Types of Headache: How to know the cause and what to do

Author: Dr Onadipe Oluwasolabomi, Doctor of Medicine MD, Reviewed by Dr Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights 

• Headaches affect 40% of the global population, with tension headaches being the most common. 
• Primary headaches aren’t linked to underlying conditions, while secondary headaches signal issues like infections, stroke, or tumours.
• Seek medical help for sudden, severe, or unusual headaches, especially with fever, confusion, or vision changes.
• Stress, dehydration, poor sleep, alcohol, and certain foods (aged cheese, processed meats) worsen primary headaches.
• Treatment of headaches commonly includes the use of medications such as acetaminophen, ibuprofen or prescription medications like sumatriptan.
• Home remedies and lifestyle changes play a crucial role in long-term headache relief. These include proper hydration, stress reduction, and better sleep habits.
  
  

Introduction

A headache is characterised by pain or throbbing in the head or face. Globally, headache disorders affect about 40% of the population and rank among the most disabling illnesses, especially in young adults.Headaches can vary in terms of the type of pain, intensity, location, and how often they occur. 

Most headaches are not typically a sign of a serious condition, but severe and recurrent headaches can cause significant distress and disrupt your daily life.[1]Understanding the type of headache you have is the first step towards alleviating your concerns and getting the care you deserve.  

Types of Headaches 

Headaches can be:

• Primary, 
• Secondary. 

Primary headaches are typically not caused by an underlying medical condition.

Secondary headaches are caused by an underlying medical condition.

Primary Headaches

Primary headaches are common and often recurrent. They affect an estimated 3 billion people each year. They include:

• Tension headaches
• Migraine headaches
• Cluster headaches.

Tension Headaches: 

Tension headaches are commonly referred to as the ‘everyday headache’ .[2]  Tension headaches occurring for 15 days or less per month are reported by more than 70% of the global population.

• They are the most common type of headaches. 
• They are described as a dull, aching, bandlike pressure across the forehead or the back of the head.[2] 
• They often start mild and can worsen during the day.
• They cause discomfort, often expressed as a “pressing” or “tightening” feeling, with episodes lasting minutes to days.[3]

Possible triggers include: 

• Stress 
• Dehydration
• Lack of sleep/ interrupted sleep
• Fasting/ skipping meals
• Poor posture 
• Excessive screaming 
• Laughing or crying vigorously.

Migraine Headaches: 

Migraine headaches are characterised by severe throbbing pain, usually on one side of the head, especially above or behind one eye. 

• They are described as agonising and unbearable
• They tend to interfere with daily life, affecting approximately 12% of the global population.[4] 
• They are more common in women and are the leading cause of years lost to disability in young women.[4]
• They often present with other symptoms like nausea, vomiting, and extreme light sensitivity.

Possible causes/triggers include[4] :

• Hormonal changes 
• Certain foods (aged cheese, processed foods, alcohol)
• Bright lights and strong smells
• Changes in sleep patterns
• Stress and anxiety 
• Weather changes.

Cluster Headaches: 

Cluster Headaches are excruciating pain centred around one eye or temple. [1] 

• They are regarded as one of the most painful types of headaches.
• They occur in clusters, striking suddenly around the same time each day for weeks, and then followed by headache-free periods.[3] 
• They are quite rare, affecting fewer than 1 in 1000 adults 
• They are more common in males. 
• They commonly present with symptoms like red watery eye and a stuffy, runny nose and restlessness from the pain.[3]

Possible causes/triggers include 

• Alcohol intake 
• cigarette smoking 
• Vigorous exercise 
• Exposure to heat
• Hot baths or showers.

Secondary headaches

Secondary headache disorders are defined as headaches due to an underlying medical condition. They consist of about 10% of all headache cases, where they manifest as a symptom of another condition. Most cases of secondary headache prompt further medical investigations to identify the underlying cause.[5]

Causes of secondary headaches include: 

• Medication overuse headache - This is caused by long-term use of pain medications like aspirin or Ibuprofen to treat headaches.
• Spinal headache - A severe headache occurring after a spinal anaesthesia injection or a lumbar puncture. 
• Sinus headache - Headache from sinus infections.
• Thunderclap headaches - An intense headache that comes suddenly, resembling the clap of thunder. It may indicate brain injury or bleeding. 
• Head Injury 
• Anaemia
• Malaria
• Dehydration 
• Stroke 
• Ear infection 
• High blood pressure 
• Meningitis or encephalitis 
• Brain tumour
• Seizures 
• Refractive errors
• Glaucoma 

When to See a Doctor

Most headaches are not usually a cause for worry, but if you are experiencing the following symptoms, seek medical attention immediately.

• Worsening headache that won’t go away.
• A headache following a significant head injury in the past three months.
• Headache accompanied by high temperature 
• A headache that started very suddenly.
• Speech problems, vision problems, and inability to move develop along with the headache.[5]
• A headache presenting with confusion, memory loss, fainting or collapse.[5]
• The headache is unlike any previously experienced.
• Headaches provoked by coughing, bending, or strenuous activity.
• Severe headache or a new type of headache in people over 50 years. 
• Daily or near-daily use of pain relievers for headaches
• Headache followed by changes in personality or abnormal behaviour.
• New headaches in people with cancer or HIV infection.

How Headaches Are Diagnosed

Headaches are described based on how the person experiencing them feels, so to get a correct diagnosis, your doctor might do the following: 

• Take a detailed history:

In the majority of cases, the diagnosis is primarily made based on the medical history.[1]  A proper history allows the doctor to determine whether the headache is primary or secondary.[2] The history will include questions on your symptoms, possible triggers, family history, and lifestyle factors. Possible questions your healthcare provider may ask you include:

• When did the headache start?
• How often does it occur?
• What does the headache feel like?
• Can you describe the location and severity of the headache?
• Do you experience symptoms like nausea or vomiting with your headache?
• Are there specific activities you do that cause or worsen your headache?
• Do you have someone in your family who experiences a similar type of headache?  
• Have you had a recent head injury?

