The Four Most Common Headache Types, and How to Tell Them Apart

How headaches are classified

Clinicians use the International Classification of Headache Disorders (ICHD-3) to tell headache types apart.¹ It groups headaches by where they are felt, how long they last and the symptoms that come with them.

Tension-type headache

The most common type.² It usually feels like a band of pressure or tightness on both sides of the head, lasts from 30 minutes to several days, and does not usually come with nausea. A European guideline recommends simple pain relievers for attacks and, for frequent tension-type headache, preventive medication such as amitriptyline, which your doctor can discuss. It also lists non-drug approaches such as biofeedback, relaxation training and physical therapy.³ Ask your pharmacist or doctor before starting any medication.

Migraine

Often on one side, throbbing, and lasting 4 to 72 hours. It often comes with sensitivity to light and sound, and sometimes nausea.⁴ Many people notice triggers such as poor sleep, skipped meals or stress. Regular sleep, meals and exercise can help some people. Treatment often includes medication for attacks, such as anti-inflammatories or triptans, and sometimes preventive medication.⁴ Your family doctor or a neurologist can diagnose migraine and discuss these options.

Cluster headache

Severe pain strictly on one side, around the eye, lasting 15 minutes to 3 hours, often at the same time of day. People tend to feel restless rather than wanting to lie still, and the eye on that side may water or redden.⁵ Attacks are usually treated with high-flow oxygen or triptan medication, and preventive prescription medication such as verapamil is often used.⁵ If this sounds like you, see your family doctor, who may refer you to a neurologist.

Cervicogenic headache

A headache that starts in the neck. It is usually on one side and is brought on or made worse by neck movement or sustained neck postures.⁶ It is the type where neck-focused exercise and hands-on care have been studied most. In a randomised trial, both exercise and manual therapy reduced headache frequency and intensity compared with no treatment, and the benefits held at 12 months.⁷ A systematic review found that spinal manipulation may help some chronic headaches, although the evidence was limited.⁸

Side by side

Based on ICHD-3 criteria.¹

Take-home

• The type of headache guides the care, so it is worth getting it identified.
• Cervicogenic and tension-type headaches are the ones where neck-focused exercise and hands-on care are most often considered.
• Migraine and cluster headache usually need input from your doctor.

Sources

1. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38(1):1-211. Classification system. Link
2. Stovner LJ, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27(3):193-210. Systematic review. Link
3. Bendtsen L, et al. EFNS guideline on the treatment of tension-type headache. Eur J Neurol 2010;17(11):1318-1325. Clinical practice guideline. Link
4. Dodick DW. Migraine. Lancet 2018;391(10127):1315-1330. Narrative review.
5. Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol 2018;17(1):75-83. Narrative review. Link
6. Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009;8(10):959-968. Narrative review. Link
7. Jull G, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002;27(17):1835-1843. Randomised controlled trial. Link
8. Bronfort G, et al. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther 2001;24(7):457-466. Systematic review. Link

This article is general education. It does not replace advice from a clinician who has examined you.