Types of Headaches: Primary, Secondary & More
James Holden Adam Debrowski, medically reviewed by Thomas J. Stokkermans, OD, PhD, FAAO
What is a headache?
A headache is a common type of pain in your head or face. It can range from a dull ache to agonizing pain. Some headaches hurt so much that you feel like you need to go to the hospital to get relief.
Headaches can be caused by something else or happen on their own. About 16% of the people on Earth will have a headache on any given day.
Most headaches only happen once in a while. Chronic (repeating) headaches can change the way someone lives their life. Medicine and lifestyle changes may help you get fewer, less painful headaches.
Types of primary and secondary headaches
Some headaches have an underlying cause, but others don't. This is why doctors classify headaches as either primary or secondary.
Primary headaches
A primary headache is not a symptom of another problem or health condition. The headache itself is the condition. Doctors usually don't know why they happen.
Even though primary headaches don't have an underlying cause, events and objects in your everyday life can still "trigger" one.
Tension headaches and migraines are diagnosed in two ways, depending on how often they happen:
Episodic – Episodic headaches happen between one and 14 times per month. Headaches that happen less than once a month (on average) are called infrequent episodic headaches.
Chronic – Chronic headaches happen 15 or more times per month.
Tension
Tension headaches are the most common type of headache. As many as four out of every five people will get them at some point in their lives.
Doctors also call them tension-type headaches or TTH for short.
Tension headaches cause a dull, constant ache. They can also make parts of your head, face or neck feel tender to the touch.
A tension headache can affect your daily activities, but it usually won’t cause severe pain. It shouldn't make you feel sick, either.
Researchers don't know exactly why they happen, but they think tension headaches could be caused by trigger points in your muscles. Sleep problems could contribute, too.
Certain things can trigger a tension headache in some people. Stress and bad posture are two of the most common. Problems like eye strain can also be triggers.
Doctors may recommend over-the-counter pain relievers to help with occasional tension headaches. Sometimes, a hot or cold compress can help you feel better.
Your doctor might recommend prescription medication for chronic headaches.
Prevention techniques like relaxation, meditation and counseling may help you have fewer or more mild headaches.
Migraine
Migraines usually hurt more than tension headaches. Most feel like a throbbing pain on one side of your head.
A migraine can also make you feel extra sensitive to light and sound or make you feel sick to your stomach. Many people vomit during a migraine.
About one in every eight Americans gets migraines. Women are three times more likely to get them than men.
The two common types of migraines are:
Migraine without aura – An intense headache that comes with nausea, vomiting, sensitivity to light and sound, or all of these symptoms.
Migraine with aura – Temporary eyesight, nerve or speech changes that come and go shortly before the other migraine symptoms start.
Almost all migraine auras change your vision for a little while. They can make zigzag lines, flashing lights, blurry spots and other visual effects appear in both eyes. You can even see them when you close your eyes.
An aura can also cause symptoms like numbness and tingling. Some people have problems talking or understanding language until the aura goes away.
An aura usually lasts between five minutes and an hour, no matter which symptoms you get.
Some people see an aura but don't feel any migraine pain afterward. This is called a visual migraine, but doctors call it an acephalgic migraine. It can be easy to confuse with serious eye problems like a detached retina.
Researchers aren't sure exactly what causes migraines, but genetics play a part. You're more likely to get migraines if one of your parents gets them too.
A trigger can bring on a migraine, but it isn't the reason you get migraines in the first place.
Migraines can't be cured, but doctors can prescribe medications that treat a headache once it starts. They can also suggest medicine and lifestyle changes to help you get fewer migraines.
Cluster
Cluster headaches come on quickly, and they're very painful. They're rare.
Most cluster headaches last between 15 minutes and 3 hours.
During this time, you'll feel intense pain on one side of your head, above one eye or near one of your temples. You might feel restless or stressed, too. Your eyes might hurt or look red, and you may notice your eyelids drooping.
Cluster headache attacks can happen for weeks or months and then go away for several months or even years (remission). These are called episodic cluster headaches.
When the attacks don't go away, they're called chronic cluster headaches.
Most people who get cluster headaches start getting them between ages 20 and 40. They're three times more common in men than women.
A doctor can prescribe treatments and therapies to help you get fewer cluster headaches or stop one that's already happening.
New daily persistent headaches
A new daily persistent headache (NDPH) starts without warning and lasts for three months or longer. Some go on for years, and some never go away at all.
Treating NDPH is a lot harder than treating most other kinds of headaches. It can also be harder to diagnose.
Doctors use many of the same medications to manage NDPH that they use to prevent migraines. Many people with NDPH work with several different doctors to develop the best management plan.
NDPH can affect someone's ability to do everyday things, such as caring for their family, going to work or spending time with their friends. This can lead to depression, anxiety or other mental health conditions. If someone already has one or more of these conditions, NDPH might make them worse.
