90% of all headaches are primary headaches. Primary headaches usually first start when people are between 20 and 40 years old . The most common types of primary headaches are migraines and tension-type headaches. They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound). Tension-type headaches usually present with non-pulsing “bandlike” pressure on both sides of the head, not accompanied by other symptoms.
- Tension headaches are the most common type of primary headache. Tension headaches occur more commonly among women than men. According to the World Health Organization, 1 in 20 people in the developed world suffer with a dailytension headache.
- Migraine headaches are the second most common type of primary headache. Migraine headaches affect children as well as adults. Beforepuberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected.
- Cluster headaches are a rare type of primary headache. It more commonly affects men in their late 20s though women and children can also suffer this type of headache.
cs can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes.
Many patients equate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. A full discussion of migraine headaches can be found in this article.
Other very rare types of primary headaches (<8%) include:
- trigeminal neuralgia: shooting face pain
- hemicrania continua: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication indomethacin.
- primary stabbing headache: recurrent episodes of stabbing “ice pick pain” or “jabs and jolts” for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with indomethacin.
- primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious etiologies(see secondary headaches red flag section) must be ruled out before a diagnosis of “benign” primary cough headache can be made.
- primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as indomethacin.
- primary sex headache: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as propranolol and diltiazem can also be helpful.
- hypnic headache: moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during night. Hypnic headaches are usually in older women. They may be treated with lithium.