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Primary vs. secondary headaches

Depending on their cause, headaches are categorized into two categories, primary and secondary headaches. Learn their differences below.

Headache is a symptom that is widely encountered in clinical practice and is one of the common causes of functional impairment according to the WHO. Headache may be experienced in different ways, along with additional symptoms.

Depending on the causes, doctors usually categorize headaches into primary and secondary headaches.

Primary headache

• A primary headache is not a result of an underlying illness. They account for more than 90 percent of all headaches.
• Primary headaches can start in the blood vessels and nerves of the head or the muscles of the neck and face.
• Stress, nutrition, alcohol, changes in sleep habits, and other factors are triggers.

15 common symptoms of primary headache

1. Constant pressure or ache
2. A pulsating or throbbing pain
3. Might linger for several hours or days
4. The degree of discomfort can make it difficult to go about usual routines
5. Painful enough to disturb a sleep routine
6. Accompanied by nausea or vomiting
7. Sensitivity to light or sound
8. The pain may be on one side of the head or both sides
9. Some patients complain of primary headache behind or around one eye
10. Patients complain of throbbing pain at the front of the head although it can be felt on the side or throughout the head
11. Associated with excessive tears, redness, or drooping eyelids on the same side as the pain
12. Nostril on the affected side has nasal congestion or post-nasal drip
13. Headaches may appear rapidly and begin immediately after the exercise due to exertion
14. May appear gradually over the day
15. Primary headaches may even develop during a daytime nap

5 types of primary headaches

Primary headaches can be one-time occurrences or may occur frequently over a long period.

1. Tension headaches:
   • The most common type of headache experienced by patients is a tension headache.
   • Half of all patients who report headaches have symptoms consistent with a tension headache.
2. Migraines:
   • Migraines are the second most common type of primary headache, and they are a common complaint.
   • About 30 percent of adult patients with headaches experience migraine-like symptoms.
3. Cluster headaches:
   • Cluster headaches are less common and more painful than tension or migraine headaches.
   • These are relatively brief (minutes to hours), but the person may experience multiple episodes in a day.
   • These cluster periods can last weeks or months and are usually followed by periods of complete remission, with no headaches for months or even years.
   • Most attacks happen at the same time of day, especially at night.
   • Cluster periods can happen at the same time of year.
4. Exertional or exercise headaches: Headache occurs as a result of physical exertion and is frequently caused by activities that increase chest pressure or tense the abdominal muscles.
5. Hypnic headaches:
   • This is a rare sleep-related primary headache that develops in people older than 50 years.
   • It is also called an alarm clock headache because it only happens while a person is sleeping and can wake them up due to severe pain.

Secondary headache

• Secondary headaches always have an underlying cause, which may need medical treatment.
• The causes can range from abuse of medications or caffeine withdrawal to something more serious, such as an infection, blood clot, or brain tumor.

16 symptoms of secondary headache

1. Vertigo
2. Light-headedness
3. A dull ache that gets worse from time to time
4. Trouble concentrating
5. Tiring quickly
6. Irritability
7. Memory problems
8. Headaches from pain medication overuse
9. Daily, chronic headaches that are usually felt on waking
10. Improvement with pain relief medication, but the pain returns when the medicine wears off
11. Nausea
12. Anxiety
13. Restlessness
14. Depression
15. Pain felt in cheeks and forehead
16. Stuffy or runny nose

3 types of secondary headaches

1. Post-traumatic headache:
   • Posttraumatic headaches generally occur within seven days following a head injury.
   • Pain that is excruciating or if the person is losing consciousness as a result of the trauma, seek emergency medical assistance. Even if the symptoms are minor, see the doctor.
   • The associated symptoms of this type can linger for several months.
2. Headaches from pain medication overuse: Chronic headaches can occur as a result of overuse of some pain relievers, especially if a person takes them more than two to three days per week.
3. Sinus headaches:
   • Pain caused by pressure or congestion in the sinus cavities.
   • Sinus headaches are common, but if they last for more than a week and are associated with fever, it could be a bacterial sinus infection.

What are the common causes of headaches?

Overactivity or issues with pain-sensitive regions in the head can induce headaches.

Primary headaches

Primary headaches can be caused by altered chemical activity in the brain, nerves, or blood vessels in and around the skull or muscles of the head and neck (or a combination of these). 

Some people may carry genes that predispose them to severe headaches.

15 common causes of primary headaches:

1. Emotional stress
2. Poor posture
3. Eyestrain
4. Lack of sleep or poor sleep
5. Changes in diet
6. Depression or anxiety
7. Dehydration
8. Menstruation
9. Hormonal changes
10. Straining while making a bowel movement
11. Excessive physical stress
12. Hypertension
13. Poor breathing during sleep
14. Increased pressure in the brain when lying down
15. Muscle tension

Secondary headaches

Secondary headaches are symptoms of an underlying problem, condition, or disease that must be addressed.

10 common causes of secondary headaches:

1. Sinus infection
2. Caffeine withdrawal
3. Medication overuse
4. Pregnancy-related
5. Another existing, known medical condition, such as high blood pressure
6. Head injury
7. Bleeding in the brain
8. Brain tumor
9. Pressure builds up in the sinus cavities due to congestion
10. Swelling of brain structures

Who suffers more frequently from migraine headaches?
See Answer

What are the treatment options for headaches?

Not all headaches indicate a significant problem; however, if they interfere with daily life or are accompanied by other symptoms, such as blurred vision or nausea, consult a doctor. Doctors may develop a treatment strategy based on various diagnoses, underlying illnesses, and headache types.

9 treatment options for primary headaches

1. Over-the-counter medications can often provide significant headache relief
2. Drinking liquids can be helpful, particularly if dehydration is the cause
3. Getting rest
4. Balanced nutrition
5. Massages that reduce stress
6. Migraine drugs are classified into two types: migraine pain relievers and migraine preventative medication, which are intended to limit the number of migraines that occur
7. A brief warm-up period before exertion or avoiding specific exercises that cause pain
8. Most people respond to over-the-counter or prescription anti-inflammatory drugs
9. Although lithium carbonate can be used to treat hypnic or cluster headaches, it has several negative effects; caffeine and indomethacin at bedtime are two further therapies that doctors may recommend

If a person is experiencing severe and incapacitating primary headaches, they should consult the doctor immediately to establish a treatment strategy.

15 treatment options for secondary headaches (depending on the underlying cause)

1. Anti-inflammatory medication or pain relievers
2. Blood pressure pills
3. Antidepressants
4. Anti-seizure medications
5. Biofeedback
6. Physical therapy
7. Nerve stimulators
8. Relaxation therapies
9. Cognitive-behavioral therapy
10. Headaches from pain medication overuse
11. Hydration
12. Rest
13. Targeted physical therapy
14. Sinus surgery
15. Antibiotics

It is critical to keep track of triggers, symptoms, and progress to properly treat headaches. 

Keeping a diary of symptoms provides the doctor with an accurate picture of the frequency and intensity of headaches. It allows them to recognize trends, such as associations with various foods or circumstances.

To discover the source of a severe headache, a doctor usually orders tests, such as a neurological exam, additional blood tests, X-rays, magnetic resonance imaging, and computed tomography scans.

When to seek help for a headache

Seek emergency if:

• A sudden headache accompanied by neurological problems, such as arm or leg weakness or double vision, or infection symptoms, such as a high temperature with a new rash
• A severe headache that strikes out of nowhere is often referred to as a "thunderclap."