Certified mental health professionals can recommend many different techniques and treatments to help people adapt to the challenges of chronic pain.
Sinus and allergy
"Sinus headaches" and "allergy headaches" aren't actual medical conditions. But other kinds of headaches (like migraines) can cause symptoms that feel like sinus or allergy problems.
One study found that 88% of patients who thought they had sinus headaches were actually having migraines. More than four out of five migraine patients felt pain or pressure in their sinuses. Three out of five people had a stuffy nose.
Some sinus and allergy problems can act as triggers for other primary headaches. A sinus infection can cause headaches too, but it's rare. The pain should go away once the infection clears up.
Allergies can inflame your sinuses, but researchers aren't sure that this causes headaches. In this case, it's more likely that your allergy headache is a different type of headache altogether.
A specialist doctor called an allergist can help you decide whether allergies are causing your symptoms.
Click on infographic to enlarge.
Other primary headaches
These aren't the only types of primary headaches. Others include:
Hypnic headache – Pain that starts while you're asleep and wakes you up.
Nummular headache – You feel pain in a small, round area on your head, about the size of a coin.
Stabbing headache – The feeling of one or more sharp jabs in your head. They're also called "ice pick headaches."
Thunderclap headache – Severe pain that lasts for five minutes or more. Some people describe it as feeling like a clap of thunder inside their head. They're easy to confuse with the pain caused by blood vessel problems in your brain.
Hemicrania continua – Similar to a new daily persistent headache, except treatable with a drug called indomethacin. Pain is always on one side of the head.
Some of these can happen at the same time as another primary headache, including a migraine. They can also be caused by a medical problem or be confused with a more serious type of headache.
Talk to a doctor any time you feel new pain in your head.
Secondary headaches
Secondary headaches are caused by a change somewhere in your body. This can be something simple (like eye strain) or something more complicated (like high blood pressure or a serious infection).
Some secondary headaches can feel like primary headaches, and vice versa. This is why it's so important to get diagnosed by a doctor.
Eye strain
Common eye problems called refractive errors can make you strain your eyes to see more clearly. This can give you a headache.
The four most common refractive errors are nearsightedness, farsightedness, astigmatism and presbyopia. They're usually easy to correct with eyeglasses, contact lenses, reading glasses or vision surgery.
An eye doctor will need to write a prescription for eyeglasses and contacts since they're made to your eyes' exact measurements.
People with 20/20 vision can get headaches from eye strain, too. But they're usually tension headaches, since the strain isn't caused by the structure of their eyes.
LEARN MORE: All About Myopia
Rebound
Taking the same pain medicine for too long can cause rebound headaches. Doctors call them medication-overuse headaches.
Most rebound headaches happen to people who are treating the pain from a different headache. Prescription medicine and drugs that don't need a prescription (over-the-counter) can both lead to rebound headaches.
For example, you may take acetaminophen (Tylenol) several times a week for tension headaches. It can help at first, but after a while, the medicine itself can start to cause pain that feels like a tension headache.
It can feel hard or even impossible to do everyday things without taking pain medicine. Rebound headaches stop once you stop taking the drug, but it can be a painful and frustrating cycle to break.
Doctors can use many different techniques and medications to help you break the rebound cycle and manage your headaches.
Caffeine withdrawal
If you have at least one or two 8-ounce cups of coffee every day (200 milligrams of caffeine) and then stop, you could get a caffeine withdrawal headache within 24 hours.
A caffeine headache should go away when you do one of two things:
Have at least 100 milligrams of caffeine.
Wait a week for the headache to go away on its own. Some go away sooner.
Most people can safely consume up to 400 milligrams of caffeine a day (about 2 to 4 cups of coffee), but it's still a stimulant drug. Other drugs can cause withdrawal headaches, too.
Substance withdrawal
Other substances besides caffeine can cause withdrawal headaches, too:
Opioids – Headaches that begin after someone takes opioid medication for longer than three months and then stops. They usually go away within a week of stopping medication.
Estrogen – Headaches that develop after someone stops using certain estrogen hormones. They're often found in birth control pills and hormone replacement therapies. The headache can last up to three days.
Other substances – Withdrawal headaches that happen when you take or ingest a substance everyday for several months, then stop. This may include drugs like antidepressants and steroids, but the research isn't clear yet.
Hypertension (high blood pressure)
You can get a headache if you have hypertension and your blood pressure gets dangerously high (180 mm Hg systolic and/or 120 mm Hg diastolic). You'll usually feel pulsating pain on both sides of your head.
This is a medical emergency. Get help right away if your blood pressure gets this high. Without treatment, it can lead to a stroke, organ damage, memory loss and other serious problems.
