What Is Headache?

What is headache?

A headache is pain experienced in any part of your head. It is one of the most common symptoms experienced by humans, and can occur for many different reasons. In fact, there are over 200 types of headache recognised in the International Classification of Headache Disorders (ICHD-3). 

Headache can feel very different depending on the cause of the pain. It could be a throbbing sensation, stabbing pain, or a dull ache; it could last minutes, hours, or even days. Learning about the difference between these types of pain can help you understand your headache type and improve your management strategies.

Causes

Headache causes are divided into two categories: primary and secondary. 

A primary headache refers to any headache that occurs on its own without an underlying medical problem. They might be triggered by a lifestyle factor, such as changes to your sleep or diet. Some examples include:

• Migraine
• Tension-type headache (aka ‘stress headache’)
• Cluster headache

A secondary headache is any headache caused by an underlying medical condition. These types of headache can be treated by addressing the disease or injury that causes your head pain. A few examples include:

• Sinus congestion
• Eye strain
• Dental problems
• Infections (i.e. cold, flu, ear infections)
• Blood vessel diseases (i.e. aneurysm, high blood pressure)
• Head injuries
• Side effects of medication

Sometimes it can be hard to tell if your headache is primary or secondary. For example, dehydration can trigger migraine attacks, but it can also cause a secondary headache that will go away once you drink enough water. If you’re unsure what is causing your headache, you should always consult your doctor.

Symptoms & types of pain

There are lots of different ways to describe head pain. While a headache may sound simple, recognising the qualities of your headache can help you understand your symptoms and help your doctor make a more accurate diagnosis.

This list of symptoms isn’t exhaustive, but it can provide a starting point for how you think about headache symptoms.

If you’re ever unsure about a new headache it’s important to see a doctor. There can be overlap between the symptoms of benign headaches and more serious ones, so getting an accurate diagnosis is key.

Major headache types

The most common primary types of headache are tension-type headache, migraine, and cluster headache. These headache disorders can sometimes affect people on a chronic basis and can be very challenging to live with.

Some secondary headache types are also very common, but they probably don’t tend to affect your daily life in the same way. Some examples include headache caused by high altitude (e.g. while flying), caffeine, alcohol, allergies, or exercise.

Tension-type headache

Tension-type headache is one of the most common headache types. Almost everyone will experience a tension headache at some point in their life. The pain is typically felt on both sides of the head and causes a dull ache or tightening sensation in the head. Most of the time the pain will be mild to moderate, and lasts between 30 minutes and 7 days.

These headache attacks can be caused by a number of triggers. As the name suggests, stress or tension is a major trigger. Other causes could be:

• Depression or emotional distress such as being upset/crying
• Poor posture
• Bright, noisy environments
• Long periods of reading

Tension-type headache is often easy to manage with over-the-counter painkillers. However, if you experience chronic tension headache (15 or more days per month), it can significantly affect your daily life. You can speak to your doctor about lifestyle changes or medical options to help prevent tension-type headache.

Migraine

Migraine is a neurological disorder that causes moderate to severe headache alongside other symptoms. It affects almost 5 million Australians and can have significant impacts on your life at home, work, and in social situations.

The symptoms of migraine can vary from patient-to-patient, but there are some symptoms that characterise migraine attacks and set them apart from other headache disorders. The pain is usually one-sided, throbbing, and is aggravated by head movement(i.e. walking up the stairs). Migraine is also accompanied by nausea, vomiting, and sensitivity to light and/or sound.

There are also four phases involved in a migraine attack. Not everyone will experience all four phases, but they include:

1. Prodromal phase. Changes in mood, behaviour, dietary cravings, in the hours or days before an attack.
2. Aura. This refers to symptoms that you might experience before or during a migraine attack which can affect your vision, senses, or neurological function.
3. Headache phase. Throbbing, one-sided head pain lasting 4-72 hours.
4. Postdrome. After the pain of a migraine attack subsides, you may feel fatigued, irritable, or have trouble concentrating. 

Click here to learn more about migraine including causes, types, treatment, and prevention.

Cluster headache

Cluster headache is a relatively rare but extremely painful type of headache. The term ‘cluster’ is used because the attacks usually occur in groups or clusters, typically for several weeks once or twice a year, at the same time of year.

Cluster headache causes severe burning or stabbing pain on one side of the head, usually behind one eye. The eye that is affected might be red and watery, droopy, or swollen. Other symptoms include a runny nose/congestion, and swelling of the forehead.

These episodes typically last between 15 to 180 minutes and occur between 1 and 8 times per day. 

Click here to learn more about cluster headache.

When to see a doctor

Headache is a common symptom, and most people will experience at least one in their lifetime. They are often mild and can be treated by resting, drinking water, or taking paracetamol/ibuprofen. 

