When you think about headaches, you might roll up any kind of pain on any part of your head into the same definition: it aches. It’s on your head. It’s a headache. But there are actually hundreds of headache classifications, and knowing the difference can help you deal with yours better when they strike.
“There are many, many, many types [of headache],” Joseph Safdieh, MD, a neurologist at NewYork-Presbyterian/Weill Cornell Medicine, tells InStyle. In fact there’s a list — the International Headache Society’s classification list — and its latest update, in the form of an outline, is hundreds of lines long. This kind of classification is mainly meant for neurologists who will determine how to approach someone’s headache treatment based on the type they have. For the most part, the average person doesn’t need to know all of the nitty gritty details.
But it is helpful to know that headache classification starts with two broad categories that get broken down into smaller categories that can then be broken down into even smaller categories, and so on. All headaches are either primary headaches or secondary headaches, Dr. Safdieh says.
Primary headaches have no underlying cause. “These are headaches that are really intrinsic to the makeup of your brain,” Dr. Safdieh says. While there may be factors that contribute to the headache, like stress or sleep deprivation, the headache itself is the main medical problem, Dr. Safdieh says. Secondary headaches, however, are a symptom of another medical problem, such as a sinus infection, a head injury, or a brain tumor. “Secondary headaches are [generally] the scary kind of headache,” Dr. Safdieh says.
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The majority of headaches we experience throughout our lives are primary headaches. Those include four smaller categories: migraines, tension-type headaches, trigeminal autonomic cephalalgias, and “other primary headache disorders” (this is essentially a miscellaneous category that includes headaches that are triggered by colds, exercise, sex, and other things).
Migraines are debilitating headaches that sometimes come with symptoms like nausea, sensitivity to light and sound, and blurry vision, among others, and as much as 12 percent of the world’s population suffers from them. In the IHS’s classification, migraine is broken into further types based on the symptoms a person experiences. For example, you could have retinal migraine (which includes loss of vision) or hemiplegic migraine (which includes loss of motor function).
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Tension-type headaches (TTH) are the most common, Dr. Safdieh says. These are the headaches most of us get — they’re typically mild and don’t follow any particular pattern. “Many patients with tension headaches do have tight neck and shoulder muscles,” he says. But the assumption that tension headaches originate from muscle strain or stress is likely incorrect. Like migraines, these headaches originate in the brain itself. Tension-type headaches are broken into four subcategories in the IHS manual: You could have: Infrequent episodic TTH (headaches one day a month), frequent episodic TTH (headaches one to 14 days a month for three months), chronic TTH (headaches 15 or more days a month for three months), or probable TTH (headaches that don’t fit any of the other subcategories). A fun surprise!
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The third type of primary headache, trigeminal autonomic cephalalgias, includes five subcategories — with one you may have heard of, called “cluster headaches.” These are more rare, Dr. Safdieh says. “It’s an uncommon but really serious and severe headache syndrome,” he says. These types of headaches are much more common in men (while migraines are more common in women). While other types of headache tend to affect large portions of your head, cluster headaches pinpoint one side, so you’ll feel pain only in one area. They tend to be extremely painful and debilitating, Dr. Safdieh says, and they “cluster” at certain times. So you may have a headache every day for a week or a month and then they’ll go away and you won’t get them again for a few years.
And that’s just the primary headache types. There are a ton more types listed under the broad classification of “secondary headaches.” Yet, again, primary headaches account for the most common headaches. Which makes total sense, given that secondary headaches are symptoms of other causes like a head or neck injury, brain tumors, psychiatric disorders, aneurysms, and infections. “Most patients worry when they come see us that they have one of those things,” Dr. Safdieh says. But, more often than not, their headaches aren’t an indication of anything scary going on.
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But there is one secondary headache that most adults will experience at least a few times: headache attributed to a substance or its withdrawal. AKA a hangover.
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In general, you kind of just know when a headache is nothing more than a headache, or when it’s caused by something harmless like a cold or a little too much alcohol. It's when your headaches are messing with your life that you'll want to consult a doctor.
“If patients are having regular headaches that aren’t responding to treatments their primary care doctor is suggesting, or if the patient has associated symptoms like numbness, tingling, visual changes, weakness, or seizures, that would make it pretty apparent that they should see a neurologist,” Dr. Safdieh says.
Typically, your primary care physician will refer you to a neurologist who can determine your very specific headache type. And then they can get you the help you need.
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