Types of Migraines and Headaches

Understanding the type of chronic head pain you have may lead to faster relief

Life With Migraine

Frequent sufferers of migraine and headaches know the struggle of managing the disease on a daily basis, and how confusing the landscape can be for getting a proper diagnosis, not to mention effective treatment. According to a 2017 survey conducted by Eli Lilly, people diagnosed with migraine experienced, on average, only 15 pain-free days out of every month, and described the pain of a migraine as the most painful thing they had ever experienced, likening the symptoms to worse than that of kidney stones, broken bones, and even childbirth. In addition, in one study from the Novartis and European Migraine and Headache Alliance, on average, 60% of employed respondents missed almost a full working week (4.6 days) due to migraine in the last month. Over 30 million individuals in the United States suffer from the neurological and debilitating illness. 

Types of Headaches and Their Treatments

It is important to first distinguish the difference between a primary and secondary headache. According to the Mayo Clinic, a primary headache is caused by over-activity of or problems with pain-sensitive structures in your head. A primary headache isn't a symptom of an underlying disease. A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions may cause secondary headaches. Individuals with headaches or migraines that occur for half of any given month are said to have chronic daily headache (CDH) or chronic migraine (CM), respectively. As detailed below, there are generally two types of headache and migraine medications:

  • pain relief – these acute or abortive medications are taken when the attack occurs to stop symptoms
  • pain prevention – these medications are taken regularly, often daily, to reduce the severity and frequency of attacks.

See the chart below for more detailed treatment options.

The toll that migraines take on an individual’s emotional, physical, and social well-being can be distressing.  If you have started to suffer from frequent migraines, the following breakdown should help define and differentiate the common variations you might experience. With this information in hand, you can better inform your doctor about the type of headache or migraine you think you have, and thus, speed up or improve your treatment plan.

Traditional Migraine

  • Affects 12% of the US population

While most everyone gets headaches from time to time (see Tension-Type Headaches below), the Mayo Clinic defines migraines as characterized by moderate to severe headaches that only affect one side of the head, with “pulsating,” “throbbing,” or “pounding” pain. Physical activity and movement often makes symptoms worse, and the pain may be accompanied by nausea, vomiting, or sensitivity to light and noise. These symptoms can last from a few hours to a few days, depending on how quickly the migraine is treated. 

About 12 percent of the general population, including children, suffers from migraines, with attacks more common in women than in men, according to the Migraine Research Foundation. Compared to chronic migraine (CM) which occurs 15 or more days per month, episodic migraine (EM) are migraines and headaches that occur less than 15 days every month (traditional migraine can also transition to chronic migraine or chronic daily/new daily persistent headache).

There are also migraines with aura, which are sensory disturbances such as bright dots, zigzag lines, tunnel vision, speech problems, or tingling on one side of the body, typically lasting between 20 to 60 minutes prior to a migraine attack. Aura attacks are not typically seen with every person who suffers from migraine, nor does it occur during every migraine, according to the American Migraine Foundation.

In addition, up to 80% of people experience symptoms of allodynia during a migraine. Allodynia refers to the experience of pain from a non-painful stimulation, such as a light touch, according to the American Migraine Foundation.  

Preventive migraine medications include cardiovascular drugs such as beta-blockers and angiotensin II receptor blockers (ARBs); antidepressants such as amitriptyline; anti-seizure drugs such as topiramate or valproate; botox injections; and nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen. Treatment for migraines depends on their frequency and severity. Pain-relieving medications typically prescribed or given over-the-counter for mild attacks include aspirin, ibuprofen, and acetaminophen, while triptans may be prescribed to severe sufferers. To manage nausea-inducing side effects, medications such as chlorpromazine, metoclopramide, and prochlorperazine tend to be prescribed in combination. Opioids and glucocorticoids (eg, prednisone, dexamethasone) may be prescribed as a last resort for those patients for which other treatments have failed or for those who cannot take other medications due to an allergy or secondary condition, according to the Mayo Clinic.

Sometimes, patients cannot find relief from any of these medications due to the severity of the migraines or secondary conditions, including medication overuse as detailed below. This more severe chronic condition, called refractory chronic migraine (RCM), is often difficult to treat, but there is hope. According to Lawrence Robbins, MD, a neurologist at the Robbins Headache Clinic in Riverwoods, IL, long-acting opioids, injections, triptans, stimulants or monoamine oxidase inhibitors(MAOIs) may help this debilitating disorder.

