Types of Headaches: A Patient’s Guide

Written by Leslie Budzynski DC, chiropractor at Bournemouth Chiropractic. In this article he offers a broad section of advice on different types of headaches. Leslie has been practising for 39 years and is registered with the General Chiropractic Council (GCC No. 00043) and the British Chiropractic Association (BCA). You can verify Leslie's registration at any time on the GCC's online register.

Headaches of various types are the reason a lot of people tend to book in to see me for chiropractic treatment. Patients often arrive having perhaps diagnosed themselves with a sinus problem or convinced they have a weak neck, when the real picture is often something else entirely. Different types of headaches have distinct patterns, distinct causes and importantly, have distinct routes to the right treatment. Some belong in this clinic and some belong with your GP or pharmacist. A very small number need urgent medical attention.

This guide walks through some of the common types of headaches one by one: what each feels like, what tends to drive it, what helps and which health provider might be best your case. The International Classification of Headache Disorders describes well over two hundred headache types [1], so this article is not exhaustive. It covers the types of headaches I see and am asked about most often and it should help you recognise your own familiar pattern to help you decide who to see. It sits alongside my main neck pain, headaches and migraines page, which covers assessment and treatment at my clinic in more detail.

Primary and Secondary Headaches: A Distinction Between Types of Headaches

Doctors divide types of headaches into two broad families:

Primary headaches are conditions in their own right, where the headache itself is the problem. Migraine, tension-type headache and cluster headache are the "Big Three."

Secondary headaches are symptoms of something else and that cause ranges from the more trivial, such as dehydration or too much wine, through to the mechanical neck pain types of headaches, such as a headache driven by the joints of the upper neck, through to the rare and far more serious.

The overwhelming majority of headaches are primary or benign secondary. A very small minority signal something that needs prompt investigation and I cover the important warning signs at the end of this guide.

Tension Type of Headaches

What a tension headache feels like

A tension headache feels like a dull, pressing, band-like ache on both sides of the head, often described as a tight cap or a weight. Mild to moderate rather than disabling. It does not usually throb, it is not made dramatically worse by routine activity and nausea is generally absent [1]. Episodes last anywhere from half an hour to several days.

What causes a tension headache

This type of headache is the most common headache in the population and despite the name, the mechanism is not fully understood. Stress, poor sleep, long hours at a desk or screen and sustained tension in the muscles of the neck, scalp and shoulders are all recognised contributors. Many of my patients notice their headache might build through the working day and eases at weekends, which tells its own story.

What helps and who best to see

Simple analgesia, such as over the counter painkillers, used sparingly, regular breaks from the desk, sleep, exercise and stress management do most of the positive work. Where the muscles of the neck and shoulders are tight and tender alongside the headache, a chiropractic assessment can establish whether the neck is contributing to the picture and I examine this routinely. Frequent tension-type headaches, meaning many days a month, deserves a conversation with your GP, not least because frequent painkiller use creates a problem of its own, which I cover below.

Migraines

What migraines can feel like

Typically a migraine is one-sided, throbbing or pulsating headache of moderate to severe intensity, lasting four hours to three days, made worse by routine movement and accompanied by nausea, sensitivity to light or sensitivity to sound [1]. Around a quarter to a third of people with migraine experience aura, most commonly visual disturbance such as zigzag lines or a spreading blind spot, in the hour before the headache. Many people also notice a warning phase of yawning, food cravings or mood change the day before and a feeling described as a washed-out hangover phase afterwards.

What drives migraines

A migraine is a neurological condition with a strong genetic component, not simply a bad headache. Triggers vary enormously between individuals: disrupted sleep, skipped meals, hormonal shifts, stress, for some, its release at the weekend.

What helps migraines and who to see

Your GP and pharmacist are central here. NICE guidance sets out clear acute treatment and, for frequent attacks, preventive medication [2], the newer preventive treatments available through GP and specialist referral have changed the outlook for many people. A headache diary is the single most useful thing you can bring to that appointment. On the manual therapy side, the UK evidence report found evidence supporting manual therapy in migraine prevention for some patients [3], which is why migraine prevention appears among the conditions chiropractors may discuss. I am always clear with patients that this sits alongside medical care rather than replacing it and that the neck is worth examining because migraine and neck-driven headache commonly coexist and are commonly confused.

Cervicogenic Headache: The One That Starts in Your Neck

What a cervicogenic headache feels like

Cervicogenic headache is generally a one-sided headache that begins in the neck or the base of the skull and spreads forwards, often towards the temple or behind the eye. The giveaways are mechanical: it is provoked or worsened by neck movement, sustained awkward postures or pressure over the upper neck, the neck itself is often stiff or reduced in movement and unlike migraine it does not usually switch sides [1]. Nausea and light sensitivity are mild or absent.