• Perform a physical exam.

This includes checking your general physical health and conducting a neurological exam to assess your vision, reflexes, balance, and coordination while walking.

• Request for tests: 

  • Request lab blood tests -  To rule out potential causes like infection or inflammation. Common tests include 
    • Full blood count 
    • Malaria Parasite test 
    • Blood glucose levels 
    • Kidney Function Tests 
    • Thyroid function Tests 

• Request brain imaging (Computed Tomography scan (CT scan) or  Magnetic Resonance Imaging (MRI))- They are usually done in cases of recurrent headache, facial pain, or sudden severe headache. 

• Lumbar puncture - This is done if brain infection is suspected.

• Keep a headache diary: 

A headache diary is vital in making a correct diagnosis, it allows for documentation of the timing and duration of each headache episode. Using a headache diary for a minimum of 4 weeks is recommended for anyone experiencing frequent headaches.[1]  This enables your doctor to understand the type of headache you have and your possible triggers.

Treatment Options for Headache

Most headaches can be managed effectively with the right combination of lifestyle changes, stress management, and appropriate medications.[1]There's no universal approach, so choose from these options and find your balance between prevention and relief.

Home remedies: 

Non-drug remedies can be beneficial in the treatment of headache disorders, but results can vary from person to person. You can try the following remedies:

• Applying cold compresses to your head and neck 
• Resting in a dark and noiseless room 
• Having a warm bath 
• Staying hydrated 
• Drinking a small amount of caffeine 
• Relaxing by meditation or practicing yoga.
• Applying lavender oil to your temples and neck.
• Gently massaging your temples, neck, and shoulders. 

DI

Medications:

• Over-the-counter options:

These options are obtained without a prescription and are effective in treating mild to moderate intensity headaches.[3]

• Acetaminophen (Tylenol, Paracetamol) - Frequently used, can be used by pregnant women and those with ulcers.

• NSAIDs, or nonsteroidal anti-inflammatory drugs (Ibuprofen, Naproxen, Diclofenac) - They help relieve headaches by reducing pain and inflammation. It should be used with caution if you have stomach ulcers.

• Aspirin, also an NSAID, can be used to treat headaches, but should not be used in children.

• Prescription options:

These medications are typically prescribed by a doctor and are used during severe or disabling headache episodes.[3]

• Triptans for migraines (Sumatriptan, Rizatriptan) - This narrows blood vessels and reduces pain. It is used for migraine attacks.

• Anti-nausea medications (Metoclopramide, domperidone) - They are used to manage nausea and vomiting associated with severe headaches. 

• Muscle relaxants (Tizanidine, Baclofen)- They help treat headaches accompanied by neck pain and stiffness.

It is important to use medications as directed, talk to your doctor about how they might affect you or react with other treatments you're currently taking.

Lifestyle tips:

Lifestyle changes are essential in reducing headache triggers and improving overall quality of life. Incorporate the following in your daily routine:

• Avoid or limit alcohol.
• Stay hydrated, aiming for 2-3L of water daily.
• Get quality sleep daily.
• Avoid excessive screen time.
• Include stress management and relaxation activities like deep breathing, yoga, daily stretching, mild exercise and music in your daily routine.
• Reduce intake of provocative food items such as dark chocolate, aged cheese, and processed meat. [1]
• Identify health conditions early and adhere to daily medications.
• Avoid screaming or crying excessively.
• Take time to reflect on yourself and your mental health regularly to reduce depression or anxiety.
• Monitor your headache frequency, triggers and other symptoms by keeping a headache chart.

Conclusion

Headaches are quite common and rarely ever mean something serious. However, some headaches are severe, agonising and recurrent, which affects the quality of life. It is important to remember that you're not alone in dealing with headaches, and help is always available. By identifying your triggers, finding treatment options that work for you, and knowing when to seek medical help, you can find relief and get back to enjoying life headache-free. 

References 

1. Schytz HW, Amin FM, Jensen RH, Carlsen L, Maarbjerg S. Reference programme: Diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020. The Journal of Headache and Pain. 2021 Apr 8;22(1). doi:10.1186/s10194-021-01228-4https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-021-01228-4#Tab3 
2. Robbins MS. Diagnosis and management of Headache. JAMA. 2021 May 11;325(18):1874. doi:10.1001/jama.2021.1640 https://jamanetwork.com/journals/jama/article-abstract/2779823 
3. Florczyk S, Elliott T, Lawrence K, Penwell-Waines L, Robes C. Headache treatment options. The Journal of the American Board of Family Medicine. 2024 Jul;37(4):737–44. doi:10.3122/jabfm.2023.230450r1 https://www.jabfm.org/content/37/4/737.long#sec-8 
4. Axiotidou M, Koutroulou I, Karapanayiotides T, Papakonstantinou D. Prevalence, triggers, and impact of migraine on University Students: A scoping review. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2025 Feb 24;61(1). doi:10.1186/s41983-025-00945-w https://ejnpn.springeropen.com/articles/10.1186/s41983-025-00945-w 
5. Hernandez J, Molina E, Rodriguez A, Woodford S, Nguyen A, Parker G, et al. Headache disorders: Differentiating primary and secondary etiologies. Journal of Integrative Neuroscience. 2024 Feb 20;23(2). doi:10.31083/j.jin2302043 https://www.imrpress.com/journal/JIN/23/2/10.31083/j.jin2302043/htm#S3 

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published May 31, 2025