A physical examination, particularly of the head, neck and neurological system, is an important first step to rule out conditions that may mimic or co-exist with headache syndromes.

Headaches can be grouped into two major headache disorder categories:

Primary Headache Disorders

Primary headaches are those in which the headache represents the primary symptom of a physiological, or bodily, disorder. No consistently organic cause can be determined for these headaches. Such headaches reflect inherited or acquired disturbances of the brain and its relationship to the rest of the body.  Primary headache types include:

• Migraine Headache
• Tension-type Headache
• Cluster Headache
• "Ordinary" Headache (probably a mild form of migraine or tension-type headaches)

Secondary Headache Disorders

These headaches arise as a symptom of another disorder.  More than 300 organic causes of such headaches exist.  Some of the more common secondary headache types are:

• Post-Traumatic Headache (one that occurs as a result of an injury or surgery)
• Reactive Headache
• Sinus Headache
• Rebound Headache

Primary Headaches

HEADACHE TYPE  - Migraine

In the past, migraines were considered vascular — or blood vessel-related — headaches. They were thought to occur when shifts in blood flow suddenly dilated (expanded) the blood vessels in and around the head causing pain.  However, the most current and respected findings suggest that migraines and other primary headaches arise from disturbances within the central nervous system. These disturbances trigger a cascade of chemical changes that cause inflamed blood vessels and neurological symptoms, including pain.  There are two major types of migraines — migraine with aura, which includes specific neurological symptoms such as vision disturbances (formerly called "classic" migraine), and migraine without aura (formerly known as "common" migraine).

Considered an inherited disorder, migraines affect women three times more often than men.  The female hormone estrogen is believed to play a role in why more women than men are afflicted by this painful condition.

As with all headaches, migraines affect people in different ways. If you are a female migraine sufferer, your headaches may have started with your first menstrual period or upon menopause (your last menstrual period).  Some women find that their migraines go away during pregnancy or after menopause. Regardless of when your headaches first began, identifying your migraine triggers is an important first step in determining effective treatment options.

You may have migraine headaches if you have the following symptoms. (Chances are you will not experience all, or even most, migraine headache characteristics.)

Key Migraine Headache Characteristics

The following recognized migraine symptom phases might occur alone or in combination with other phases:

• Prodrome. This consists of events that occur hours to days before the actual headache.  Prodrome symptoms include:

• Mood changes.
• Stiff neck.
• Chilled feeling.
• Sluggishness and fatigue.
• Increased frequency of urination.
• Constipation or diarrhea.
• Loss of appetite or food cravings.
• Increased sensitivity to light, sound and smells.
• Fluid retention.

• Aura (present in migraine with aura). These neurologic symptoms typically occur five to 20 minutes before the headache and last up to 60 minutes. Occasionally, the aura symptoms occur during the headache phase. The most common aura symptoms are visual, such as bright zigzag lines, sparkling moving figures, blind spots and distorted objects.
• Headache Phase.  Sixty percent of migraine headaches occur on one side of the head (unilateral), while 40 percent occur on both sides (bilateral).  For some people, migraine headaches consistently occur on a particular side of the head, while others experience pain on different sides of the head at different times.  Migraine headaches typically last hours to days, but rarely last less than four hours. Other common headache phase symptoms include:

• Throbbing and pulsating pain that may vary in intensity.
• Nausea or vomiting.
• Loss of appetite.
• Diarrhea.
• Blurred or restricted vision and sensitivity to light.
• Other sense changes, such as sensitivity to sound, smells, or touch.
• Fatigue, depression, irritability and anger.
• Mental dullness, confusion, hyperactivity.
• Lack of coordination, vertigo (spinning sensation), double vision.
• High or low blood pressure.
• Skipped heart beats.
• Nasal congestion.

• Postrome.  After a severe migraine attack, people often feel tired or "washed out," irritable, and listless. Other symptoms may include:

• Impaired concentration.
• Muscle weakness and aching.
• Food cravings or loss of appetite.
• Feelings of euphoria or hyperactive behavior.

