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Headaches & migraines

The following is a very brief outline of the main headache and migraine types. Most of them can exist in recurrent or chronic forms. It does not include some of the rarer classifications and It is not intended for self-diagnosis.
Some secondary headaches (that is headaches linked to other conditions) are mentioned but the full list is too lengthy to include.
Please note; Some similar types have been grouped together for convenience.

Consultation with a headache/migraine specialist is strongly advised for an accurate assessment and diagnosis.

Tension-Type headaches

These sometimes occur as a result of stress, anxiety and / or depression, but there are also many other causes. The pain starts gradually, is mild to moderate and does not usually affect your ability to carry out normal daily activities. Individuals describe it as a feeling of pressure or a tight band around the head.
Muscle Contraction/ Musculoskeletal headache

Many spinal problems, chronic muscle tension or joint dysfunctions in the head, neck, jaw or elsewhere in the spine can cause headache and face pain with variable presentations.
Migraine without aura (common migraine)

This is the most frequently encountered form of migraine. Migraine is a severe headache type affects between 17 per cent of women and 6 per cent of men. Attacks last from 4 to 72 hours. Presentation is variable but often includes the following;

  • Patients are usually symptom-free between attacks
  • Headache is at least two of the following
  • Unilateral (on one side)
  • Pulsating
  • Moderate to severe
  • Aggravated by routine activities
  • Accompanying symptoms may include
  • Photophobia (more sensitive to light)
  • Phonophobia (more sensitive to noise)
  • Nausea and Vomiting

It is important to realise that not all four main symptoms have to be present. It is quite possible to have a mild headache which is bilateral, but still have migraine. Sometimes in the day or two before an attack, prodromal symptoms, such as cravings and lethargy, can be experienced.

Migraine with aura (classic migraine)

Symptoms are usually the same as migraine without aura(above), with the addition of neurological disturbances lasting 15 minutes to an hour before the commencement of the headache. These are typically visual disturbances such as blind spots, flashing lights or zigzag patterns in the vision, but can include tingling, pins and needles or numbness in the limbs, anxiety, or problems with co-ordination and articulation (e.g. getting words mixed up). Some people experience the aura only, without the development of a headache

Menstrual migraine

Over half of the women who suffer from migraine feel that their attacks are linked to their menstrual cycle. However, true menstrual migraine, associated with known hormonal triggers, is defined as attacks, which occur within two days either side of a monthly period and at no other time. Hormonal factors are one of many triggers for migraine and women can be more susceptible to other factors around the time of their period.

Abdominal migraine

Describes recurrent and episodic attacks of abdominal pain lasting for several hours with complete freedom from symptoms between attacks. It usually occurs in children; it is unusual for adults to develop “abdominal” migraine without the more usual accompanying symptoms of headache etc.

Hemiplegic migraine

Symptoms include temporary paralysis down one side of the body, which can last for several days. Other symptoms include vertigo or difficulty walking, double vision or blindness, hearing impairment, and numbness around the mouth leading to trouble speaking or swallowing. This form of migraine may be confused with a stroke, but the effects are usually fully reversible.

Basilar artery migraine

It is possible (but not proven) that in some cases during a migraine attack, the basilar artery, a blood vessel at the base of the brain, goes into spasm causing a reduced blood supply to parts of the brain. This type of migraine can cause giddiness, double vision, unsteadiness, and fainting or even loss of consciousness.

Vestibular migraine

Also known as migrainous vertigo. sometimes considered a sub type of the above with similar symptoms but less severe. May or may not be associated with actual headpain.

Chronic migraine

Is a sub-type of chronic daily headache. Chronic migraine is when an individual experiences more than fifteen headache days per month over a three month period of which more than eight are migrainous, in the absence of medication overuse.

Cluster migraine

This is a misnomer which is sometimes incorrectly applied when individuals experience frequent migraine attacks {as many as two or three a week for a short period of time). it should not, however be confused with true cluster headache( see below).

Ocular migraine

Involves an aura that significantly affects vision. Visual symptoms with an ocular migraine are short term. A migraine aura involving vision will usually affect both eyes, and may include flashes of light, zigzagging patterns, blind spots, and shimmering spots or stars.

