When is a Headache More Than a Headache?

With very few exceptions, everyone experiences a headache from time to time. As uncomfortable as they can be, most headaches are nothing to worry about. However, there are times when they can serve as a sign that something is wrong.

To help you figure out what pain you are feeling, let’s take a look at the different types of headaches and what could be causing them.

The first thing you need to know is that headaches fall into two categories: primary and secondary.

Primary headaches account for 98% of the headaches, with the headache being the primary medical issue experienced. A distinguishing feature of primary headaches is that they go away without any complications. There are three types of primary headaches: migraines, tension headaches, and cluster headaches. Here’s how they differ:

Migraines: Typically cause severe throbbing pain, usually on one side of the head, which may last for a few hours or even several days. Some people also experience nausea, light sensitivity, vomiting, and/or visual changes. Things ranging from specific sounds, lights, and odors to sleep deprivation, hormones, excess caffeine, and certain food often trigger migraines.

Tension headaches: The most common type of headache, tension headaches, cause pressure and tightness all around your head. Sometimes described as a ‘hat band headache,’ they typically last for 30 minutes or more and accompanied by tightness in the neck, shoulders, jaw, and/or a dull pain at the back of the neck, forehead, cheeks, or behind the eyes.

Cluster headaches: Cluster headaches are severe headaches that come on quickly in spurts or “clusters.” Cluster headache pain is typically felt on one side of the head or even behind one eye. Other symptoms include a feeling of warmth in the face, puffiness around the eyes, and a runny or stuffy nose.

As uncomfortable, and even debilitating, as primary headaches can be they are the cause of the pain being experienced and do resolve on their own. That is what makes them different from secondary headaches.

Secondary headaches are the symptom of another medical issue. If you have ever had a sinus infection or neck injury, you may have experienced a secondary headache as a symptom. Fortunately, those types of secondary headaches are manageable and far from concerning.

However, secondary headaches can serve as a warning about a life-threatening condition such as a stroke or aneurysm. Of particular concern is a sudden and severe headache. If you or someone else experiences a severe and sudden headache, you should call 9-1-1 immediately.

Other issues of concern include: 

• A headache that comes on very abruptly
• A headache associated with a fever or neck stiffness
• A headache that lasts more than 72 hours/3 days with less than a continuous four-hour pain-free period while awake
• A migraine with changing or unusual symptoms
• Headaches brought on by coughing, sneezing, bending over, exercise or sexual activity
• A headache brought on by an injury, especially if you lost consciousness, or are experiencing confusion, slurred speech, vomiting, or drowsiness

Again, severe and sudden headaches should never be ignored. If you experience one, seek help immediately.

If you have questions or concerns about other types of headaches, contact your doctor for advice or to schedule a consultation.

Adam Cohen, MD, is the director of Emergency Medicine and an Emergency Medicine physician at SVMC.