From the Guidelines
Primary headaches are caused by a variety of factors, including tension, abnormal brain activity, nerve signal and blood vessel changes, and genetic predisposition. These factors can lead to different types of primary headaches, such as tension-type headaches, migraines, and cluster headaches. Tension-type headaches result from muscle tension in the head, neck, and shoulders, often triggered by stress, poor posture, or eye strain 1. Migraines are caused by abnormal brain activity affecting nerve signals, blood vessels, and chemicals, with triggers including hormonal changes, certain foods, stress, sensory stimuli, sleep changes, and weather changes. Cluster headaches involve the trigeminal nerve and hypothalamus, with triggers such as alcohol, strong smells, and high altitudes.
Some of the key factors that contribute to primary headaches include:
- Genetics, which play a significant role in many primary headaches, particularly migraines
- Environmental factors like bright lights, loud noises, and strong odors
- Lifestyle factors such as irregular sleep patterns, skipped meals, dehydration, and excessive caffeine consumption or withdrawal
- Physical activity, which can cause exertional headaches
- Straining, which can lead to cough headaches
- Sleep patterns, which can contribute to hypnic headaches
It's essential to note that nonpharmacologic therapy, such as physical therapy and aerobic exercise, may be beneficial in managing tension-type, migraine, or cervicogenic headache 1. However, the evidence for other behavioral interventions, such as biofeedback, cognitive behavioral therapy, and mindfulness-based therapies, is insufficient to recommend for or against their use in treating and preventing headaches 1. Aerobic exercise or progressive strength training may also be helpful in preventing tension-type and migraine headache 1.
From the Research
Primary Headache Disorders
Primary headache disorders are defined as headaches that are unrelated to an underlying medical condition and are categorized into 4 groups:
- Migraine
- Tension-type headache
- Trigeminal autonomic cephalalgias
- Other primary headache disorders 2
Causes of Primary Headaches
The exact causes of primary headaches are not fully understood, but several factors are thought to contribute to their development, including:
- Genetic factors
- Environmental factors
- Cortical hyperexcitability
- Regional brain dysfunction
- Central sensitization
- Neuroplasticity changes 3
- Multifactorial etiology, involving genetic and environmental factors 4
Types of Primary Headaches
There are several types of primary headaches, including:
- Migraine: a debilitating headache disorder that can be treated acutely with analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, and lasmiditan 2, 5, 6
- Tension-type headache: the most common primary headache disorder, with a worldwide lifetime prevalence of 46% to 78% 4
- Trigeminal autonomic cephalalgias: a group of rare headache disorders characterized by autonomic symptoms such as lacrimation and nasal congestion 2
- Other primary headache disorders: a category that includes several rare and unusual headache disorders 2