All Headache Types

Understanding the different types of migraine and headache

When people hear the term ‘migraine,’ they often think of a severe headache. What they don’t always know is that migraine is a neurological disease and that there are a number of different subtypes of migraine. There are also many headache types. 

Abdominal Migraine - Abdominal migraine is a form of migraine seen mainly in children, however it is seen in older adults on occasion. As children with this condition grow older, about half of them will ‘grow out’ of abdominal migraines, into the teenage years. Typical features include abdominal pain, nausea and/or vomiting and sometimes pallor (lack of healthy colour of the skin). The pain is often felt as moderate to severe in intensity.  

Aura Without Headache (formerly Migraine Without Headache) - Also called a Silent or Acephalgic Migraine, this type of migraine can be very alarming as you experience dizzying aura and other visual disturbances, nausea, and other phases of migraine, but no head pain. It can be triggered by any of a person’s regular triggers, and those who get them are likely to experience other types of migraine, too. The International Headache Society classifies this type as Typical Aura without Headache.

Basilar Migraine - A rare type of migraine where the sufferer can experience an aura consisting of two or more of the following: slurred speech, a spinning sensation, ringing of the ears, heightened sense of hearing, double vision, aura symptoms in both eyes, reeling/lurching walking, decreased level of consciousness or bi-lateral (2-sided) sensory symptoms.

Cervicogenic Disorder (Headaches due to Neck Problems ) - Aone-sided headache that may be associated with neck disorders such as arthritis and prior neck injuries. Neck triggers and reduced range of motion are typical. Some controversy exists among headache specialists, about the origin of this pain. Chiropractors often address neck problems. See the book Non-Drug Treatments for Headache. 

Chronic Migraine  (CM) -  When people with migraine have headache on  more than 14 days a  month, they are diagnosed with chronic migraine. Chronic Migraine is one cause of very frequent headache, with some patients having headache almost every day or even every day. Some days patients may mistake the pain for a  “tension-type headache” or even think the pain is coming from their sinuses when the pain is less severe.  Many patients with chronic migraine also use acute headache pain medications on more than 10-15 days per month, and this can actually lead to even more frequent headache. Botox injections are treatments approved by Health Canada. You can also visit www.mychronicmigraine.ca Also visit the CM button on the top-far-right of our homepage. 

Cluster Headache (CH) - Usually a one-sided type of headache that affects males over females by approximately 3:1. The pain attacks can be very severe. Attacks come in “clusters”, then often take a holiday. The pain is very often on the same side. The pain sensation is often piercing in quality (like a red hot poker through the eyeball), quite intense and may be associated with redness or watering of the eye and stuffiness of hte nose. Direct oxygen administered by face mask can sometimes be used to abort this headache. The chronic version is referred to as Chronic Cluster Headache. Cluster headaches can be an excruciating type of headache, and are sometimes referred to as "suicide headaches." 

Hemicrania Continua (HC) - This is a chronic daily headache sub-type that is characterized by continuous, moderately severe, one-sided headache pain that varies in

intensity. Sometimes it may be associated with tearing or drooping of the eye. For this reason it is sometimes confused with cluster headache. It is known for its rapid response to a medication called Indomethacin. Usually, this headache is continuous but it can be remitting (comes and goes).

HemiplegicMigraine (HM) - If you have ever had a migraine that felt more like a stroke, it was probably a Hemiplegic Migraine. HM is a rare type of migraine with aura that is accompanied by motor weakness (paralysis) that is fully reversible, but may last for weeks. There are two types of HM that are often experienced in childhood, and cease in adulthood. Paralysis, fever, headache, nausea and/or vomiting are symptoms, there are others. HM can be confused with a TIA or Stroke, or some other neurological disorder, so having a full neurological work-up is important to confirm the diagnosis of HM and to rule-out other serious ailments.

HypnicHeadache - Hypnic Headache has also been called the 'alarm clock headache', due to its nocturnal ability to wake patients from sleep at roughly the same time. It is a headache characterized by short-lived headaches that occur exclusively during sleep, are generalized and may be severe. Some patients suffer for decades before a proper diagnosis is made. Initially, caffeine at bedtime is recommended; Indomethacin can also be tried.