Migraine Triggers

A wide range of factors — both internal and external — can trigger migraine attacks. Knowing what triggers your migraine headaches is the first step in learning how best to manage them. You may find it useful to jot down when your migraines occur and what provokes them in your Personal Headache Journal.

My headaches are triggered by (please print and check all that apply

Common Foods

q    Aged cheese
q    Alcoholic drinks (especially red wine)
q    Caffeine (in coffee, soft drinks, teas)
q    Chocolate
q    Concentrated sugar (sweets, cookies, cakes)
q    Dairy products (milk, ice cream, yogurt, aged cheese)
q    Fermented, pickled foods (herring, pickles, vinegar, yogurt, sour cream, etc.)
q    Food additives (aspartame, monosodium glutamate or MSG, saccharin, sulfites)
q    Fruits (especially avocados, bananas, citrus, figs, plantain, passion fruit, pineapple, raisins
q    Meat with nitrates (food preservatives)
q    Vegetables (specifically, onions, broad beans such as lima and navy beans, pea pods, nuts, peanuts)
q    Other ____________________________

Lifestyle/Physical

q    Fatigue
q    Hormonal changes (menstrual period, pregnancy, menopause, oral contraceptives)
q    Missed meals
q    Oversleeping
q    Psychological factors such as stress, anger, emotional "letdown," exhilaration or anticipation
q    Strenuous exercise
q    Sexual orgasm
q    Tobacco smoking
q    Vacations, weekends, or other time off
q    Other__________________

Medications/Chemical

q    Histamines
q    Hormone supplements
q    Nitroglycerin
q    Reserpine
q    Tyramine
q    Other_________________

HEADACHE TYPE – Tension

Many headache experts believe that tension-type headaches are simply a milder form of migraine headaches with many of the same headache triggers. (See Migraine Headache Triggers.) As a result, treatment options may include many of the same therapy approaches.  You may have tension-type headaches if you have the following symptoms. (Chances are you will not experience all, or even most, tension-type headache characteristics.)

Key Tension-Type Headache Characteristics:

• Tension-type headaches affect women more frequently than men.
• Pain is more intense as the day advances.
• Pain is episodic (occurring randomly and lasting for hours to days at a time) or chronic and persistent (occurring daily).
• Associated with sensations of tightness, pressure, or band-like constriction around the head.
• Associated with changes in muscle tension in the neck or head.

Be aware that what appears to be a "daily" tension-type headache may actually be a rebound reaction to pain-relief medications. See Rebound Headache.

HEADACHE TYPE – Cluster

Just as migraines are far more common in women, cluster headaches are 16 times more common in males than females. The term "cluster headache" was originally used to describe the clustering of painful attacks that occur many times throughout the day from weeks to months at a time and then subside for a few weeks or months. This "quiet period" is called the interim. (In the chronic form of cluster headaches recurring attacks can occur for years at a time without an interim phase.)

Cluster headaches can resemble migraine headaches and be unbearably painful — so much so that cluster headache sufferers report frequently feeling suicidal due to the intense pain.  Without proper diagnosis and treatment options, cluster headaches can last for years.  Potent blood vessel dilators, such as alcohol, nitroglycerin and histamines can trigger an attack. You may have cluster headaches if you have the following symptoms. (Chances are you will not experience all, or even most, cluster headache characteristics.)

Key Cluster Headache Characteristics:

• Can resemble a migraine headache.
• While the attacks can begin at any age, they typically begin between ages 20 and 40.
• Extremely painful headaches that last from 30 to 90 minutes and commonly occur up to six times a day during the cluster headache "active" phase.
• Frequently occur at night, and often at the same time each day.
• Can be associated with panic or fear.
• Generally localized (or restricted) to one side of the head, affecting the eye, forehead, cheek, or temple.
• Associated with nasal congestion, eye drooping, contracting of eye pupils, excessive tearing, and other facial changes.
• Accompanied by tenderness in the neck.

HEADACHE TYPE – "Ordinary"

What many people refer to as an "ordinary" headache may actually be an extremely mild form of migraine. Most "ordinary" headaches respond to simple remedies, such as mild non-prescriptive analgesics (painkillers) or relaxation techniques. You may have an "ordinary" headache if you experience the following symptoms:

Key Common Headache Characteristics:

• Occurs once in a while.
• Is not associated with an underlying medical condition, such as head injury or allergies. 
• Responds to minimal treatment such as rest and nonprescription pain relievers, or goes away without treatment.

