An over­view of the most frequent types of head­a­ches

All known headache types can, in principle, be categorised into one of two major groups. The first group comprises primary headaches with no identifiable cause. Secondary headaches, on the other hand, are the symptom of an underlying condition.

Primary headaches

Headaches are unpleasant and can seriously impair day-to-day life. However, 90 per cent of all primary types of headaches do not present a risk to health. The pain occurs spontaneously, that is to say there is no recognisable cause, which is why they are referred to as primary headaches. The most frequent types are tension and 'cluster' headaches as well as migraines. 

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Tension headaches - as if your head were in a vice

Of all known headaches, tension headaches are the most common. In the majority of cases, both sides of the head are affected and the pain radiates from the back of the head to the forehead or into the shoulders. They can last anywhere between 30 minutes and an entire week. Such headaches are often experienced as a dull pain, as if you were wearing a hat that is too tight. As a rule, those affected describe the pain as slight to, at worst, moderate. Physical activity often helps to alleviate the suffering. For the most part, the symptoms only occur occasionally. They can, however, also become permanent in nature. Tension headaches are classed as chronic if they are experienced for more than 14 days a month over a period of at least three months. 

Migraines - like a blow to the head

Migraines are the second most frequent type of headache and can have a major impact on the lives of those affected. Typical symptoms include intense, one-sided, seizure-like and pulsating pain which can switch to the other side of the head over the course of the attack and become more severe with even just light physical activity. They can last anywhere between a few hours and several days. Half of all migraine sufferers report experiencing one attack a month, and one in ten patients suffer from four or more attacks. Noise and light often intensify the pain together with symptoms such as nausea and vomiting.

Migraine attacks can be preceded by visual impairments such as flickering, streaking, lines or visual field loss, tingling arms and legs and difficultly finding words. Around ten to 15 per cent of all migraine patients suffer from a 'migraine aura' which eases once the headache begins. Some sufferers observe certain changes in behaviour in advance and can predict that an attack is imminent. Typical indicators are pronounced mood swings, e.g., depression or hyperactivity, or a craving for certain foods.

Cluster headaches - unbearable pain up to eight times a day

Cluster headaches are rare. They affect one in every thousand Germans, with men suffering considerably more frequently than women. The term 'cluster' is used as these are experienced as frequent, episodic events. Those affected will typically suffer headaches at night for a period of weeks or months up to eight times a day and then be headache-free for months or even years. Chronic cases are also reported with either no or only very brief pain-free intervals. 

Each attack is extremely intense, is associated with piercing or stabbing pain and lasts between 15 minutes and three hours. The pain is always experienced on one side, in the eye socket and temple area. Typical headache side effects are watery and red eyes, redness of the face, runny or blocked nose, and/or drooping eyelids. During an attack some patients will continuously walk to and fro or rock their upper body back and forth.

Secondary headaches

Headaches caused by illness or the excessive consumption of or withdrawal from certain substances including alcohol and medications are known as secondary headaches. These are far rarer than primary headaches. They represent just eight per cent of all headaches.

Medication headaches - a vicious circle

Although it may sound like a contradiction in terms, pain medication to treat acute headaches can cause persistent headaches. For those affected, this marks the start of a vicious circle: Sufferers use painkillers often or even daily out of fear of attacks or increase their dosage without consulting a doctor. This excessive use can affect the brain's metabolism and lower the threshold at which the stimulus is perceived as pain. Stimuli that were previously assessed as normal, i.e., not painful, now result in the sensation of pain and headaches become chronic, in other words, pain is experienced on at least 15 days per month.

In Germany, around 40 to 50 per cent of all patients with chronic symptoms suffer medication headaches.

Headaches as a result of illness

Headaches are only very rarely the result of organ damage, illness and injuries. 
You should consult your doctor if you experience any of these symptoms:

• fever and temperature
• a stiff neck and pain in the neck and back
• muscular and joint pain which gets continually worse or which no longer goes away
• fatigue
• memory and concentration disorders combined with exhaustion, nausea, dizziness and difficulties walking
• if the headaches type which you have experienced for many years suddenly changes