As far as doctors know, mild and moderate hypertension don't cause headaches.
| You won't need to go to the doctor for all headaches. But some are caused by a serious problem and need to be treated as quickly as possible. Talk to a doctor right away if you notice any "red flag" symptoms, including: •Severe, sudden pain with a stiff neck •Severe pain with a fever, nausea and/or vomiting that isn't caused by another illness •Loss of consciousness •Confusion, weakness or double vision •Pain after a head injury •Shortness of breath and/or convulsions (violent, uncontrollable muscle movements) A headache can be a symptom of a stroke. Know the signs of stroke and get medical help right away if you think you or someone you know is having one. |
Trauma
Injuries to your head or neck can cause different types of headaches. Some headaches are symptoms of a concussion.
Possible head injuries include blows to the head, neck whiplash, objects that travel into the head, force from an explosion and others.
Surgery can be another source of head trauma.
Surgeons need to open part of the skull when they perform surgery on the brain. This is called a craniotomy. Like other surgeries, a craniotomy can have complications, and headache is one of them.
Some trauma headaches don't last very long, but others can go on for three months or longer.
They start within seven days of the injury or procedure, regaining consciousness, or stopping medication that makes it hard to know you have a headache.
Cerebrospinal fluid disorders
Your brain and spinal cord are surrounded by fluid that protects them and supplies them with nutrients. This is called cerebrospinal fluid. Sometimes, this fluid builds up and causes too much pressure inside your skull.
High pressure can cause a condition called pseudotumor cerebri, or PTC for short. This means "false brain tumor," since it shares many of the same symptoms. Another name for PTC is idiopathic intracranial hypertension, or IIH.
PTC can cause headaches that are usually worse in the morning or when you're lying down. They can happen anywhere in your head. It can also cause nausea, ringing in your ears, neck or back pain, double vision and other symptoms.
More women than men experience PTC. It is most common in women aged 15 to 40 who are 20% or more over the recommended body weight for their frames. Certain medications, such as tetracycline antibiotics and oral contraceptives, can also cause PTC.
If PTC isn't treated, it can lead to vision loss and blindness.
Low cerebrospinal fluid pressure can cause a headache, too. For example, people can get a headache after having a spinal tap or lumbar puncture. This is called a spinal headache, and it usually goes away within 24 hours.
Other secondary causes
These aren't the only things that can cause secondary headaches.
Some headaches are caused by serious medical problems. Urgent conditions such as stroke, aneurysm and hemorrhage need to be treated right away. They can cause permanent damage or death if they aren't treated.
These headaches aren't nearly as common as others, but you should always talk to a doctor just in case.
Headache causes
Many headaches don't have a clear underlying cause. These include two very common types of headache: migraines and tension headaches.
They usually hurt because of temporary changes to the blood vessels, nerves or muscles in and around your head. But doctors don't know exactly why they happen in the first place.
Other headaches are caused by short- or long-term issues. Some simple causes are easy to treat. But the cause can also be very complicated. These can be harder for a doctor to treat.
Some happen because of an urgent problem and need to be treated as quickly as possible.
Diagnosis and treatment
There are more than 150 types of headaches. Some are harder to diagnose than others.
Your doctor can tell you which type you have or refer you to a medical specialist who can.
A doctor will ask you for any information that could help them diagnose your headaches. They might ask you some of the following questions:
What does your headache feel like?
How long did it last?
Which time of day did it happen?
What did you eat or drink beforehand?
Did you use any medicine to treat the pain?
Are you sleeping well?
Are you under physical or emotional stress?
Do you have any other health conditions?
Every time you get a headache, try to write down your answers in a headache journal. Show it to your doctor during your appointment. This information will help them make the right diagnosis.
Medications
Medications can help relieve the pain of a headache, but it's important to stay mindful about which ones you're taking and how often you take them.
Over-the-counter drugs such as ibuprofen (Advil, Motrin), aspirin (Bayer), acetaminophen (Tylenol) and naproxen (Aleve) can help pain once in a while. But they're more likely to cause rebound headaches if you take them too often. Ibuprofen, aspirin and naproxen can also lead to stomach ulcers and internal bleeding when you take them for a long time. Taking too much acetaminophen can cause serious liver damage.
Make sure to follow all of the directions printed on the box or container before you take any medicine.
Your doctor might suggest prescription medication for certain headaches. For example, many people with migraines take prescription medicine to treat their headaches, prevent them, or both.
Doctors can try many different medications (and combinations of different drugs) to help you manage your headaches. What works for some people may not work as well for others.
Talk to your doctor before you start or stop any new medications. They'll consider your headache symptoms and medical history to make the best possible recommendation.
Lifestyle changes
Many people get fewer or less painful headaches when they make certain changes in their everyday lives. These changes may work for you too, but it depends on the type of headache you get, your triggers and your body’s response to the changes.
Migraines in particular can be very sensitive to certain things in your environment.
