From the Guidelines
Headaches are primarily classified into three distinct types: migraines, tension headaches, and cluster headaches, each with unique diagnostic requirements and characteristics.
Types of Headaches
- Migraine headaches are diagnosed based on at least two of the following features: unilateral location, throbbing character, worsening pain with routine activity, and moderate to severe intensity, along with at least one of the following features: nausea and/or vomiting, photophobia, and phonophobia 1.
- Tension headaches are characterized by at least two of the following features: pressing, tightening, or nonpulsatile character, mild to moderate intensity, bilateral location, and no aggravation with routine activity, along with both of the following features: no nausea or vomiting and no photophobia and phonophobia 1.
- Cluster headaches are diagnosed based on five attacks with a frequency of one to eight attacks on any given day, severe unilateral, bilateral, supraorbital, or temporal pain lasting 15 to 180 minutes, and at least one of the following features on the same side as the pain: lacrimation, nasal congestion, rhinorrhea, forehead and/or facial sweating, ptosis, miosis, or eyelid edema 1.
Importance of Accurate Diagnosis
Accurate diagnosis is crucial for effective treatment and management of headaches. A detailed history and thorough physical and neurologic examination are essential for distinguishing between different types of headaches.
Treatment Considerations
Treatment varies by type, with tension headaches typically responding to over-the-counter pain relievers, migraines requiring specific medications or preventive treatments, and cluster headaches often needing oxygen therapy or injectable medications. It is essential to understand the specific headache pattern for effective treatment, and any sudden, severe headache or one accompanied by fever, confusion, or neurological symptoms requires immediate medical attention.
From the Research
Types of Headaches
- Primary headache disorders, which are unrelated to an underlying medical condition, can be categorized into four groups: + Migraine + Tension-type headache + Trigeminal autonomic cephalalgias + Other primary headache disorders 2
- Secondary headache disorders are defined as headaches due to an underlying medical condition and are classified according to whether they are due to vascular, neoplastic, infectious, or intracranial pressure/volume causes 2
Characteristics of Each Type
- Migraine: + Associated with significant work- and family-related disability 3 + Can be treated acutely with analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, and lasmiditan 2 + Preventive treatments include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA 2
- Tension-type headache: + Characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity 4 + Diagnosis is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition 4 + Pharmacological therapy is the mainstay of clinical management and can be divided into acute and preventive treatments 4
- Cluster headache: + One of the most common primary headache types 5 + No specific characteristics mentioned in the provided studies
Diagnosis and Treatment
- Adequate treatment is possible only on the basis of the correct diagnosis 5
- The current diagnostics process for headache is based on the 'International Classification of Headache Disorders' (ICHD-3-beta) that was produced under the auspices of the International Headache Society 5
- Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder 2