Ice pick headaches - are pretty self-explanatory. They feel like you’re getting stabbed in the head with an ice pick. They often come on suddenly, delivering an intense, sharp pain. They’re short–usually only lasting 5-30 seconds–but incredibly painful. These headaches occur on the orbit, temple, and parietal area of your head. That’s where your trigeminal nerve is, which is the nerve in your face that’s responsible for biting and chewing, as well as face sensation. The nerve is on the side of your head just past your eye and above your ear. If you get sharp pains in this area, chances are you’re getting ice pick headaches.

Medication Overuse Headache (MOH) - This headache was formerly referred to as Medication-Induced Headache and also Rebound Headache. MOH is a condition that wherein, over time, pain relievers and other acute medicines (eg. triptans) which are used to stop  headaches and are taken too frequently - now cause more frequent or daily headaches. It is a concept of too much of a good thing. Medication overuse headache requires that the patient be withdrawn from the substance being overused. This can be done in several ways, depending on the type of medicine that is being withdrawn. Outpatient detoxification at home may work for some patients, while some patients requiring more aggressive detoxification might require a hospital setting, or a physician’s help. 

Menstrually Associated Migraine (MAM) - This migraine type was previously referred to as "Menstrual Migraine". In prepupertal children, the incidence of migraine is equal to boys and girls. Howerver, with menarche and throughout childbearing years, the incidence of migraine in women becomes two to three times that of men. Up to 60% of female migraineurs experience migraines around the Menses. The link between migraine and female sex hormone is well establisehd. The International Headache Society defines this headache as having two subtypes. The most common type is referred to as Menstrually Related Migraine without Aura which must have an onset during the pre-menstrual time period (2 days before to 3 days after the onset of menstruation).

Medicinal treatment consists of acute and preventative medicines. Both Riboflavin and Magnesium have been used with some success and may be worth trying in women who prefer a "non-drug" therapy.

Migraine with Aura - Migraine with aura represents the least common form of migraine affecting less than 10% of migraine sufferers. Experts suggest that approximately one third of patients with migraine have an aura with some of their headaches, and about half of these patients will have an aura with every headache. The aura usually precedes the headache, but it may occur during the headache also. The symptoms are variable and can include visual disturbances such as black dots, zig zag lines or flashing lights, sensory disturbances, numbness or tingling sensations, motor weaknesses. Auras usually last 15 – 30 minutes, however, in some cases, the aura may occur with no headache - see Aura Without Headache.

Migraine Without Aura (formerly Common Migraine) - This is the most common type of migraine that is typically experienced on one side of the head, but occasionally presents itself on both sides. It generally consists of moderate to severe throbbing pain. It is commonly associated with light or sound sensitivity. Nausea and vomiting may be present. The majority of sufferers are female and the aura, consisting of neurological sensations (listed above), is absent during this type of migraine attack. Approximately 90% of migraine patients suffer from “migraine without aura”. Diagnosing migraine without aura can be difficult because the symptoms are similar to several other types of migraine. The key differentiator is that Migraine Without Aura lacks the warning phases (prodrome and aura) that other types of migraine have.

MyofacialPain - Myofacial Pain Syndrome is a chronic pain disorder. In Myofacial Pain pressure is placed on sensitive points - known as “trigger points”. Experts believe that the actual site of the inury or the strain begins the development of a trigger point that, in turn, causes pain in other areas; this situation is known as referred pain.

New Daily Persistent Headache (NDPH) - A sub-category of chronic daily headache in which the headache often begins abruptly and affects mostly women. Many patients will recall the exact day that these headaches began - sometimes for no apparent reason. In some cases, they can be triggered by a flu-like illness or brought on by surgery. NDPH can be refractory (stubborn) to treatment in some patients.

Paroxysmal Hemicrania  - This is a very rare headache type that is cluster-like in its presentation, that often begins in adulthood and is characterized by severe, throbbing pain that is boring, or drilling in nature and it usually affects one-side of the face, in and around the eye. The pain of PH is a red, tearing eye, a droopy or swollen eyelid, and nasal congestion. Interestingly enough these are features of cluster Headache - which affects more males than females. PH tends to affect more females than males. There are 2 types - a chronic type and an episodic type. The drug Indomethicin almost always brings resolution to this headache. Non-Drug treatments are not known.

