Headache Types and Pain Areas

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Identifying the type of headache a person is having is essential for managing it correctly and knowing when it's potentially dangerous. Fortunately, the location of pain on the head can be an excellent first clue in teasing out a headache diagnosis. Headaches are common, with over 90% of people experiencing one or more in their lifetime.

While over 200 headache disorders exist, this article will review some more common ones and how they are treated. The connection between headache type and location will also be explored.

A person with a headache lying on a couch, touching the bridge of their nose

Meeko Media / Getty Images

Headache Types and Pain Areas

Headaches are broadly categorized as primary or secondary headaches.

Primary vs. Secondary Headaches

Primary headaches exist on their own with no underlying cause, whereas secondary headaches stem from a health-related condition or factor (e.g., illness or medication).

Headaches

Primary Headaches

Migraine, tension-type, and cluster headaches are the most common primary headaches.

Migraine headaches cause a pounding or throbbing sensation, typically on one side of the head but sometimes on both. They may be accompanied by nausea, vomiting, sensitivity to light (photophobia), and/or sound (phonophobia).

Migraine headaches are classically triggered by one of many factors, including lack of (or excessive) sleep, skipping meals, bright lights, dehydration, or changes in the weather.

There are multiple types of migraine. Migraine without aura is the most common, followed by migraine with aura.

What Is an Aura?

An aura consists of reversible neurological symptoms that precede a migraine headache. Examples of aura symptoms are seeing bright zigzag lines, feeling pins and needles in a limb, or having trouble speaking.

Rarer migraine types include:

Tension-type headaches are a pressure or tight band-like sensation across the forehead or around the head. They tend not to be as painful or debilitating as migraine headaches.

Tension-type headaches are also not accompanied by nausea, vomiting, or light/sound sensitivity, although muscle tenderness surrounding the skull is common. Like migraine, tension-type headaches may be triggered by lack of sleep, hunger, dehydration, or stress.

Cluster headaches are excruciatingly painful and localized in or around the eye or temple. They are much less common than migraine or tension-type headaches and occur as attacks that last from 15 to 180 minutes, up to eight times a day.

Cluster headaches are accompanied by at least one cranial autonomic symptom (e.g., eye tearing, runny nose, facial flushing, or upper eyelid drooping).

Do Primary Headaches Occur in Children?

Yes. Tension-type headaches occur in 10% to 24% of children and adolescents, whereas migraine occurs in 3% to 10%. Cluster headaches very rarely occur in children.

While not an exhaustive list, other primary headache disorders, albeit rare in occurrence, include:

  • Paroxysmal hemicrania is a severe headache around or behind the eye or in the temple, lasting two to 30 minutes. One or more cranial autonomic symptoms accompany the headache.
  • Hemicrania continua is a one-sided daily headache that persists for three or more months. One or more cranial autonomic symptoms accompany the headache.
  • Primary stabbing headache causes a single or series of severe "ice-pick" pains around one or both eyes. The headache is brief, typically resolving within 10 seconds.
  • Hypnic headaches are recurring headaches that occur during sleep, causing a person to wake up. The pain occurs on both sides of the head in two-thirds of cases.
  • Nummular headache is a small, coin-shaped area of pain felt on any part of the scalp, usually the side of the head.
Headache Area and What It May Indicate (Not an Exclusive List)
  Both Sides of Head One Side of Head Forehead Around/ Behind
Eyes
Back of Head
Primary Headache Disorder Tension-type, hypnic headache Migraine, cluster, hemicrania continua, paroxysmal hemicrania, nummular Tension-type Cluster, paroxysmal hemicrania, primary stabbing headache Tension-type

Secondary Headaches

Common secondary headaches are those related to infection, head trauma, or a blood vessel problem in the head or neck.

A headache attributed to infection may occur due to a whole-body illness or a localized nervous system infection, such as meningitis (inflammation of the membranes insulating the brain and spinal cord). Meningitis typically causes a headache felt all over the head, a fever, and a stiff neck.

Common whole-body illnesses associated with headaches are viral infections, especially influenza (the flu) and COVID-19. With COVID-19, the headache is typically on both sides of the head and has a pressing or throbbing quality.

A sinus headache is another secondary headache related to infection. It's associated with dull pain or pressure in the forehead, cheeks, or behind the eyes.

A headache attributed to trauma or injury to the head or neck often resembles a migraine or tension-type headache. It develops within seven days of the trauma or injury (e.g., fall, sports impact injury, or motor vehicle accident). Accompanying symptoms may include dizziness, unusual tiredness, problems concentrating, irritability, and anxiety.

A headache attributed to an ischemic stroke (a blockage of blood flow in the brain) may feel like a migraine or tension-type headache.

In contrast, a headache attributed to a subarachnoid hemorrhage (when a brain artery bursts) causes a very sudden and extremely painful thunderclap headache.

A headache attributed to giant cell arteritis (inflammation in branches of a large neck artery) is usually felt on one side of the head or near the temple. It's associated with scalp tenderness and/or jaw claudication (pain when chewing).