Retinal migraine

Involves a migraine headache associated with visual loss in one eye only (scotoma) lasting less than one hour. During some episodes, the visual loss may occur with no headache. At other times a throbbing headache on the same side of the head as the visual loss may occur, accompanied by severe light sensitivity and / or nausea. After each episode, normal vision returns.

Chronic daily headaches

Defined as headaches which occur on more than 15 days each month. The onset is usually gradual over a period of time. It is described as a syndrome and can consist of several different types of headache occurrring throughout the month, such as tension headache, muscle contraction headache and medication misuse headache, sometimes with superimposed attacks of migraine.

Post-traumatic headache

As the name implies this is a headache or migraine that follows some form of trauma/accident (usually involving the head or neck). May take the form of different headaches or migraines (already described above) with the possible addition of other symptoms such as depression, irritability, memory impairment, dizziness, sleep disturbance and fatigue.

Medication overuse headaches

Sadly a common cause of headaches and migraines. Although pain killing medications can be very effective in relieving headache, it is also possible, if taken too often,for them to cause rebound headaches. In the United Kingdom, the most commonly implicated drugs are those containing codeine but all simple analgesics( incl non-steroidal anti-inflammatories) and ergotamine compounds have been implicated. In recent times, the triptan class of drugs has also been reported to cause chronic headache. Individuals find that they are experiencing more and more headaches, often daily, and that they require increasing amounts of medication to relieve them.

New daily persistent headache

A sub group of chronic daily headache above. Similar in many ways to chronic tension type headache but the onset is sudden.

Cluster headache

Also known as “the suicide headache” because the pain is so intense. The pain is centred around one eye and is described as excruciating and knife-like. The eyelid will droop and the eye becomes watery. The nostril on the affected side may become blocked or watery. Individual attack last only a short time, usually between 15 minutes and one hour; but attacks occur in “clusters” ranging from once every other day to up to eight times a day. Clusters usually last for six – eight weeks (sometimes at the same time of year ), with periods of remission usually lasting months or even years in between.

Trigeminal neuralgia

One sided, very severe, short lasting bouts of stabbing pain in the face. Individual attacks can be triggered by any contact with affected area for example; shaving/washing/eating/talking etc
Trigeminal autonomic cephalagias and other hemicranias

This classification includes a number different headache types,including cluster headaches and trigeminal neuralgia listed above, as well as less common ones such as S.U.N.C.T / S.U.N.A, paroxysmal hemicrania etc. Basically they all take the form of one-sided severe, frequent, short lasting head or facial pain. Frequently accompanied by various eye or nasal symptoms (tearing, stuffiness etc)

Post Herpetic Neuralgia

Shingles (herpes zoster virus) can cause pain resulting from various cranial nerves. The pain may start during an acute rash of herpes but the main problem is pain that persists after the herpes rash has gone. Common symptoms include a constant deep pain, with repeated stabs, or needle pricking pain. Even light touch can trigger these symptoms which may be accompanied by itching. Half of patients have no pain after three years.

Hypnic headache

Also known as alarm clock headache- is a relatively rare headache type that occurs only at night and usually wakes the sufferer at the same time in the early hours. It is worth noting that ‘normal’ migraine may also start at the night.

Sinus headache

Normally consists of recurrent recurrent dull, achy pain with a feeling of fullness/congestion (worse on bending) located over one or more sinuses such as forehead, between eyes, face, cheek, jaw or teeth.
Thunderclap headache

Sudden onset of severe headpain; overlaps with a number of different primary headache types including; exertional/exercise induced headache, orgasmic headache/migraine etc. However it may possibly be secondary to a number of medical conditions, if you feel you may fall into this category you should contact your medical practitioner urgently.

Secondary headpain

This category consists of headaches/migraines that are the result of an underlying medical condition. The causes are many and extremely varied including; neurological disease, vascular conditions, endocrine problems, systemic illness, metabolic abnormalities, brain pathologies/damage and referred pain from elsewhere.

Your head pain specialist will consider these possibilities during consultation and if necessary organise further investigations.

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