In addition, a new class of calcitonin gene-related peptide (CGRP) inhibitors offers an exciting and hopeful development for preventing chronic migraine, episodic migraine, and cluster headaches (see below). These inhibitors, some expected to enter the market in 2018, involve an injection, every one to three months, to prevent migraines. In short-term studies, CGRPs have been very well tolerated, without liver or kidney irritation. Long-term adverse effects remain unknown. Read about what this new class of medications may mean for you.

Migraine Causes & Triggers

Both genetics and the environment may cause migraines, but if you don’t have a family history of migraines, then they could be caused by a variety of things—from changes in the weather to too much stress. It’s possible that migraines may also be caused by imbalances in chemicals in your brain. The hormone serotonin helps nerves communicate with each other as well as regulate pain in your body; a lack of which may cause a migraine. Learn more about the science of common migraine triggers at the American Headache Society.

Common triggers include:

  • Alcohol
  • Certain foods, such as aged cheese and foods with aspartame (an artificial sweetener)
  • Changes in your sleeping habits
  • Dehydration
  • Depression
  • Eating foods that contain caffeine (eg, coffee, chocolate)
  • Extreme fatigue
  • Grinding your teeth
  • Hormonal changes and menstruation (in women)
  • Hunger
  • Poor sleeping habits, lack of sleep, or too much sleep
  • Skipping meals
  • Some medications, such as oral contraceptives

The Connection Between Sleep Apnea and Migraine

A recent study suggests that migraine sufferers, especially men with a history of chronic migraine, have a higher risk of sleep apnea and other sleep disturbances compared to those without migraine. When participants completed surveys on their associated health conditions and sleep disturbance diagnoses at baseline and over the course of one year, results showed that 37% of participants were at a high risk for sleep apnea, while approximately 10% of participants self-reporting a sleep apnea diagnosis (of that 10%, approximately 75% reported a physician’s diagnosis). Researchers recommended that migraine sufferers talk to their doctors about the benefits of proper sleep hygiene practices, including maintaining a regular sleep schedule and getting adequate hours of sleep for managing the disease. 

Tension-Type Headache

  • Also known as: muscle contraction headache, psychomyogenic headache, stress headache, ordinary headache, essential headache, idiopathic headache, and psychogenic headache.
  • Affects 75% of the US population

Tension-type headache (TTH) is a neurological disorder characterized by a predisposition to attacks of mild to moderate headache with few associated symptoms. According to the American Migraine Foundation, TTH is the most common type of headache, occurring in about three-quarters of the general population.

Tension-type headaches most commonly last from 30 minutes to several days. The pain is generally reported as mild to moderate and commonly described as “vice-like” on both sides of the head (bilateral); sufferers can still go about normal activities despite the headache. While a tension-type headache is not accompanied by nausea or vomiting, it may be accompanied by increased sensitivity to either light or sound. It also may be associated with tenderness of the pericranial (head and neck) muscles, particularly when occurring often, according to the American Migraine Foundation.

Due to their milder intensity, most TTH cases can be treated with over-the-counter NSAIDs or aspirin. More frequent instances can be treated with preventive medications, such as the anti-depressant amitriptyline, as well as non-medication measures such as biofeedback, relaxation, cognitive behavioral therapy, acupuncture, massage therapy and physical therapy, according to the American Migraine Foundation.

Tension Headache Causes & Triggers

These types of headaches can occur when the neck and scalp muscles become too tight or tense. In addition, people who have migraines are also more likely to experience moderate or severe tension headaches. Tension headaches may be caused by a genetic, inherited tendency to experience headaches. Many people who experience chronic tension headaches have an increased sensitivity to pain, which may be caused by misinterpretation of nerve pathways to the brain.

