Types of Headaches


Types of Headaches



Tension-type Headache
Tension-type headache (TTH) has been known as muscle contraction headache, psychomyogenic headache, ordinary headache, idiopathic headache and even psychogenic headache. This makes no sense since so many of us have TTH and we do not differ psychologically from people without TTH. Therefore, we are in agreement that all these types of names should be commonly referred to as TTH.
The International Headache Society described tension-type headache as infrequent episodes of headache that last minutes to days. The pain is usually bilateral in location with a pressing or tightening quality. Tension-type headache does not usually worsen with physical activity and may not cause disability. Nausea is usually not a symptom, but light sensitivity (photophobia)or sound sensitivity (phonophobia)may be present.
Diagnostic Criteria for Infrequent Episodic Tension-type Headache     (ICHD-II Classification link to
  1. At least 10 episodes occurring on <1 day per month on average (<12 days per year) and fulfilling criteria B-D below
  2. Headaches lasting from 30 minutes to 7 days
  3. Headache has at least two of the following characteristics
    1. Bilateral location
    2. Pressing/tightening (nonpulsatile) quality
    3. Mild or moderate intensity
    4. Not aggravated by routine physical activity such as walking or climbing stairs
  4. Both of the following:
    1. No nausea or vomiting (anorexia may occur)
    2. No more than one of photophobia or phonophobia
  5. Not attributed to another disorder

Tension type headaches is the most common type of headache and as many as 30% to 78% of the general population experience at some time during their lifetime. Studies further suggest that there is a biological mechanism underlying these types of headaches and they are not psychogenically based. The exact mechanisms are not known, but peripheral pain mechanisms are most likely involved.

Tension-type headaches occurring frequently or even daily are classified as chronic tension-type headaches and are a serious condition that is associated with headache-induced disability and significantly impacts quality of life. Pain mechanisms peripherally and centrally may be involved in chronic tension-type headache, making treatment more challenging.


Migraine Headaches
Migraine headaches are less common than tension-type headaches. Nevertheless, migraines afflict about 28 million people in the United States alone. As many as 6% of all men and up to 18% of all women (about 12% of the population as a whole) experience a migraine headache at some time. Roughly three out of four migraine sufferers are female. It is important to recognize that children also get migraine and it affects between 5-10% of children under the age of 18 years.
Migraine is described as a recurrent headache lasting 4-72 hours and often has unilateral pulsating pain, moderate to severe intensity pain, nausea and/or photophobia. The pain of migraine can be aggravated by routine physical activity.
About one in five migraine sufferers experiences an aura prior to onset of a migraine headache. Auras are neurologic symptoms that may occur before during and after a migraine. There are many different types of either visual or other sensory auras and they may differ between attacks.
Classification Criteria for Migraine
(ICHD-II criteria link to
  1. At least 5 attacks fulfilling criteria B-D below
  2. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
  3. Headache has at least two of the following characteristics:
    1. unilateral location
    2. pulsating quality
    3. moderate or severe pain intensity
    4. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)
  4. During headache at least one of the following:
    1. nausea and/or vomiting
    2. photophobia and phonophobia
  5. Not attributed to another disorder

Differentiating between Tension-Type Headaches and Migraine Worksheet
Columns A and B show the symptoms commonly seen in these two headache types. Compare your symptoms with those listed and determine what type of headache you may have by noting whether your symptoms are most like those in column A or B. Some people have both of these types of headache. If your headaches are very severe or if you think they are some other type, do not delay in seeking professional medical attention.
Many headache sufferers experience both types of headaches. Learning to distinguish between the two headache types may help direct appropriately treatment.
Intensity, Duration and Quality of Pain
Mild or moderate pain intensity
Duration of headache
            30 min – 7 days
            4-72 hours
Intense pounding, throbbing and/or debilitating
Distracting but not debilitating
Steady ache
Location of Pain
One side of head
Both sides of head
Associated Symptoms
Sensitivity to light and/or sounds
Aura before onset of headache such as visual symptoms

Cluster Headaches
Cluster headaches occur in about 1% of the population and are distinct from migraine and tension-type headaches on several levels. Most of the cluster headache sufferers are men with onset between ages of 20-40 (where most migraineurs are women with onset following the start of menstruation).
  • These attacks are characterized by severe, unilateral pain that is around the eye or along the side of the head.
  • Headache attacks last from 15 to 180 minutes and occur once every other day to up to 8 times daily.
  • Attacks are associated with tearing on the same side of the head that the pain is located. Patients may also experience nasal congestion, runny nose, forehead and facial sweating, dropping eyelids or eyelid swelling.
  • During an attack, patients may be restless or agitated due to excruciating pain



Classification Criteria for Cluster Headache
(ICHD-II criteria link to
  1. At least 5 attacks fulfilling criterial B-D
  2. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes if untreated
  3. Headache is accompanied by at least one of the following
    1. Ipsilateral conjunctival injection and/or lacrimation
    2. Ipsilateral nasal congestion and/or rhinorrhea
    3. Ipsilateral eyelid edema
    4. Ipsilateral forehead and facial sweating
    5. Ipsilateral miosis and/or ptosis
    6. A sense of restlessness or agitation
  4. Attacks have a frequency from one every other day to 8 per day
  5. Not attributed to another disorder



  • In about 5% of the cases, cluster headache may be hereditary
  • Attacks occur in clusters or periods with weeks or months between new cluster periods; remission periods may be months or even years
  • 10-15% of patients do not experience long periods of remission
  • During a cluster period, attacks may be provoked or triggered by alcohol or selected drugs like histamine or nitroglycerin
  • Pain usually presents on the same side each attack


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