Headache Types: How to Know Which One You Have

Headache is the most common neurological symptom, with over 50% of the global population experiencing at least one type. While most headaches are benign, distinguishing between primary headache disorders (where headache is the condition) and secondary headaches (where headache is a symptom of another condition) is clinically important.

Tension-type headache — the most common type — presents as bilateral pressing or tightening pain of mild to moderate intensity, described as a 'band around the head'. It lasts 30 minutes to several hours, is not aggravated by activity, and is not associated with nausea. It responds well to simple analgesics and stress reduction.

Migraine presents as unilateral pulsating or throbbing pain of moderate to severe intensity lasting 4–72 hours, often with nausea or vomiting, and worsened by routine physical activity. Approximately one-third of migraineurs experience aura — visual disturbances (scintillating scotoma), sensory changes, or speech disturbance preceding the headache by up to 60 minutes.

Cluster headache — the most severe primary headache — causes excruciating unilateral periorbital pain lasting 15–180 minutes, occurring in clusters of attacks over weeks to months. Associated ipsilateral autonomic features (red eye, tearing, nasal congestion, ptosis) are characteristic. Secondary headache red flags requiring urgent evaluation: thunderclap onset, fever with meningism, new neurological signs, headache in cancer or HIV patients, and progressive worsening over weeks.

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