Common triggers include:

  • A head injury
  • An illness, such as a sinus infection
  • Drinking alcohol
  • Eating foods with too much caffeine or withdrawal symptoms from a lack of caffeine
  • Excessive smoking
  • Frequently clenching your jaw
  • Grinding your teeth
  • Overexertion (caused by intense physical activity, etc.)
  • Poor posture
  • Sitting or standing in an uncomfortable position for too long (eg, working at a desk, sewing)
  • Sleeping with your neck in an abnormal position
  • Straining your eyes (working at a computer, reading something with very small text, etc.)
  • Tiredness

Cluster Headache

  • Affects 0.1% of the US population

While often confused for a migraine, it is important to note cluster headaches may have different properties. Cluster headache (CH) is a primary headache disorder that consists of severe headaches on one side of the head associated with red or teary eyes, runny or stuffy nose, flushing or sweating of the face, and/or a sense of restlessness and agitation, according to the American Migraine Foundation. The term “cluster” refers to the recurrence of headache attacks in a series (cluster periods) lasting for weeks or months, separated by periods of remission lasting months or years. Extremely rare, cluster headache affects about 1 in 1000 adults, according to the World Health Organization.

Acute cluster headache treatment may include prescription of oxygen triptans, ergots such as dihydroergotamine, and lidocaine nasal spray. Preventive treatments include cardiovascular drugs such as verapamil, corticosteroids, and anti-seizure drugs like topiramate and valproate, among others. Surgical options and neurostimulation have also shown promise as potential alternative or complementary treatments, according to the American Headache Society.

Cluster headaches can also sometimes be mistaken for short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome headaches, a rare disorder which primarily affects men over the age of 50. This disorder is marked by bursts of moderate to severe burning, piercing, or throbbing pain, usually on one side of the head and around the eye or temple. The pain usually peaks within seconds of onset and may follow a pattern of increasing and decreasing intensity, according to the National Institute of Neurological Disorders and Stroke. The duration, frequency, intensity, and time of day occurred differentiate it from cluster headaches.

Cluster Headache Causes & Triggers

Cluster headaches are most likely caused by abnormalities in the region of the brain called the hypothalamus. What makes these headaches different than other types of headaches is that they work like clockwork: Episodes usually occur at the same time of day and they typically follow the seasons of the year, so they’re very predictable.

Unlike tension headaches and migraines, cluster headaches aren’t usually triggered by something. These headaches are mostly attributed to changes in the brain—not changes in your environment or how you handle stress.

Medication Overuse Headache (MOH)

  • MOH is also known as rebound headache, drug-induced headache, or medication-misuse headache.
  • Affects 1-2% of the population
  • Days per month a patient can take over-the-counter NSAIDs/acetaminophen for headache pain and not develop MOH is 14; days per month a patient can take triptans, opioids, butalbital, or combination analgesics for headache pain and not develop MOH is 9 (according to Narayan Kissoon, MD, Mayo Clinic, AAPM 2018) 

Headaches can surprisingly come about from taking too much medication. According to the American Migraine Foundation, medication overuse headache (MOH) affects between 1 and 2 percent of the general population in the US. Medication overuse is often motivated by a patient’s fear of future headaches, and can lead to the development of refractory headaches, according to Wolff’s Headache and Other Head Pain. These types of headaches are typically experienced 15 or more days a month for at least three months, and develop or markedly worsen during medication overuse. Overuse is defined by the number of days per month that medication is taken and also depends on the drug being used, although acute medications are typically involved, according to the International Classification of Headache Disorders.

While MOH can be difficult to diagnose, sufferers should discuss concerns with their physician and seek preventive medication to decrease their reliance on acute medication. Be aware that medications may not be fully effective until the medication overuse has been addressed and eliminated. Stopping acute medication abruptly can also lead to withdrawal symptoms and a period of increased headache.

Controlling Your Headache

Being aware of your migraine frequency and understanding what type of headache you may have can help in getting a clear diagnosis the next time you step into a doctor’s office. The severe pain involved with migraines could mean a number of different things, and getting ahead of your disease is the first step toward relief. For more information on migraines, visit the American Migraine Foundation, Migraine Research Foundation or National Headache Foundation.

 

Other types of migraine/headache not featured: acephalgic/silent, hemiplegic, hypnic, ophthalmic, ophthalmoplegic, status, and vertebrobasilar. Headaches may also be associated with alcohol, allergies and sinus infections, altitude, arthritis, caffeine withdrawal, exertion, eyestrain, hormonal changes, hunger, hypertension, post-traumatic stress disorder, temporomandibular joint (TMJ) contractions, trigeminal neuralgia, and other conditions.

-Reported by PPM Associate Editor Steven Aliano 

-For more resources, follow Dr. Lawrence Robbins Chicago Headache Clinic Blog

Updated on: 10/11/18
Continue Reading:
A Closer Look at Migraine and Headache Treatment
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