Headaches are common conditions for many people. It is important to understand the different types of headaches and their causes of headaches. There are also a number of possible treatment options for these different types.

Cluster headaches
Cluster headaches are severe headaches that occur in a series. The cluster period may last between a few weeks to several months with changing periods of dormancy. These periods of remission vary from weeks to months.

Cluster headaches affect men at 3-4 times the rate of women (as opposed to migraine, which has a higher prevalence in women). During a specific cluster period, the pain stays on the same side, but after a period of dormancy, the site of the pain can change to the opposite side. During cluster periods, as the pain tends to be excruciating, the patient can be totally incapacitated. Other ipsilateral symptoms can also classically accompany a cluster headache. These may include nasal congestion, forehead and facial sweating, eyelid oedema and others. The IHS has created diagnostic criteria for cluster headaches.

A migraine is a unilateral headache. Migraine headaches are a relatively common type of headache in Australia, affecting approximately 12% of women and 6% of men. The preponderance of women may be related to hormonal changes or menstrual migraine. There is no medical consensus on the cause of migraines; however vascular, neurogenic and other mechanisms have been proposed causes. Migraines are broadly divided into two subgroups: with and without prodromal auras.

Migraine without aura
Most migraines, about 80%, are without an aura. Migraines without aura are recurrent headaches that manifest as repeated bouts of severe headache that are pounding in nature. The International Headache Society (IHS) has published diagnostic criteria for migraines without aura.

Migraine with aura
Migraine with aura is less common, with about 20% of all migraines being associated with an aura. These migraines are also recurrent headaches but involve focal neurological symptoms that occur before or during the onset of the migraine.
Often these symptoms begin slowly, over a period of 5-20 minutes and last about one hour. To be considered a prodromal aura the migraine headache must begin within 60 minutes of the end of the aura phenomenon. The IHS has diagnostic criteria for migraine without aura

Myofascial pain 
Muscle pain is called myofascial pain. The fascia is the connective tissue covering the muscles.

Myofascial pain remains one of the most common causes of headache. Its primary cause is grinding caused by increased tension in the muscles involved with chewing (mastication). The muscles of mastication are attached to the side of the skull and any misalignment of the jaw causes increased muscle tension in the jaw and may include muscles in the floor of the mouth and neck.
The symptoms of myofascial headache are that the pain can be constant and severe, often worse in the mornings and may improve during the day. A dental examination can show either signs of bruxing or grinding.

Treatment may involve the wearing of a splint at night-time. In some cases an injection of botulin toxin may be necessary to achieve relief of the headache and other symptoms.

Headaches originating from sinus structures
The term 'sinus headache' is outdated because it applied to both primary headaches as well as secondary headaches, possibly attributed to various conditions involving nasal or sinus structures. These are headaches with pain of the nose or sinuses.

Sinus headaches are uncommon and caused by inflamed sinuses (sinusitis). They are felt as a shooting, severe pain in the middle ot upper face eg behind the eyes or forehead.

The sinuses are small air spaces in the skull, found behind the nose, eyes and cheeks. When they are working well, they open out into the nose, allowing mucus to drain and air to circulate in the cavity. When the lining of the nose and upper airways becomes infected, the infection can spread to the sinuses and cause them to become swollen and block the small opening from the sinuses to the nose. This build-up of pressure inside the sinuses is called sinusitis and creates the facial pain or a sinus headache.

Often the pain will go away of its own accord once the cold or virus resolves eg it gets better once the cold goes away. However, sinusitis and sinus headaches can last much longer because the bacteria infects the trapped mucus, blocking the sinuses or the sinuses swell up because of an allergy.

A sinus headache can be a constant, throbbing pain felt in the face (around the eyes, cheeks and forehead), usually only on one side or the face. It may be worse in the morning. The pain may also get worse when the head is moved eg bending down or there is extreme changes in temperature (such as going from a warm room into freezing air outside). The pain can also spread to your teeth, upper jaw and other parts of your head. Other symptoms can be that the face feels swollen, tender to the touch and green or yellow mucus discharge from the nose and a high temperature.

Tension headaches
Tension headaches are the most common form of headache and the prevalence could be as high as 30% and 80% of all headaches. Like many headaches, the exact mechanisms that are at play before or during tension headaches are unknown.

The typical symptoms of a tension headache include bilateral pain, less frequent episodes and the headache generally lasts from minutes to days. The pain is not usually as intense as some other headaches and is commonly described as squeezing or head pressure. Unlike migraines, activity does not exacerbate a tension headache, which is different from migraine. As well there may be light or sound sensitivity, but not both as with migraine and nausea is not often associated with tension headache. The IHS has issued diagnostic criteria for tension headaches.


The Australian Pain Management Association Inc. (APMA) is a health promotion charity providing advocacy, information and practical support for people living with chronic (persistent) pain and their families. APMA is the consumer health organisation for all Australians who live with pain. APMA is your voice.


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