While not an exhaustive list, other secondary headaches include:

  • Cervicogenic headaches stem from a bone, joint, or soft-tissue problem in the upper spine. It causes one-sided pain that begins in the neck or base of the skull, spreading to the front of the head.
  • Medication-overuse headache occurs in people with a preexisting primary headache disorder (usually migraine or tension-type). It develops from overuse of headache painkillers.
  • Caffeine-withdrawal headache develops within 24 hours after the last caffeine intake and can feel like a migraine or tension-type headache.
  • A headache attributed to a brain tumor may feel like a migraine or tension-type headache that worsens in the morning or when lying down. Nausea and/or vomiting may accompany it.
  • A headache from hydrocephalus occurs when fluid collects within the brain's hollow spaces.
  • A low CSF pressure headache occurs when the brain has low cerebrospinal fluid (CSF) pressure. It causes a severe headache, often felt at the back of the head when sitting or standing up.
Headache Area and What It May Indicate (Not an Exclusive List)
  Both Sides of Head One Side of Head Front of Head (e.g., face/temple) Back of Head
Secondary Headache Disorder Caffeine withdrawal, medication overuse, a virus, meningitis, stroke, head/neck trauma, brain tumor, hydrocephalus Caffeine withdrawal, medication overuse, head/neck trauma, giant cell arteritis cervicogenic, brain tumor, hydrocephalus Sinus headache, giant cell arteritis Cervicogenic, low CSF pressure

Treatment for Different Headache Types

The treatment of a headache depends on whether it's a primary or secondary headache. Other factors are also considered, like age and headache severity and impact.

Primary

Managing a primary headache disorder often requires a combination of medication and home remedies.

As an example, mild migraine headaches can usually be treated with a nonsteroidal anti-inflammatory drug (NSAID) like Motrin (ibuprofen). Sleeping in a dark, quiet room or placing a cold pack on the head can also be soothing.

More severe or persistent migraine headaches may require a triptan like Maxalt (rizatriptan) or a calcitonin gene-related peptide (CGRP) blocker like Nurtec ODT (rimegepant).

Examples of treatments for other primary headache disorders include the following:

  • Tension-type headaches are often relieved with Tylenol (acetaminophen) or ibuprofen. Healthy lifestyle behaviors like keeping to regular sleep and eating schedules are encouraged for prevention.
  • Cluster headaches are managed by inhaling oxygen or taking an injectable triptan or nasal spray triptan, like Zomig (zolmitriptan). Stopping smoking and avoiding heavy alcohol use are advised for prevention.
  • A primary stabbing headache can be treated with Indocin or Tivorbex (indomethacin), a prescription NSAID.

Precautions

Due to potential harm, not everyone can take Tylenol or NSAIDs. Only take these drugs under the guidance of a healthcare provider.

Also, aspirin (an NSAID) must be avoided in children and teenagers (under 19) due to the risk of a potentially fatal condition called Reye's syndrome.

Secondary

Treating a secondary headache requires addressing the root cause. The headache is cured once the health-related problem or factor is reversed (if it can be), such as treating underlying inflammation or infection.

Examples of treatments for other secondary headache disorders include the following:

  • Caffeine withdrawal headaches can be alleviated within one hour by intaking 100 milligrams (mg) of caffeine, around one cup of coffee.
  • Viral-related or sinus headaches are usually treated with Tylenol or an NSAID. An antibiotic is required if a bacterial sinus infection is present.
  • Giant cell arteritis is treated with high doses of corticosteroids (has an anti-inflammatory effect).
  • Cervicogenic headaches are treated primarily with physical therapy.
  • Low CSF pressure headaches are treated with bed rest, caffeine intake, and, more definitively, an epidural blood patch.

Potentially fatal headaches like those attributed to severe traumatic brain injury, subarachnoid hemorrhage, ischemic stroke, or meningitis require hospital care and monitoring, intravenous (IV) medications, and/or surgery.

Headache Types That Don’t Go Away

Unfortunately, headaches sometimes occur very frequently, even daily.

These chronic (long-term) headaches, namely chronic migraine or chronic tension-type headaches, affect around 4% of the population. They occur on 15 or more days per month and often require additional therapies to combat them.

For instance, Botox (onabotulinumtoxinA) is a Food and Drug Administration (FDA)-approved preventive treatment for chronic migraine, whereas Elavil (amitriptyline) is used off-label (not FDA-approved) to prevent chronic tension-type headaches.

Complementary therapies like biofeedback and acupuncture are often recommended as part of a chronic headache care plan.

If your headaches are chronic or interfere with daily functioning or quality of life, please make an appointment with a healthcare provider or headache specialist.

Additionally, see a healthcare provider for a headache if you are over 65, pregnant, postpartum, or have a history of cancer or human immunodeficiency virus (HIV).

Seek Emergency Medical Care

Go to your emergency room or call 911 immediately if:

  • Your headache begins suddenly and feels like the "worst headache of your life."
  • Your headache is associated with stroke-like symptoms, seizures, fever, stiff neck, or a significant head injury.

Summary

There are over 200 kinds of headaches, so sorting out the type of headache a person has can be challenging. The area of head pain or headache location is often a good first clue.

The two most common primary headache disorders are tension-type and migraine headaches. Tension-type headaches are associated with a tightening sensation felt all over the head, whereas migraines are throbbing and typically occur on one side of the head.

Secondary headaches arise from an underlying health issue, like an infection, head injury, or blood vessel problem in or near the brain. These headaches may be felt all over or on the front, back, or side of the head, depending on the root cause.

Once the type of headache is identified, you and a healthcare provider can devise a uniquely tailored treatment plan. Such plans often involve some combination of lifestyle changes, medication, trigger avoidance, complementary therapies, and home remedies.

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By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.