When a headache strikes, most people will reach for an aspirin and take a nap. But headaches can be much more complex than we think.
“Currently, there are 16 primary headache diagnoses from relatively common disorders to ones that are pretty rare,” says Aakash Bhargava, MD, a headache specialist with Hartford HealthCare Ayer Neuroscience Institute Headache Center.
Dr. Bhargava explains what the difference between a primary and secondary headache is, and dives into three of the most common reasons you might have one.
Headaches can be conditions or symptoms.
Primary headaches, like migraines, are standalone conditions. But secondary headaches are a symptom of an underlying issue.
“Primary headaches seem to be related to abnormal functioning of the brain and related nerves around the head and neck that sense pain,” Dr. Bhargava says. “Symptoms are not caused by an underlying medical condition.”
Some common causes of secondary headaches include:
- Allergies
- High or low blood pressure
- Trauma to the head or neck
- Sleep apnea
- Thyroid disease
- Certain substances like cocaine, alcohol or caffeine
- Medications
In rare cases, secondary headaches can also be a sign of something more serious like an infection in the brain (COVID, Lyme disease, flu), brain diseases, or issues with the head and neck blood vessels like a stroke.
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3 types of headaches you might have.
Three of the most common types of primary headache include:
Tension
- What it feels like: Band-like pressure around the head
- Pain: Mild to moderate
- Duration: Generally a few hours, but can linger for days, weeks or even years
- Other symptoms: Physical movement generally doesn’t make it worse
- Treatment: Over-the-counter pain relievers
Migraine
- What it feels like: Throbbing, pulsing ache that can move around or hurt more on one side.
- Pain: Moderate to severe
- Duration: Around four hours, without treatment
- Other symptoms: Light/sound sensitivity, nausea or vomiting, “auras” that cause vision changes, numbness, difficulty speaking, weakness or clumsiness. It may be hard to exercise or even move.
- Treatment: Many new treatments have emerged to prevent migraine or help with pain during an attack.
Cluster
- What it feels like: Pain behind the eye.
- Pain: Severe, often disabling.
- Duration: 15 minutes to 3 hours. Can occur multiple times a day.
- Other symptoms: Tearing, eyelid swelling, runny nose, sweating. It can be difficult to stay still.
- Treatment: Triptan medications and oxygen supplementation.
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Diagnosing headaches starts with a talk with an expert.
Diagnosing primary headaches, Dr. Bhargava says, typically requires listening to patients describe their symptoms.
“The most important part of making a diagnosis is determining if symptoms are due to a primary or secondary headache. Complicating the issue is that secondary headaches can present with any type of pain – tension, migraine, cluster, etc.,” he says.
Providers look for “red flags” like having a new type of headache after age 50, fevers, weight loss, new weakness, numbness or behavior changes, he adds.
“We might send the patient for CT or MRI imaging of the head and neck, lab work or a lumbar puncture to help us determine what’s causing the headache,” he says.
