To help you gain an understanding of headaches, this article looks at two categories of headache: primary and secondary. Then it provides details about five types of headache: COVID-19 headache, cluster headache, sinus headache, tension headache, and migraine.
Headache is the most common type of pain that people experience. The pain and discomfort may feel achy, throbbing, or sharp around the head, neck, face, or forehead.
Most headaches are harmless and last only a few hours. However, a headache can be a symptom of numerous diseases, disorders, or conditions affecting the neck, eyes, brain, jaw, or teeth.
Conditions that can cause a headache range from the common cold, flu, and stress to severe conditions, such as meningitis, stroke, or a brain tumor.
Symptoms, causes, and treatments depend on the type of headache and the underlying condition.
There are over 150 different types of headaches. However, the two main categories of headaches are primary and secondary.
Primary headaches
Primary headaches are not the result of any other disease or condition. Their cause is likely a combination of genetic and environmental factors that affect pain-signaling nerves in the brain.
Triggers or precipitating factors also play a role.
The three familiar types of primary headaches include tension headaches, migraine headaches, and cluster headaches.
Secondary headaches
Secondary headaches are symptoms due to another medical condition. A sinus headache is an example of a secondary headache. Some underlying conditions can be serious.
Some of the conditions that may cause secondary headaches include:
- brain aneurysm
- brain tumor
- extremely high blood pressure
- giant cell arteritis
- head injury
- seasonal allergies
- sinus infection
- temporomandibular joint (TMJ) disease
- trigeminal neuralgia
The following sections look at five types of headaches in more detail. The types discussed are COVID-19 headaches, cluster headaches, sinus headaches, tension headaches, and migraine headaches.
Cluster headaches are a very uncommon type of headache. They are associated with severe excruciating pain on one side of the head along with a sense of restlessness or agitation.
Cluster headaches occur with sharp pain near an eye, tearing, nasal congestion, and flushing. The pain of a cluster headache is due to blood vessel swelling. The exact cause of cluster headaches is not clear.
The daily attacks of one to eight headaches can go on for weeks or months. Headache-free periods, which can last for months to years, separate episodes. People with chronic cluster headaches do not experience remission periods
Onset of cluster headaches typically occurs in people ages 20–40 years. Cluster headaches are more common in men than women.
Experts believe changes in the hypothalamus may play a role in cluster headaches. This area of the brain helps regulate key body processes, including the body’s internal clock. It regulates the daily and yearly rhythm. This may explain why cluster headaches occur at certain times of the day and year.
During a cluster period, things that cause blood vessel swelling can trigger an attack. Known cluster headache triggers include alcohol, even in small amounts, and cigarette smoking.
Cluster headache therapies include:
- calcium channel blockers to lower blood pressure
- ergotamine to narrow blood vessels
- dihydroergotamine (D.H.E. 45) injection, a pain medication that also treats migraine
- lidocaine nasal spray
- steroids
- supplemental oxygen
- triptans, such as sumatriptan (Imitrex)
Get more detail about cluster headaches here.
Headache is a common symptom of COVID-19. Most people experience it during the acute infection. Taking acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may help relieve it, along with other symptoms such as fever and body aches.
Case reports observe that headaches may become persistent for some people months after their infections.
Like other lingering post-COVID-19 problems, such as fatigue, memory and concentration problems, and shortness of breath, to name a few, more research is necessary to fully understand persistent headaches after COVID-19 infection.
Check here for details and the latest stories about COVID-19.
Migraine headaches are moderate to severe headaches most often affecting one side of the head. They can last several hours to a few days. Other symptoms that occur with migraine include weakness, nausea, vomiting, and sensitivity to sound and light.
An aura precedes the headache in up to 30% of cases. Auras are usually visual disturbances of some kind.
Known risk factors for developing migraine include:
- ages 15–55 years
- family history of migraine
- female biological sex
Migraine causes
Like other primary headaches, the exact cause of migraine is unclear. There is evidence it may involve imbalances in brain chemicals, such as serotonin.
Serotonin can affect blood vessels. High serotonin levels cause blood vessels to narrow and reduce blood flow. Low levels lead to dilation or widening of these vessels. This dilation causes pain.
Another theory is that migraine headaches relate to a pattern of electrical activity in the brain.
There also appears to be a hereditary link to migraine. The condition tends to run in families.
One or more specific substances or situations often trigger migraine. Known triggers for migraine include:
- alcohol, especially red wine
- altitude changes
- changing hormone levels, particularly in females
- environmental factors, such as smoke, bright lights, or loud noise
- certain foods, such as chocolate, cultured dairy products, aged cheese, and nuts
- excessive exercise or exertion
- extreme hunger or missed meals
- illnesses
- migraine medication overuse
- stress, including emotional stress
- too much caffeine
- weather changes
Migraine treatments
Migraine therapies include:
- triptans
- dihydroergotamine
- pain relievers
- drugs to control nausea and vomiting
Drugs to prevent migraine include:
- erenumab (Aimovig)
- fremanezumab (Ajovy)
- galcanezumab (Emgality)
- tricyclic antidepressants
- beta blockers
- calcium channel blockers
The Food and Drug Administration (FDA) has also approved several medical devices for the treatment of migraine. Talk with your doctor about all treatment options.
Wondering if it is a headache or migraine? Read tips on how to know the difference.
Sinus headache is considered a secondary headache because it is caused by sinus disease. The most common cause is acute sinusitis, which is inflammation or infection of the sinus cavities. Symptoms include pressure around your eyes, pain when you touch your cheekbones, upper tooth pain, fever, pain when moving your head, and congestion with yellowish-green nasal discharge.
Sinus headache causes include infections, allergies, and sinus tumors, which can all cause swelling and inflammation that may block the sinus cavity. A sinus CT scan or X-ray can see whether there is sinus blockage.