However, you should see a doctor if you experience headache frequently or if it prevents you from doing things you normally do. You should also see a doctor if you need to take pain medicine frequently to treat headache (more than 2 or 3 times per week). These are signs that you might have migraine or another headache disorder, which your doctor can help you manage. They might also refer you to a specialist.

Even if you know you already have migraine or a headache disorder, you should still see a doctor if something changes or worsens about your attacks. 

In some cases, a headache could be a symptom of a serious medical disorder. You should seek medical attention as soon as possible if you experience:

• ‘Thunderclap’ headache – a sudden, severe headache
• A headache that progressively gets worse over several weeks
• A morning headache with nausea that doesn’t go away
• Headache accompanied by:
  • Stiff neck
  • Fever
  • Change in personality or your level of consciousness
  • Double vision or loss of vision
  • Loss of balance or sensation
  • Nausea and/or vomiting
  • Convulsion
• A new headache for patients with cancer, immunodeficiency, or a family history of glaucoma
• Headache after a head injury or accident
• Visual aura symptoms (see migraine aura) that last longer than an hour, include muscle weakness, are different than usual, or occur for the first time when you take an oral contraceptive pill

If possible, seek emergency care or call 000 for any of these symptoms to get an accurate diagnosis as soon as possible.

Diagnosis

You can get a diagnosis for your headache by seeing your general practitioner. There are many different types of headache, so they will probably ask you a number of questions about your medical history and the nature of your headache. 

They might also do a physical examination or run tests if they suspect the headache is caused by another medical condition. This could include blood tests, an MRI scan (magnetic resonance imaging), or a lumbar puncture.

If possible you should keep a headache diary in the weeks leading up to your appointment. A headache diary will help you track many of the things that your doctor will ask you about, such as:

• How many days you have a headache
• Headache severity
• What the pain feels like (i.e. stabbing, dull ache, etc)
• Any other symptoms you experience
• Possible triggers (i.e. caffeine, stress, lack of sleep, exercise)

Your headache diary can be as simple or as detailed as you like, but it is generally good to record as much information as possible. Visit this page to find some downloadable headache diaries & resources.

In addition to physical symptoms, you should let your doctor know how it affects your everyday life – at home, in the workplace, or socially. This can be taken into account when you are developing a treatment and management plan.

A general practitioner may be able to diagnose and treat your headache but sometimes they will refer you to a specialist. This might be a neurologist, dentist, ear nose and throat specialist, or other specialist depending on your symptoms.

Treatment & prevention strategies

The management and treatment of headache will depend on what type of headache you have. There is no permanent cure for headache, but there are several options that can be very helpful.

For a mild headache, you can try some simple home remedies:

• Lie down in a dark, quiet room
• Use a warm or cold compress on your forehead or the back of your neck
• Sleep
• Take a short walk in fresh air
• Make sure you have had enough water and food

You can also take over-the-counter pain medication for the occasional headache, such as paracetamol or ibuprofen. 

However, if your headache is severe or occurs frequently you should discuss treatment options with your doctor. You can work with them to develop a headache management plan that suits your lifestyle and preferences. It will often involve some combination of acute medication, preventive medication, complementary therapies, and lifestyle changes. Some of these options include:

• Avoiding known triggers (i.e. certain foods, lack of sleep, loud environments)
• Stress management & cognitive behavioural therapy
• Over-the-counter painkillers
• Prescription headache medication such as triptans
• Preventive treatments (i.e. oral medications, new injectable treatments, natural remedies, neurostimulation devices)

Keep in mind that some painkillers can cause medication overuse headache. If you take them too often, they can actually make your headache attacks more frequent, severe, or harder to treat. As a rule of thumb, over-the-counter painkillers should be limited to 3-4 days a week, or 1-2 days a week for triptans.

It can be complicated to treat headache, and there might be a period of trial and error. But with a trusted health professional and good support system, you can find the best possible treatment plan to manage your headache.

Further information & resources

Headache is a more complicated symptom than it appears, with many different types, causes, and symptoms. If you want to learn more about anything covered in this article, view the following resources on our website:

• Headache types directory – brief explanation of over 60 different headache types
• Migraine – overview article
• Treatment of headache – explaining the treatment for many different headache types
• Migraine & Headache Australia Support Group – Facebook group for Australians living with headache disorders
• Doctor Directory – list of neurologists in Australia that specialise in headache 

Resources from other websites:

• Recent research articles about headache – find scientific journal articles about headache or migraine.
• The Australian and New Zealand Headache Society – ANZHS is an organisation for clinicians with an interest in headache, and they also have resources available for patients

References:

1. International Headache Society, 2018, The International Classification of Headache Disorders 3rd edition (ICHD-3). Retrieved from: https://ichd-3.org/ 
2. Deloitte Access Economics, 2018, Migraine in Australia Whitepaper. Retrieved from: https://www2.deloitte.com/au/en/pages/economics/articles/migraine-australia-whitepaper.html