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The Hierarchy of Headaches


HEADACHES, LIKE BACK pain, are a universal human phenomenon that just about every adult has experienced at some point in time and can relate to. From the dull twinges to the nausea-inducing pounders, headaches can run the gamut. The Headache Society has cataloged and classified more than 150 primary and secondary headache disorder types. So how do you figure out what brings a headache on so that you can stop it in its tracks? More importantly, how do you know when the headache(s) you're experiencing warrant further medical attention?

First, let's cover the distinction between a primary headache and a secondary headache. A primary headache is one that occurs independent of any other medical issue – meaning it isn't caused by another medical condition. However, a secondary headache is a symptom brought on by another health issue or neurological concern. Especially for people who encounter headaches with some frequency or regularity, distinguishing between primary and secondary headaches is essential. If another condition is causing the headache, it needs to be evaluated and addressed by a neurological expert so that the headache symptoms it's causing can hopefully be eliminated.

Where primary headaches are concerned, the most common types include tension headaches and migraines. Tension headaches are characterized by a dull pain, pressure or tightness that uniformly surrounds the forehead or back of the head and neck and tend to "build" over time. Though pain from a tension headache can range in severity from mild to severe, many people believe its primary difference from a migraine is in the intensity of the pain. This isn't necessarily true because the mechanism of migraine is thought to be different. Furthermore, the differences in clinical characteristics involve more than just severity. Migraine headache can come on quite suddenly and severely, seemingly out of nowhere (although many people have an "aura" that can serve as a warning that the headache is coming.) Migraine headaches can also affect one side of the head more than the other, and people who get these types of a headache can also experience nausea or vomiting in severe cases and may also develop an acute sensitivity to light or noise during a migraine episode. Migraine is felt to be "underdiagnosed" – meaning that many individuals suffering from migraine don't know it. They believe they have sinus headaches or tension headaches and may miss opportunities to more successfully treat them because of the misdiagnosis.

Though the symptoms may present similarly to those experienced by people suffering from a primary headache, secondary headaches are brought on by another cause that usually involves the head or the neck. The origins of a secondary headache can vary significantly. For some people, it's a headache brought on by dental pain from an infected tooth. For others, it can be the symptom of a concussion. In rare but serious cases requiring immediate medical attention, a secondary headache can be caused by bleeding from the brain.

Most headaches are episodic, meaning they are infrequent and don't require medical attention. Others are considered chronic – meaning they occur more than a few times a month. So how can you tell whether a headache is severe enough to warrant medical attention? If a headache follows a blow to the head, is accompanied by sudden, excruciating pain, a stiff neck, fever, convulsions, confusion, loss of consciousness or associated with severe pain in the eye or ear – immediate medical evaluation is crucial. In less severe cases, where a headache occurs more than three times in a month, a visit to the doctor is where to find out what may be causing the headaches and to help minimize their frequency and severity.

Of course, the best headache is the one you never get. Especially when it comes to primary headaches that have no other underlying cause, figuring out your headache "triggers" and avoiding them is the best defense. In today's digital age, too much screen time can be a headache trigger for many people. Take frequent breaks from your computer and smartphone screens to give your eyes a rest. And, how's your diet? Sensitivity to certain foods can bring on headaches for some people. Sleepless? Stressed out? Lack of sleep, disordered sleep (as with obstructive sleep apnea) and life-stress are also common headache triggers. Consistently getting enough shut eye, certain forms of biofeedback and mindfulness meditation have been shown to help lessen the headache occurrences and severity for many sufferers. Are you experiencing headaches often enough for there to be a pattern to them, but you aren't exactly sure what the cause is? Try keeping a journal. When a headache comes on, write down what you did that day or the day before that might have triggered it. After a few entries, you may begin to see a pattern emerge that will help you stop a headache in its tracks next time. It's worth the effort. We are learning more and more about premonitory phases (with symptoms other than pain that may begin hours or days prior to certain headache types) and postdromal phases (symptoms such as fatigue, or GI symptoms that may continue for some time after migraine headache pain has resolved).