Be sure to check with your health-care provider if you begin to experience headaches on a regular basis.

Secondary Headaches

HEADACHE TYPE – Post-Traumatic

Post-traumatic headaches frequently occur in people with head and neck injuries, including closed-head injury and whiplash, regardless of the severity of the accident or injury.  For example, one study indicated that headaches occur in up to 88% of people with mild head injury, while another study found that 60% of patients had headaches for more than two months following the initial mild to moderate head or neck trauma.

You may have post-traumatic headache or resulting post-traumatic syndrome if you experience the following symptoms after a head- or neck-related injury, accident or surgery. (Chances are you will not experience all, or even most, post-traumatic headache characteristics.)

Key Post-Traumatic Headache Characteristics:

• Headache, neck and shoulder pain
• Sleep disturbance
• Trouble thinking or concentrating
• Mood and personality changes
• Dizziness with or without vertigo (spinning sensation)

HEADACHE TYPE – Reactive

Reactive headaches are those triggered by a "reaction" to something in your environment or your life.  Reactive headaches can be caused by literally hundreds of factors, ranging from allergens, such as dust and mold, to kidney failure and brain tumors.

Help for Reactive Headache Sufferers

Perhaps the best solution for reactive headache sufferers is to identify and, if possible, avoid or eliminate whatever triggers the headache. A visit to your physician to rule out the more serious causes of reactive headaches is in order. You also may want to keep track of headache triggers in your Personal Headache Journal.  If your headaches seem to be triggered by an allergic reaction, consider seeking help from a medical professional, such an allergist, who specializes in identifying and treating allergic reactions.

You may have a reactive headache if you experience the following symptoms. (Chances are you will not experience all, or even most, reactive headache characteristics.)

Key Reactive Headache Characteristics:

• May be a part of an allergic response to dust, pollens, animal dander, household chemicals, medication, or other external substances.
• Goes away when the headache factor (dust, pollen, etc.) is not present.

HEADACHE TYPE – Sinus

Sinus headache may well be the most misdiagnosed headache disorder. Some 80% to 90% of people who believe they have sinus headaches actually suffer from a form of migraine instead. The reason for this confusion has to do with the feeling of pressure around the sinuses, which also can occur during a migraine or other headache attack.  Furthermore, certain sinus medications contain pain-relieving ingredients that can ease headaches symptoms, further convincing a person that he or she suffers from sinus headaches.

You may have a sinus headache if you have the following symptoms. (Chances are you will not experience all, or even most, sinus headache characteristics.)

Key Sinus Headache Characteristics:

• Dull or aching pain generally located in the front of the face and forehead.
• Pain ranges from mild to severe.
• Pain relief typically occurs when fluids are drained from the sinus cavity.

If you suffer from what appears to be frequently occurring sinus headaches, seek the advice of a headache specialist to find out if you actually have a migraine or some other type of headache.

HEADACHE TYPE – Rebound

Rebound headaches — also known as "toxic" headaches — are caused by excessive use of certain medications, including many of the analgesics and other agents used to treat chronic headaches.  Preventive medications will not be effective until the medication that caused the headache is discontinued and withdrawal is complete. Withdrawal may require hospitalization.

Rebound headaches are fairly common. In fact, one study found that 73 percent of headache clinic patients suffered from chronic, daily headaches caused by overuse of medications.

You may have rebound headaches if you have some of the following symptoms. (Chances are you will not experience all, or even most, rebound headache characteristics.)

Key Rebound Headache Characteristics

• Gradual increase in headache frequency.

• Daily frequent use of rebound-headache-inducing agents at regular, predictable intervals, especially if you are taking headache medications (including over the counter or non-prescription pain relievers) regularly.

• Alternate or preventive medications fail to control the headache attacks.

• Psychological or physical dependency on rebound-headache-inducing medications.
• The headache predictably begins within hours to days of the last dose of the medication.
• Waking up with or experiencing a headache at the same time each day when this had not been your headache pattern.