These changes have helped some people limit how many migraines they have every month:
Increasing their physical activity
Drinking more water
Drinking less caffeine and/or alcohol
Quitting smoking
Adjusting their diet
Using therapy and/or relaxation techniques to reduce stress
Taking steps to get better sleep
If you get headaches, try to keep a diary. Keep track of where your pain is, when you get the headache and any potential triggers. This can help a headache specialist decide which changes might be worth trying.
Headaches and the eyes
Your eyes play an important role in certain headaches. They might feel extra sensitive to light during a migraine or look bloodshot during a cluster headache.
During a rare retinal migraine (sometimes called an ocular migraine), you could even temporarily lose your vision in one eye.
Your eyes can trigger headaches, too. One of the most common triggers is eye strain, when your eyes are tired and overworked. You could also have a refractive error, such as nearsightedness, that isn't fully corrected.
Eye diseases can cause headaches, but they're much less common.
One of these conditions is narrow-angle glaucoma. It happens when there's too much pressure inside your eye. It's very painful and needs to be treated right away.
When someone has giant cell arteritis (GCA), the blood vessels in their temples can swell and cause headaches and pain in the temples. Older people are more at risk of developing giant cell arteritis.
A headache in the temple area should be treated with care, especially if it’s tender to the touch and it seems harder to chew on that side. GCA can quickly cause blindness and even death. Seek emergency medical care if you or someone you know may have GCA.
Eye inflammation like uveitis, iritis and even pink eye can also cause headaches.
Talk to an eye doctor any time you notice vision changes, eye pain or changes to the way your eyes look in the mirror.
SEE RELATED: Which kind of eye doctor should I see?
The global prevalence of headache: An update, with analysis of the influences of methodological factors on prevalence estimates. The Journal of Headache and Pain. April 2022.
Muscle contraction tension headache. StatPearls [Internet]. October 2022.
Headache. MedlinePlus [Internet]. April 2018.
Tension-type headache (TTH). The International Classification of Headache Disorders, 3rd edition (ICHD-3). Accessed April 2023.
Tension-type headaches. Cleveland Clinic. February 2021.
Migraine. MedlinePlus [Internet]. May 2021.
Migraine without aura. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Migraine aura. Cleveland Clinic. November 2021.
Migraine. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Clinical features of visual migraine aura: A systematic review. The Journal of Headache and Pain. May 2019.
Retinal migraine: Symptoms, causes and treatment. American Migraine Foundation. May 2022.
Demystifying migraine with aura. American Migraine Foundation. November 2021.
Advances in genetics of migraine. The Journal of Headache and Pain. June 2019.
Cluster headaches. Johns Hopkins Medicine. Accessed April 2023.
Cluster headache. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
New daily persistent headache (NDPH). The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
New daily persistent headache (NDPH). Cleveland Clinic. August 2022.
New daily persistent headache: A systematic review on an enigmatic disorder. The Journal of Headache and Pain. July 2019.
Headaches connected to allergies and sinus problems. American Academy of Allergy, Asthma & Immunology. September 2020.
Is it migraine or sinus headache? American Migraine Foundation. June 2021.
Sinus infection (sinusitis). Centers for Disease Control and Prevention. August 2019.
Hypnic headache. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Nummular headache. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Primary stabbing headache. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Ice pick headaches. American Migraine Foundation. January 2022.
Primary thunderclap headache. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Hemicrania continua. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Medication-overuse headache. StatPearls [Internet]. July 2022.
Medication-overuse headache (MOH). The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Caffeine withdrawal headache. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Caffeine. MedlinePlus [Internet]. September 2021.
Headache attributed to withdrawal from chronic use of other substance. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Estrogen-withdrawal headache. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Relation of hypertension with episodic primary headaches and chronic primary headaches in population of Rafsanjan cohort study. Scientific Reports. December 2021.
Headache attributed to arterial hypertension. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Acute headache attributed to traumatic injury to the head. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Persistent headache attributed to traumatic injury to the head. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Headache. National Institute of Neurological Disorders and Stroke. February 2023.
Acute headache attributed to craniotomy. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Persistent headache attributed to craniotomy. The International Classification of Headache Disorders, 3rd edition. Accessed April 2023.
Headache. Mayo Clinic. June 2020.
Headaches. Cleveland Clinic. August 2022.
Headache medicine. Cleveland Clinic. November 2021.
Lifestyle modifications for migraine management. Frontiers in Neurology. March 2022.
What Is glaucoma? Symptoms, causes, diagnosis, treatment. American Academy of Ophthalmology. EyeSmart. December 2022.
Giant cell arteritis. American Academy of Ophthalmology. EyeWiki. August 2022.
Page published on Thursday, June 24, 2021
Page updated on Tuesday, May 30, 2023
Medically reviewed on Monday, March 13, 2023
