Makings Heads & Tails of Your Headache

There are enough types of headaches to… well, make your head hurt to think about. Most people will have suffered some form of headache throughout their lifespan. Understanding what type of headache you’re experiencing is the first step to treating it effectively.

Would you believe there is an International Headache Society, who publish The International Classification of Headache Disorders? This classification system is what your healthcare provider bases their diagnoses off when assessing your headache. There is a lot of cross-over amongst the conditions and it can be difficult to differentiate all of them, but being as accurate as possible will ensure your management is appropriate.

The classifications are split into 3 parts; primary headaches, secondary headaches, and neuropathies & facial pains.

Primary Headaches include:

  • Migraine
  • Tension-type headache
  • Trigeminal autonomic cephalgias
  • Other (including primary cough headache, primary exercise headache, headache associated with sexual activity, etc)

Secondary Headaches include headaches attributed to:

  • Trauma of the head or neck
  • Cranial or cervical vascular disorder
  • Non-vascular intracranial disorder
  • A substance or its withdrawal
  • Infection
  • A disorder of homeostasis
  • A psychiatric disorder

Neuropathies & Facial Pains include:

  • Painful lesions of the cranial nerves and other facial pain
  • Other headache disorders not classified elsewhere

In this blog, we will focus on the most common headaches. The ones that can be managed effectively with Osteopathy, in conjunction with a wider conservative care team including General Practitioners. The following is a simplified description of the 4 most common headache types. It is important to recognise that individual experiences of symptoms and severity can vary greatly.

Cervicogenic (neck-related) Headache

This relates to headaches caused by non-traumatic disorders of the neck. This can include joint, muscle, or disc related neck pain. The timing of the onset is usually aligned with the onset of neck pain or dysfunction. The pain location can often spread from the neck, up into the back of the head and across the cranium. Although, different neck structures will contribute to different pain referrals across the head, so the location can be variable.

For these headaches, there is usually a painful restriction of neck movement that worsens the headache symptoms. The headache also tends to improve alongside improvements to the neck disorder. In severe cases, this can be accurately tested with diagnostic blockades of the cervical structure’s nerve supply.

There is some cross-over with headaches caused by more broad myofascial type pain, these usually have a more band-link pressing quality and fall into the tension-type headache category.

Migraine without aura

Migraines are recurrent, moderate-to-severe attacks that last 4-72 hours. These headaches are typically unilateral (one-sided), pulsating quality, and intense. They can often by aggravated by simple physical activity, and will be associated with either nausea and vomiting or photophobia (visual sensitivity to lights) and phonophobia (sensitivity to sounds).

Migraine with aura

These are migraines that are preceded by an ‘aura’. Occasionally the aura will not be followed by a headache, especially if treatment is sought immediately. An aura consists of reversible visual, sensory, or speech/language symptoms. Atypical auras can even involve motor weakness, and brainstem or retinal symptoms. The aura experience is often very different from person to person, however it will have at least three of the following characteristics:

  1. at least one aura symptom spreads gradually over ≥5 minutes
  2. two or more aura symptoms occur in succession
  3. each individual aura symptom lasts 5-60 minutes
  4. at least one aura symptom is unilateral
  5. at least one aura symptom is positive
  6. the aura is accompanied, or followed within 60 minutes, by headache

Tension-Type Headache

This is the classic head-in-a-vice type headache. It’s the most common headache, with studies showing that up to 78% of people will experience at least one throughout their life. It usually feels like a band around the whole head, pressing and tightening down on you. Sometimes referred to as a stress headache, it is most often caused by a combination of muscle tension and psychogenic stress. Like many musculoskeletal disorders, its physical characteristics can’t be disentangled from its psychological characteristics. Therefore, a combination of physical treatments (massage, mobilisation, medications, etc) and psychological treatments (mindfulness, decreasing stressful stimuli, increasing joyful stimuli, etc) is the gold standard management. If it is only treated physically, with no effort made to modifying the psychosocial triggers, it is unlikely to have a long-term effect on reoccurrence.

Cluster Headache

Cluster headaches are a type of trigeminal autonomic cephalalgia (TAC) – which is an awful mouthful. Put simply, TACs are headaches felt on one side of the head, with prominent autonomic symptoms on the same side of the head. These autonomic symptoms can include; a watery eye, swollen eyelid, drooping eyelid, runny nose, facial sweating, etc.

Cluster headaches are 15-180 minute episodes that occur with a frequency between one every other day up to 8 times a day! These nasty head pains are severe or very severe, and usually felt around or behind the eye and temple region. As mentioned above, this will be paired with prominent autonomic symptoms on the same side of the head.

There are various medications that can be used to treat cluster headaches, which help to reduce pain and prevent the frequent recurrence during a cluster period. However, there is no known cure to the condition.

Let’s Wrap Our Heads Around All Of That

So in conclusion, a simple headache can be caused by a multitude of different reasons. Getting an accurate diagnosis is an important first step to treating and overcoming these disabling conditions. If you’re experiencing frequent or disruptive headaches, book in with the team to get a thorough examination and a personalised treatment plan!


Josh Roberts

Josh is an Osteopath with Peninsula Osteopath + Allied Health. He has also completed a Bachelor of Exercise and Sport Science and is qualified in Cupping and Myofascial Dry Needling. Josh has a special interest in active populations and runners, but has a passion for helping anybody understand and overcome their pain, enabling them to live their life to the fullest.