Types and Symptoms of Headache

If your head hurts, you have a headache. The most important symptom in the diagnosis of headache is pain. Beyond that, it gets complicated. The International Headache Society has developed a highly detailed classification system for identifying headache types based on how the headache presents. You can review this classification scheme at www.i-h-s.org. From a practical standpoint, the most important distinction to make is whether a headache is secondary (due to some other, underlying cause, like a tumor, infection, bleeding, or inflammation) or primary (not due to some other underlying cause). Secondary headaches can be scary because they include things like meningitis, subarachnoid hemorrhage, and brain tumors. They are also much, much rarer than primary headaches which include migraine, tension-type headaches, and cluster headaches. Of course, there are many other headache types in each group, but the first and most important question to be answered is: “Is my headache primary or secondary?” It is a question best answered by a physician.

How does a physician go about determining whether a headache is secondary or primary? It all starts with the history. For example, someone who has had headaches for years is not as likely to have a secondary headache as someone whose headaches started a few weeks ago. Someone with fever and chills and a stiff neck along with their headache is more likely to have a secondary headache than someone who has a red, puffy eye and a runny nose with their headache. There are dozens and dozens of different scenarios that the clinician must sort through before coming to a diagnosis. That is why you need a skilled and experienced person listening to your history. When appropriate your doctor will supplement the history and examination with blood tests and imaging studies. The selection of these tests is based on things learned during the history and physical examination. They can include anything from genetic testing to measures of clotting and inflammation to MRI’s with special software to look at venous and arterial bloodflow.

While a number of headache types are described in the following pages, it is important to remember that few individuals have all the elements and only the elements of one particular headache type, and it is the skill and experience of the headache specialist that narrows the field to the most likely diagnosis, and it is that diagnosis that guides treatment.