Post-Traumatic Headache (PTH) - Headaches that begin after a fall or injury are often referred to as Post-Traumatic Headaches. These headaches can occur after mild, moderate, or severe injury. This headache was formerly known as “Headaches After Head Injuries”. The diagnosis is controversial. At this time, the diagnosis of headache following injury needs to occur within 7 days of the injury. These headaches may clinically resemble migraine, tension type, occipital neuralgia and others. If the headache lingers after a head injury after 3 months, then the diagnosis of chronic post-traumatic headache is often made. A button on the upper-far-right of our homepage has an article on PTH.

Occipital Neuralgia (ON) is a relatively rare head pain disorder that is experienced on the back of the head, at the occipital region. It is thought to be provoked (triggered) by touching the face; brushing the hair; wearing a hat; lying on a pillow or some other sudden movement. The pain sensation is sharp, piercing, or stabbing in quality and severe in intensity. Attacks generally last from a few seconds to a few minutes. Migraine medicines, nerve blocks (freezing the nerve) and physiotherapy are recommended treatments. 

Retinal Migraine - When a headache causes you to temporarily lose vision in one eye, it is a Retinal Migraine. Most common in women during their childbearing years, the blindness can last anywhere from a minute to months, but is usually fully reversible. This is a specific type of aura that accompanies a migraine, and it’s a condition we know very little about. What we do know is that Retinal Migraine may be a sign of a more serious issue, and those who experience it should make a point to see a specialist such as an Optometrist.

Temporomandibular Joint (TMJ), (TMD) - The temporomandibular joint is the joint between the lower jaw (mandible) and the skull. Excessive wear; damage to this joint or inflammation can cause pain. Clicking, or popping sounds are sometimes noted. There is a strong correlation between clenching or grinding of the teeth, and headache pain. Bite-Plates should be a discussed with your dentist. Experts recommend TMJ patients - NOT chew gum. Stress is often a factor. Lifestyle changes are effective treatments. Self-help tips can be found at www.tmj.org 

Tension -Type Headache (TTH) - This is the most commonly experienced type of headache.This headache is bilateral (two-sided) and is usually pressing or squeezing in sensation (rather than throbbing). It is not accompanied by nausea – unlike migraine. It is mild-to-moderate in severity. Routine or exercise does not make a TTH worse (unlike migraine). This featureless headache has no vomiting or nausea. In its chronic form it is referred to as Chronic Tension-Type Headache. 

Trigeminal Neuralgia (TN) this headache is considered quite rare and it is characterized by sharp, short jabbing pains to the face. This intense pain may last from a few seconds to one minute, striking many times during the day. These headaches are most commonly found in women over 55. Treatment usually involve anticonvulsants, neurosurgery (freezing of the nerve) and some might benefit from a ‘TN Diet'. See Appendix II in the book Non-Drug Treatments for Headache, for TN contacts in Canada.

Pinpointing the cause of headache is sometimes complicated. There are many types, and many methods of treatment. Focusing on where exactly your head hurts and the accompanying symptoms can help you and your doctor determine what type of migraine or headache you suffer from, resulting in a more effective treatment plan and fewer painful days. Looking for a headache doctor? Check out our database to find a doctor 

 

some medical definitions reprinted with permission from:

*  The American Migraine Foundation, Mt Royal, NJ - reprinted with permission www.AmericanMigraineFoundation.org  

research provided by:

* Migraine Canada - www.MigraineCanada.org 

* Help for Headaches - www.headache-help.org 

* Book Glossary  - Non-Drug Treatments for Headache - published 2016 by Help for Headaches

addition term edits and modifications from:

* Dr. Werner Becker, MD, FRCPC Professor Emeritus, University of Calgary, Calgary, Alberta 

 

Definitions of both Chronic Headaches and Non-Drug Terms

Chronic Daily Headache, Glossary (PDF)
Non-Drug Treatments for Headache, Glossary (PDF)

The opioids (narcotics) cause progression of the illness (Chronic Daily Headache), not termination, and will actually make the individual much worse over time. It is easier and quicker to give the patient a pain killer than to "get into the trench" and try solve the problem. Patients with chronic daily headache require time, diligence, and frequent access from their physician.

Interview: Dr. Joel Saper, MHNI
-from the book Chronic Daily Headache

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The book Chronic Daily Headache features
an article reviewed by a Headache Neurologist
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