain is typically a stabbing or piercing pain, which is extremely severe.
- Despite the severity, the headache usually lasts only 10 minutes to 3 hours and then resolves.
- However, the headache can recur several times over the course of a day or week.
- Laying down often worsens the pain.
Symptoms frequently seen with cluster headache include:
- watering of the eye on the side of the headache and
- nasal congestion on the side of the headache.
- The eyelid on the affected side may appear droopy.
- Cluster headaches are frequently triggered by alcohol consumption.
5. Mixed or Mixed Tension Migraine
This headache type has features of both migraine headache and tension headache.
- Sufferers describe the pain as dull and constant or throbbing and the severity may be mild, moderate, or severe.
- Other symptoms of migraine, including light and sound sensitivity or nausea and vomiting, may be present.
- There may be neck pain or scalp muscle tension.
Different things can trigger different types of headaches.
For example, the following might lead to recurrent tension headaches:
- stress at work or at home,
- poor sleeping habits,
- diet changes,
- visual problems,
- environmental stressors or
- poor posture.
Migraines can be triggered by many different factors, including:
Cluster headaches can be triggered by alcohol or seasonal variation. Sinus headaches are triggered by a sinus infection.
Types of Headache Pain
The different types of pain associated with a headache can lead to a specific diagnosis as to headache type.
- Throbbing or pulsing pain is associated with migraine while pressure or “vice-like” pain is typically associated with tension headaches. In these headaches, the severity may vary from mild to severe.
- Cluster headache is stabbing, piercing, and severe.
- Sinus headaches are described as pressure and pain behind the eyes, along the cheeks, or in the areas of the upper teeth and forehead.
Headache Types by Location
Forehead: Headaches that occur along both sides of the forehead are often tension headaches or sinus headaches. If the pain is one-sided, then migraine or cluster headache may be more likely.
Top of head: Pain along the top of the head is non-specific and can be seen with tension headaches as well as migraine headaches.
Back of head: Headache pain occurring along the back of the head is often associated with tension headache, especially if spasms of the neck or cervical spinal muscles are identified. Other causes include shingles and occipital neuritis.
Side of head: Pain on the side of the head can be associated with migraine headaches, especially if the pain is one-sided or unilateral. Very severe pain on one side of the head may suggest cluster headache. Tension headache can cause pressure and pain along both sides of the head. Giant cell arteritis is a less common cause of pain on the side of the head in people over the age of 55 years.
Behind eye: Pain located behind one eye can be seen with migraine headache. If the pain is located behind both eyes, sinus headache may be a consideration. Rarely, orbital tumors can cause pain behind the eye.
CAUTION: If you are experiencing the worst headache of your life, or if you have unexplained symptoms such as weakness, numbness or tingling, imbalance, or falling, you should be seen for evaluation immediately. While uncommon, life-threatening causes of headaches may include intracerebral bleeding and brain aneurysm.
"NINDS Headache Information Page." National Institute of Neurological Disorders and Stroke. 3 Nov. 2015.
Bajwa, Z. H., et al. "Evaluation of Headaches in Adults." UpToDate. 22 Jan. 2016.