COMMON HEADACHE TYPES
Tension-Type Headache or TTH accounts for up to 90% of primary headaches, making it the most common headache type by far. The duration can last anywhere from a few minutes to a few days and is described as a tight pressure around the head, usually across the temples and forehead. The severity can range from mild-moderate and is categorised further into 3 classifications depending on the frequency and chronicity.
Episodic presentations of headache that is either frequent or infrequent, that is bilateral (affecting both sides), and is described as a tightening pressure of band-like quality at the frontal and temporal region. Episodes can last from minutes to days and the pain is usually of a mild to moderate intensity. Unlike Migraine, Tension-Type Headache is not aggravated by exertion and is not associated with nausea and vomiting. The pain is constant and does not have a pulsating quality. Sensitivity to light and sound may present in some cases.
(2a) Episodic Tension-Type Headache
(2ai) Infrequent Episodic Tension-Type Headache:
Classification of Infrequent Episodic T-TH relies on the frequency of headache occurrence to be less than 1 episode per month, with each attack lasting between 30 minutes and 7 days.
(2aii) Frequent Episodic Tension-Type Headache:
Classification of Frequent Episodic T-TH is recognised upon headache occurrence of 10 episodes within 14 days, with each attack lasting between 30 minutes and 7 days.
(2c) Chronic Tension-Type Headache: Also known as New Daily Persistent Headache
A more severe version of Frequent Episodic Tension-Type Headache, this disorder is one of the most disabling headache diseases due to its chronicity and unrelenting quality. To classify for this headache diagnosis, the frequency of headache occurrence must be greater than 15 days of headaches per month for a period of more than 3 months.
Chronic Daily Headache
CDH closely mimics the symptoms of Tension-Type Headache, however the diagnosis is reached only when the following criteria is fulfilled; (1) pain that is experienced in the head, neck and face that is present for; (2) at least 15 days a month, for more than 3 months in a year. It is closely associated with medication overuse and differentiation of the conditions is crucial.
Severe and intense pain that is commonly unilateral (one-sided), Migraines are considered one of the most disabling and incapacitating disorders. Migraines account for up to 30% of all headache types. The characteristic signs of Migraine are the accompaniment of “associated features”, most notably, visual disturbances and aura, nausea and vomiting or sensitivity to light, smell or sound. Contrastingly, migraines can also present without aura and are classified as “Migraine without aura”.
Severe and intense pain that is commonly unilateral (one-sided), Migraines are considered one of the most disabling and incapacitating disorders, and account for nearly 30% of all headache presentations. The characteristic signs of Migraine are the accompaniment of “associated features”, most notably, visual disturbances and aura, nausea and vomiting or sensitivity to light, smell or sound. Contrastingly, migraines can also present without aura and are classified as “Migraine without aura”.
(1a) Migraine with Aura:
Migraine with aura presents as headache accompanied with varying neurological symptoms such as visual or auditory hallucinations/disturbances. These symptoms may occur before and after the headache and are termed, “Prodromal” and “Postdromal” symptoms, respectively. These two phases may last hours or days preceding and succeeding the migraine pain. Prodromal and Postdromal symptoms can include increased or decreased alertness, depression and fatigue, cravings for particular foods, repetitive yawning, and neck pain.
(1b) Migraine without Aura:
The less common form of migraine with a presentation unaccompanied by true aura symptoms. Typical characteristics include one-sided locality of head pain which is of; pulsing or throbbing quality, that is moderate to severe in intensity, and is aggravated upon exertion. Associated features may also include the accompaniment of nausea and vomiting, and sensitivity to light, sound and smell.
(1c) Menstrual Migraine:
The occurrence of migraine pain in relation to the menstrual cycle is a common feature in the majority of female migraine sufferers. This sub-type of Migraine can be further classified into; (1ci) Pure Menstrual Migraine and (1cii) Menstrually-related Migraine. The migraine can occur at any time prior, during or succeeding the menstrual cycle. Common associated symptoms include fatigue, changes in appetite, joint pain, and lack of coordination.
Menstrual Migraine is considered when symptoms of classic Migraine occur in close relation with the menstrual cycle, either immediately before, during or after. Previous theories pointed to hormone level imbalances as the culprit, however, research has concluded definitively that this may not be the case. Results from numerous studies have identified no difference in hormone level changes in Menstrual Migraine sufferers and controls (Migraine-free individuals). MM is considered a Primary Headache disorder as the cause remains unknown. Menstrual Migraine is a serious condition that affects 60% of female migraine sufferers.
The most common Headache type within the third category of Primary Headaches, Cluster Headaches are also termed “Suicide Headaches” due to the extreme nature of pain that is experienced within an episode. The attacks occur in ‘clusters’ of minutes to hours at a time. Individuals can experience several episodes in a day. The symptoms of Cluster Headache are readily identifiable and distinguishable in comparison to the other headache types. Typically, Cluster Headache sufferers will experience alternating periods of remission (headache-free periods) and symptomatic periods lasting for months at a time.
Attacks which occur in “clusters” lasting weeks to months, with variable periods of intermission. The intensity of headache is widely regarded as the most severe pain of all headache types, often referred to colloquially as the “Suicide Headache” due to the common reported desire to commit suicide due to the extreme nature of the pain.
The pain is strictly unilateral (one-sided), and commonly located behind, or above the eye, and in the temple. Attacks occur between 15-180 minutes and in episodes ranging from once a day up to 8 times per day. Characteristic symptoms of Cluster Headache include the following; teary eyes, red or itchy eyes, nasal congestion, dripping nose, facial sweating, drooping eyelid, restlessness and agitation.
Similar Disorders Include;
(3b) Paroxysmal Hemicrania:
Presentation as above, with the substitution of attacks occurring at a frequency of more than 5 per day, within episodes lasting 2-30 minutes, accepts a diagnosis of Paroxysmal Hemicrania, in the absence of another pathology that does not better account for this presentation.
(3c) Short Lasting Unilateral Neuralgiform Headaches with Conjuctival Tearing (SUNCT):
Presentation as above, with the substitution of attacks occurring at least once a day, within short lasting episodes of 1-600 seconds per episode. Described often as a single stab, series of stabs or oscillating pattern.
(3d) Hemicrania Continua:
Presentation similar to (3b) Paroxysmal Hemicrania, that is present for more than 3 months. This disorder responds absolutely to indomethacin.
Seeing your Practitioners for Headaches and Migraines
Classification and identification of your specific Headache type is vital in determining what treatment options may be available to you. Within the first assessment, your Headache Clinician will be able to identify your likely Headache diagnosis, the treatment options available for the identified condition, and, if determined that treatment is likely to succeed, a recommendation of a suitable plan for the treatment of your Headaches or Migraines.