What drives this type of headache

Referred pain from the joints, discs and soft tissues of the upper three levels of the neck, which share nerve pathways with the head and face. Whiplash, years of desk and office work, and degenerative change in the upper neck are the common backgrounds I see.

What helps, and who to see

Cervicogenic headache is the headache type that most clearly belongs in a chiropractic clinic and it is on the list of conditions for which UK advertising regulators accept the evidence for chiropractic care. Headache arising from the neck responds to treatment directed at the neck: mobilisation and manipulation of the restricted segments, soft tissue work and exercises to rebuild endurance in the deep neck muscles. Identifying it correctly is the crucial step, because a cervicogenic headache treated as migraine, or the reverse, frustrates everyone. That differential examination of the neck is a core part of what I do and my neck pain and headaches page explains the assessment in detail. If your headaches are worse after a poor night, your pillow may also be part of the story and I have written separately about avoiding neck pain while sleeping.

Cluster Headache

What this type of headache feels like

Cluster headache feels like attacks of excruciating, strictly one-sided pain in or around the eye, lasting fifteen minutes to three hours, occurring up to several times a day in bouts or clusters, that run for weeks. The affected eye waters and reddens, the eyelid may droop, the nostril blocks or runs on the same side and, unlike migraine, sufferers are typically restless and agitated rather than lying still [1]. Attacks often wake people at the same time each night.

What drives it

A primary headache involving the trigeminal nerve and the hypothalamus, which explains the uncanny clockwork timing. It is rare, more common in men and strongly associated with smoking, though quitting does not necessarily switch it off.

What helps and who to see

This one is unambiguous: cluster headache is GP and neurologist territory. Ordinary painkillers are useless against attacks that are this short and severe. The effective treatments, high-flow oxygen and specific injectable medication, along with preventive drugs, need proper medical diagnosis and prescription [2]. If this description rings true, please do not book in with me first. See your GP. My role with these patients is recognising the pattern and sending them to the person quickly.

Sinus Headache: Rarer Than You Think

What a sinus headache feels like

Pressure and pain over the cheeks, brow or bridge of the nose, typically worse on bending forwards. Here is the finding that surprises almost everyone: research examining nearly three thousand people with self-diagnosed or even physician-diagnosed sinus headache found that around nine in ten actually met the criteria for migraine or probable migraine [4]. Migraine frequently produces facial pressure, a blocked or runny nose and watery eyes, because the same nerve pathways are involved and so it is often confused with the sinus.

What drives a true version of this headache

True sinus headache accompanies acute sinusitis: an infection, usually on the heels of a cold, with thick discoloured mucus, reduced smell, facial tenderness and often fever.

What helps and who to see

Genuine acute sinusitis is pharmacist and GP territory and most cases settle with time, steam and simple measures. The practical message is different: if you have recurrent sinus headaches with no infection to show for them, the more likely explanation is a migraine and a GP review with that question may help you access treatment that works.

Menstrual and Hormonal Types of Headaches

What hormonal headaches feel like

For many women these types of headaches are migraine by another name. Menstrual migraine strikes in a window from two days before a period to the third day of bleeding, tends to be more severe, longer and more treatment resistant than attacks at other times and usually occurs without aura [1].

What drives these types of headaches

The fall in oestrogen just before menstruation is the best-established trigger. The same sensitivity explains why migraine often changes around pregnancy, perimenopause and starting or stopping hormonal contraception or HRT. Perimenopause in particular is a common time for headaches to worsen or first appear.

What helps, who to see and where to begin

Your GP, because timing offers treatment options that do not exist for other headaches: short-term preventive strategies around the period and hormonal approaches among them [2]. A diary mapping headaches against your cycle for two or three months turns a vague suspicion into a clear pattern that your GP can act on. One important safety note: migraine with aura affects decisions about oestrogen-containing contraception, so mention aura explicitly.

Medication Overuse Headache

What this type of headache feels like

A dull, nagging headache present on most days, often worst on waking, in someone who started out with migraine or tension-type headache and now takes painkillers frequently. The irony is that the treatment has become the cause.

What drives it

Regular use of acute headache medication, on ten or more days a month for triptans, opioids or combination painkillers. Fifteen or more days a month for paracetamol or ibuprofen, sustained over three months, can itself perpetuate this type of daily headache [1]. Nobody gets into this position through carelessness. It is the entirely understandable result of treating pain that keeps coming back, and codeine-containing remedies are often responsible.

What helps and who to see

Your GP. The treatment is simple to describe and hard to do: withdrawing the overused medication, usually with a preventive treatment to help, under proper guidance [2]. Headaches worsen for a spell before they improve, which is exactly why support matters. If you recognise yourself in this section, that recognition is the most important step, and please do not stop prescribed medication without medical advice.

The Types of Headaches at a Glance

At-a-glance summary of the main types of headaches covered in this guide.

