Clarksville TN Chiropractor Discusses Different Types of Headaches
Headaches range from mild to severe, and most of them are not dangerous. A small number are. Because this page describes how headaches are grouped, and because reading a description of your own symptoms is exactly when people talk themselves out of seeking help, the features that need urgent assessment come first.
Read this part first: the features that need urgent assessment
Seek emergency medical care for:
- A headache of sudden, severe onset, reaching maximum intensity within about five minutes
- Headache with fever, or with a stiff neck, or with a rash. Any one of these is enough, and they often do not appear together
- Headache with new neurological symptoms: weakness, numbness, difficulty speaking, confusion, loss of coordination, or visual loss
- Headache after a head injury, particularly with drowsiness or repeated vomiting
- A painful red eye with blurred vision or halos seen around lights
- In anyone over fifty, a new headache with scalp tenderness, pain in the jaw when chewing, or any change in vision. Visual loss from this cause can be permanent, and it is treatable if caught early.
- Severe neck pain, or a new and unexplained headache, or both, especially alongside visual disturbance, unsteadiness or slurred speech. Either symptom alone can be the first sign. That combination can indicate a tear in an artery in the neck, and it needs immediate medical investigation rather than manual treatment. It does not always announce itself at once: in reported cases the neurological signs followed the first headache or neck pain by a median of several hours to several days, so a day or two of "just" severe neck pain and headache does not rule it out.
Arrange prompt medical review for:
- A headache that is new in a person over fifty
- A headache that has changed its usual pattern, or is progressively worsening
- A headache consistently worse on coughing, straining or exertion
- A headache that changes markedly with posture, clearly worse either standing up or lying down
- Headache with vomiting that has no other explanation
- Headache in someone who is pregnant or has recently given birth, is immunosuppressed, or has a history of cancer
- Headache on most days of the month in someone taking pain relief for it regularly, which can be caused by the pain relief itself
This list is not exhaustive, the timings on it are approximate, and it is not a test to pass before seeking help. If something about your headache worries you, that is reason enough.
How headaches are grouped
Headaches are divided into those that are the condition itself, called primary, and those that are a symptom of something else, called secondary. Tension-type headache, migraine and cluster headache are all primary. The descriptions below follow the International Classification of Headache Disorders, third edition (ICHD-3), which is the reference clinicians use.
Our page on headache tips covers cervicogenic headache, which is headache referred from a structure in the neck, and is the presentation most relevant to a chiropractic examination.
Tension-type headache
The most common primary headache. An episode lasts anywhere from 30 minutes to seven days. ICHD-3 asks for at least two of four features, not all of them: pain on both sides, a pressing or tightening quality rather than a throbbing one, mild or moderate intensity, and not being made worse by ordinary physical activity such as walking or climbing stairs. It comes without nausea or vomiting, and with no more than one of light sensitivity or sound sensitivity.
Migraine
Migraine attacks last between four hours and three days when untreated. As with tension-type headache, ICHD-3 asks for at least two of four features rather than all of them: pain on one side, a pulsating quality, moderate or severe intensity, and being made worse by routine physical activity or causing you to avoid it. That last one is among the more useful points of separation from tension-type headache, which is characteristically not aggravated by activity. An attack also involves at least one of nausea or vomiting, or the combination of light and sound sensitivity.
Some people experience an aura: fully reversible symptoms that can be visual, sensory, or affect speech and language, and less commonly motor, brainstem or retinal. Here too the definition is a threshold rather than a portrait. ICHD-3 asks for at least three of six characteristics, among them that a symptom spreads gradually over five minutes or more, that each symptom lasts between five and sixty minutes, that at least one is one-sided, and that the aura is followed by headache within an hour. An aura can also occur without any headache following it.
Cluster headache
Cluster headache is uncommon and severe. The pain is one-sided, around or behind the eye or at the temple, and lasts between fifteen minutes and three hours untreated. It occurs anywhere between once every other day and eight times a day during a cluster period.
What distinguishes it is what accompanies the pain on the same side as the headache: a red or watering eye, a blocked or running nostril, a drooping or swollen eyelid, a smaller pupil, or sweating of the forehead and face. Many people are restless or agitated during an attack rather than wanting to lie still, which is close to the opposite of the behaviour typical of migraine.
Why these categories overlap, and why this page cannot classify you
ICHD-3 is direct about this, and it is worth quoting in substance rather than glossing: the diagnostic difficulty most often encountered among the primary headache disorders is telling tension-type headache apart from mild migraine, and it is compounded because people with frequent headaches often have both disorders at once.
Every one of these definitions also carries a final clause that the descriptions above leave out: the pattern counts as that headache type only if it is not better accounted for by another diagnosis. That clause is doing real work. It is the reason a headache can tick every box below and still be something else, and the reason the features at the top of this page are not cancelled by a good match down here.
That is the honest limit of a page like this one. These descriptions are useful for recognising that a pattern exists and for describing it accurately to someone who can examine you. They are not a test you can apply to yourself, and a headache that does not match any description here is not thereby explained. The categories also do not tell you the cause: a secondary headache can imitate any of them, which is why the features at the top of this page are worth more than the taxonomy below them.
Where a chiropractic examination fits
An examination can assess whether the neck is contributing to a headache pattern, which is a specific and limited question. It looks at the movement and tenderness of the upper cervical joints, at posture and sustained loading, and at whether the headache can be provoked or eased by the neck. Where the picture does not fit a neck-related headache, or where anything on the list above is present, a referral is the appropriate answer rather than a course of treatment.
If you are dealing with recurring headaches and want that question answered, contact Source Chiropractic to arrange an examination.
Related: headache tips and what an examination looks for, and how chiropractic care approaches headaches.
Follow the evidence
Research, with context.
Published sources behind the discussion. Read the findings alongside the limits; a study is not a diagnosis or a promise of a result.
A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache
200 people with cervicogenic headache, assigned to manipulation, specific exercise, both, or a control group.
What it foundManipulative therapy and exercise each reduced headache frequency and intensity, with benefits reported at 12 months.
What it cannot tell usParticipants were not blinded, and the combined approach was not significantly superior. These findings concern cervicogenic headache, not migraine in general.
Publication details & citation
Jull et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002. DOI: 10.1097/00007632-200209010-00004.
Read the publication recordChiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial
104 people with migraine, assigned spinal manipulation, sham treatment or usual pharmacological management.
What it foundMigraine days decreased in all groups, with no significant between-group difference in the primary outcome. The authors considered the observed manipulation effect probably a placebo response.
What it cannot tell usThe trial was small. Secondary outcomes do not overturn the primary result, and a treatment trial of this size cannot establish the frequency of rare serious harms.
Publication details & citation
Chaibi et al. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. European Journal of Neurology. 2017. DOI: 10.1111/ene.13166.
Read the publication record
Read our editorial policy for how sources and clinical review are identified.