There are many types of headache. Migraines and tension headaches are so common that almost everyone has had them before. Other types of headache include cluster headache, headache due to neck joint issues, sinus headache, occipital neuralgia, post-trauma headache, and medication overuse headache.

What is a migraine headache?

  • It is one sided in most people, both sided in 30%
  • It builds up slowly, is throbbing, and is worse when there is exertion and activity
  • Patients find relief by lying down in a dark room
  • Lasts anything from 3 hours to 3 days
  • There is sensitivity to light and sound, and there be an aura which refers to changes to your vision or hearing right before the attack happens
  • It can be treated with medications or pain procedures like a sphenopalatine injection or occipital nerve block

What is a tension headache?

  • It is always on both sides of the head. If it is not symmetrical, it is unlikely to be tension headache
  • There is a pressure sort of sensation along with tightness
  • Comes on slowly
  • Can last for many days
  • Usually manageable with simple pain killers

What is a cluster headache?

  • It is a headache that is felt behind the eye or around one temple
  • Always on one side
  • Severe in intensity, coming on quickly within minutes
  • Continuous and excruciating
  • Lasts 30 mins to 3 hours
  • There may be a red-eye, a blocked nose, and droopy eyelids
  • Strong opioids may be required
  • Can try sphenopalatine blocks or stellate ganglion blocks

What is a cervicogenic headache?

  • This is a headache due to wear and tear or injury of the small joints of the neck
  • Problem lies in the neck but is felt in the back of the head, neck as well as the trapezius
  • It can be treated with physiotherapy, medications and pain procedures that target the small nerves that cause the pain sensation i.e. radiofrequency ablation

What is occipital neuralgia?

  • Pain at the back of the head near the bony prominences
  • May have an electric sensation or a dull ache
  • It can spread upwards over the scalp
  • There may be nausea vomiting, difficulty balancing, and slurred speech
  • Treatment includes medications, injections, pulse radiofrequency to the nerve 
  • Occasionally surgery may be required to free up the nerve that is caught in between the muscles

What is sinus headache?

  • This occurs as a result of sinusitis, an infection of the sinuses
  • It mimics migraines and tension headaches
  • There may be fever and tenderness over the sinuses
  • Treatment will require antibiotics and surgery to open up the sinuses for drainage

What is post-trauma headache?

  • Can be due to injury, trauma, or surgery to the skull
  • There is headache, giddiness, and changes to mood, as well as personality changes
  • It may be difficult to concentrate, and oversensitivity to light or sound
  • Medications may be tried first
  • Occipital or sphenopalatine blocks may be tried to hasten recovery

What is medication over-use headache?

  • Medications like opioids and paracetamol that are used to treat headache can become the source of headache if taken over a long time
  • Treatment is to stop the medications
  • A preventer like amitriptyline may be used for long term control
  • It can be difficult to ascertain which medicine is causing the headache

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