When a Headache Needs Urgent Medical Attention

The majority of headaches, including severe ones, are not dangerous. A small number are, and headache specialists screen for a recognised set of warning features [5]. Seek urgent medical help, through your GP, 111 or 999 depending on severity, if a headache comes with any of the following.

A thunderclap headache, meaning it feels like the worst headache of your life reaching maximum intensity within a minute, needs emergency assessment. So does headache with fever and a stiff neck or rash, with new weakness, numbness, slurred speech, confusion or visual loss, with a first seizure or following a significant head injury. See your GP promptly for a brand new or clearly changed headache after the age of fifty, a headache that is steadily progressive over weeks, one that is consistently triggered by coughing, straining or exertion, one that changes with lying or standing, new headache in pregnancy or soon after birth, or a new type of headache in anyone with a history of cancer or a weakened immune system [5].

I screen every headache patient against these features at their first visit, and when something needs a GP or hospital rather than me, rest assured that I will refer you on. That is precisely how my chiropractic clinic works: assessment first, and I triage before any treatment.

Frequently Asked Questions About Types of Headaches

What type of headache have I got? How can I tell?

The pattern of the headache tells the story about how to tell which type of headache you have: where the pain sits, what it feels like, how long it lasts and what accompanies or provokes it. A one-sided throbbing headache with nausea points to migraine, a band of pressure on both sides to tension-type, and a headache that starts in the neck and follows neck movement to a cervicogenic headache. Keeping a simple diary for a few weeks usually makes the pattern obvious.

Can a chiropractor help with all types of headaches?

It depends on the type of headache chiropractors treat most successfully. Headache arising from the neck, called cervicogenic headache, is the clearest case, as treatment directed at the neck addresses the source. There is also evidence supporting manual therapy in migraine prevention for some patients, alongside medical care. Cluster, sinus, hormonal and medication overuse headaches belong with your GP, and an honest assessment with me will tell you which category you are in. The chart above may help you gather information, but if not, feel free to book in for a free 15 minute chiropractic consultation and I can help you decide which type of headache you most likely have and what to do next.

What is the difference between a migraine and a cervicogenic headache?

Both migraines and cervicogenic headaches can be one-sided, which is why they can be confusing. Migraine typically throbs, brings nausea and sensitivity to light or sound, and can swap sides between attacks. Cervicogenic headache starts at the neck or base of the skull, spreads forwards, stays on the same side and is provoked by neck movement or sustained postures, with the neck itself usually stiff. Examination of the neck is how the two are separated. Again, this is why I encourage a free consultation, so I can tell you whether chiropractic is likely to help.

Why do I keep getting sinus headaches?

Quite possibly you do not have sinus headaches at all. Research on people with self-diagnosed or even physician-diagnosed sinus headache found that around nine in ten met the criteria for migraine, which commonly causes facial pressure, a blocked nose and watery eyes. Genuine sinus headache accompanies an actual infection with discoloured mucus and often fever. Recurrent sinus headaches without infection need a GP review with migraine as a differential diagnosis.

When should I worry about a headache?

Seek urgent help for a headache that reaches maximum intensity within a minute, or one accompanied by fever and stiff neck, new weakness or speech disturbance, confusion, visual loss or a head injury. See your GP promptly for a new or changed headache after the age of 50, a steadily worsening headache, or one triggered by coughing or exertion. Most headaches are not dangerous, but these features always deserve assessment.

Can neck problems cause headaches?

Yes, neck problems can sometimes cause headaches. The joints and nerves of the upper three levels of the neck share pathways with the nerves supplying the head and face, so pain from the upper neck is felt in the head. This is a recognised diagnosis with formal criteria and it is one of the conditions for which the evidence for treatment directed at the neck is accepted by UK regulators. These are called cervicogenic headaches, and chiropractic treatment could help this type of headache.

Working out the type of headache you have is the first step to the right treatment, whoever is providing it. I assess patients from across Poole, Bournemouth and Westbourne, examine their neck thoroughly and tell them honestly if I can help or refer them back to their GP. I also answer numerous questions on our FAQ's page, which should be useful too.

Written by Leslie Budzynski DC, GCC-registered chiropractor (GCC No. 00043) with 39 years of clinical experience. Principal chiropractor at Bournemouth Chiropractic.

References

1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 2018;38(1):1-211. doi:10.1177/0333102417738202
2. National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. NICE guideline CG150, 2012 (updated 2021). nice.org.uk/guidance/cg150
3. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropractic & Osteopathy, 2010;18:3. doi:10.1186/1746-1340-18-3
4. Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Archives of Internal Medicine, 2004;164(16):1769-1772. doi:10.1001/archinte.164.16.1769
5. Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology, 2019;92(3):134-144. doi:10.1212/WNL.0000000000006697

This post is for information only and does not constitute medical advice. If you are experiencing severe or worsening symptoms, please consult your GP or call 111. If your headache is sudden and severe, or accompanied by any of the urgent features described above, call 999.