Isn’t a Headache just a Headache? How Different Can They All Be?

No items found.
April 1, 2022
May 7, 2021
2
minutes
Isn’t a Headache just a Headache? How Different Can They All Be?

Did you know that there are over 300 different headache disorders?  Headache specialists like me use a diagnostic guide called the International Classification of Headache Disorders (ICHD) which differentiates headaches based on the location, quality, severity, duration and associated features. It also separates headaches based on whether the pain is caused by another medical condition, and whether it’s a facial pain disorder.  

Tension Type Headache

The most common headache worldwide is tension type headache - and it typically happens in just about everyone.  This is the kind of headache that people might describe as a “normal headache.”  In general, tension type headache is more notable for the features it doesn’t have, rather than any particular unique feature.  It can last minutes to hours to days, and it is typically not associated with nausea, light or sound sensitivity, and does not worsen with activity.  There can be tenderness of the muscles around the head, and if you experience this on more days than not, you could have a diagnosis of chronic tension type headache.  

Migraine

Migraine is unique because it can be severe, debilitating and even at times disabling. Migraine is not “just a headache” - it can even in the absence of any pain. Migraine is strongly familial, and you only experience migraine if you have the genetic predisposition for migraine.  Migraine occurs in approximately one out of six people, sothere are more than 40 million Americans with migraine and more than one billion people worldwide. 

Typically migraine will affect one side of the head more than the other, will be throbbing or pulsating in quality, will be moderate to severe in intensity, and will last 4-72 hours.  It is possible for migraine to last even longer - we call that status migrainosus.  There are always non-pain associated symptoms, such as nausea, light or sound sensitivity, and a hallmark of migraine is that it exacerbates with activity.  The more you try to do, the worse the migraine typically gets.  That’s why “just pushing through it” usually isn’t an option.  

Some people experience aura symptoms with migraine. These are usually visual, but can be sensory, motor or even cognitive changes that occur prior to (rarely during or after) the migraine attack.  Classic visual aura symptoms are seeing zig-zag lines, colors, or an area of blurring that moves across your field of vision.  Some people experience numbness and tingling that spreads from their hand, up their arm to their face, typically all on one side.  Some people experience vertigo, word finding difficulties or “brain fog”.  It’s important to discuss these symptoms with your doctor, to make sure that they really are just migraine aura, and because the presence of these symptoms may change your doctor’s recommendations.  

The frequency of migraine determines whether you have specific subtypes, like chronic migraine.  Chronic migraine is the presence of some degree of headache on at least 15 days out of the month, the majority of these with migraine features.  The subtypes of migraine determine which kind of treatments are best for you, and if you need to consider preventive medications.  

Neura's headache quiz can tell you whether the headaches you experience may indeed actually be migraine.

Cluster Headache

Cluster headache is famous for being the worst pain known to mankind.  It typically occurs in clusters - 4-6 week periods (sometimes longer) - with attacks from every other day up to multiple times per day.   It is one in a family of headaches that are notable for the following features: only occurring on one side, and having non-pain symptoms that also occur on the same side, such as tearing, eyelid drooping, nasal congestion, flushing of the skin or a sensation of ear fullness.  Instead of being exacerbated by activity, cluster headache is associated with agitation, which is a feeling that if you stop moving the pain will worsen.  The attacks last 15 minutes up to 3 hours.  

There are many other headache diagnoses - some mundane (cold stimulus headache AKA “brain freeze”, external torsion headache aka “ponytail headache”) and some very rare. Getting the diagnosis right is very important - each of these headaches and their subtypes are treated very differently.  Success depends on this very important first step. 

If you're interested in talking with a board-certified neurologist specializing in headache medicine, you can do so via the Neura Health app, from the comfort of your own home. We can diagnose and treat all headache disorders. We are here to help you, so please sign up today!!

For more great content, follow us:
Instagram IconFacebook Icon
Thomas Berk, MD
Thomas Berk is Medical Director at Neura Health and a Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine
About the Author
Dr. Thomas Berk is Medical Director of Neura Health and a neurologist and headache specialist based in New York City. He has over 12 years of clinical experience, having graduated from the NYU Grossman School of Medicine in 2010. He completed his neurology residency at NYU as well and is a board-certified headache specialist, having completed a headache fellowship at the Jefferson Headache Center. He is an emerging leader of the American Headache Society and has been on the Super Doctors list of rising stars for the past five years.

Share this article

Need help with headaches?

Track your headache attacks

Talk with neurologists

Get Rx delivered

Learn More

Finally, expert headache care at your fingertips

Neura Health is a comprehensive virtual headache and migraine clinic. Track headaches, discuss with a neurologist and get help from anywhere.

Phone and Leaf Mockup