Treatment for sinus headache involves treating the infection or allergy response and includes:
- pain relievers, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn)
- steroids or corticosteroid sprays to reduce inflammation
- antihistamines if an allergic reaction is a cause
- antibiotics if infection is a cause
Some people who feel they have a sinus headache may actually have a migraine. A migraine can have similar pain symptoms and can cause nasal congestion and pressure around the eyes, forehead, and cheeks. Contact your doctor if you have recurring symptoms of sinus headache.
Learn more about sinus infection.
Tension headaches are the most common type of headache. They can happen to anyone. The dull pain usually affects both sides of the head. Tension headaches can last 30 minutes to several days. They may recur from time to time, a few times a month. They are considered chronic when a person experiences 15 a month for at least 3 months.
The typical triggers of a tension headache include:
- anger and other strong emotional stress
- anxiety
- fatigue
- stress, including emotional stress
- muscle tension in the head, neck, jaw, and shoulders
Tension headache treatments focus on pain relief. Treatments include pain relievers, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
Most headaches are not a cause for concern. However, some headache symptoms may indicate a serious underlying condition that requires urgent medical attention.
Pay close attention to any headache that seems different than usual, including its pattern of symptoms. If you develop this type of headache, seek immediate medical care. Having an excruciating headache or a headache that does not respond to your typical headache medications are other reasons to contact a doctor right away.
A constant headache in a person with no history of headaches and recurring headaches in children are also concerning.
A severe or sudden headache with a stiff neck, fever, convulsions, confusion, or pain in the eye or ear calls for urgent medical care.
A severe headache that wakes you in the night or occurs on waking up in the morning needs evaluation. Your doctor can determine whether further testing is needed.
If there is any doubt, seek medical help as soon as possible.
Serious symptoms that might indicate a life threatening condition
In some cases, headache may occur with other symptoms that can be a sign of a serious or life threatening condition. Get immediate help (call 911) for any of these serious symptoms:
- confusion
- convulsions
- fever
- loss of consciousness
- loss of vision
- paralysis of the face or eyelids
- slurred speech
- stiff neck
- sudden and new onset of severe headache
It is not always possible to prevent headaches. However, if you get them often, avoiding your triggers can help.
First, you need to identify your headache triggers. Keeping a headache diary can help you do this. Make notes in your journal about your habits — eating, drinking, sleeping, etc. This could help you detect patterns you might not see otherwise.
Depending on your triggers, you may be able to prevent headaches by:
- being physically active most days of the week
- drinking alcohol in moderation or not at all
- eating meals at a consistent time
- getting enough sleep
- not smoking
- reducing stress
- seeking treatment for mental health conditions
- staying hydrated
- following your treatment plan if you have a history of allergies or migraine
Alternative therapies may help headaches. According to the National Center for Complementary and Integrative Health, these may include:
- acupuncture
- biofeedback
- chiropractic techniques to relieve tension in the head and neck
- guided imagery and other relaxation techniques
- massage
- supplements, including butterbur, coenzyme Q10, feverfew, magnesium, riboflavin, and omega-3 fatty acids
- tai chi
Read here for tips on how to talk with your doctor about alternative medicine.
An occasional tension headache is not cause for concern. You can usually find relief with self-care and over-the-counter (OTC) remedies. However, contact your doctor if you get frequent or long-lasting tension headaches, cluster headaches, or migraine headaches.
To help diagnose the type and cause of your headache, your doctor may ask you several questions, including:
- Did your headache develop abruptly or over several hours?
- How do you normally treat your headache symptoms?
- How often do you have headaches?
- Is your headache throbbing or sharp?
- What time of day does your headache occur?
- What activities did you participate in prior to the headache?
After taking your medical history, your doctor may order medical tests to further evaluate your headaches. These tests include:
- neurological exams, including testing your reflexes
- vision exams
- an MRI scan to look for abnormalities that could cause headaches
- a magnetic resonance angiogram (MRA), which works similar to an MRI to look for abnormalities
The following commonly asked questions have been answered by Dr. Susan W. Lee, D.O.
Why might I have a headache when I cough?
Coughing increases the pressure in your abdomen and torso. This pressure may be transmitted to the head and may also activate pain receptors in the brain, resulting in headaches.
Why might I have a headache when I wake up?
Morning headaches may happen because of a lack of sleep, sleep apnea, muscular tension in the neck that occurs from poor sleep posture, or jaw tension that develops overnight. Sometimes, a headache that develops overnight may be a sign of increased pressure in your head, which would need further evaluation by a neurologist.
What does a COVID-19 headache feel like?
There is no one specific characteristic of a headache due to COVID-19. These headaches may feel similar to a migraine headache or a tension headache, or they may feel like severe pressure throughout the entire head.
How long might a headache last?
Most headaches last minutes to hours, although some people may experience a headache that lasts days.
How do I know if my headache is serious?
If you have a new headache that appears very suddenly and is severe from the onset, this requires immediate medical attention. Other signs of a possibly serious condition include:
Please consult with a physician if you are concerned that your headache may be serious.
What medicine is best for headaches?
If your headache is mild, an OTC analgesic, such as aspirin, may be sufficient to treat it. Otherwise, speak with your doctor for the best treatment options based on your individual situation.
There are numerous types of headache. Tension headaches are the most common. A tension headache is a primary headache, meaning it is not due to another medical condition.
Other primary headaches include migraine and cluster headaches. Migraine headaches are also fairly common, while cluster headaches are rare. Sinus headache is an example of a secondary headache because it is caused by another condition. In this case, the cause is sinusitis, which is inflammation of the sinus cavity.
Treatment and prevention depend on the type of headache and how often you get headaches. Talk with your doctor if headaches are affecting or interfering in your daily life.
