Primary vs. Secondary Headaches

Primary vs. Secondary Headaches | Dr. Ali Ghahary
Primary vs. Secondary Headaches | Dr. Ali Ghahary

Headaches are common and are something that people can experience occasionally. Usually, they are easily treated with over-the-counter pain relief medication, such as Acetaminophen or Ibuprofen, and generally do not require any kind of special treatment. That being said, not all headaches are alike. The level of pain one experiences may differ from the next, and the type of treatment that helps one may not help another. There are also various types of headaches that one can get that should be considered, including the following:

PRIMARY HEADADACHES:
• Tension headaches
• Cluster headaches
Exertional headaches
Hypnic headaches
• Migraine headaches

Primary headaches are defined as being the condition itself and aren’t caused by any underlying conditions, though they do have triggers.

SECONDARY HEADACHES:
• Medication-overuse headaches
• Sinus headaches
Caffeine-related headaches
Head-injury headaches
Menstrual headaches
Hangover headaches

Secondary headaches are defined as being a symptom of something.

The most common type of primary headache that affects individuals are tension headaches. They are usually episodic in nature, occurring a few times per month on average, although they can also be chronic in nature. They can be triggered by everything from sitting at a computer for too long, being in cold weather, fatigue, dry eye, a common cold or flu, sinus infections, caffeine, tobacco use, poor posture, and even emotional stress/anxiety. The pain associated with tension headaches can range from mild to severe and is often described as the feeling of pressure in the forehead (sometimes described as a tight band squeezing the forehead), tenderness of the forehead and scalp, and dull head pain. In many cases, OTC medications (such as Acetaminophen and Ibuprofen, as mentioned) will be used to treat tension headaches, but in some cases may require stronger prescription medication such as Naproxen or Ketorolac. If you are unable to find relief through these pain relievers, then your doctor may also prescribe a muscle relaxant. Other recommended treatment methods may also include acupuncture, stress management classes, biofeedback and cognitive behavioural therapy (CBT). You may also find relief from applying an ice pack or heating pad to your head for approximately 5 to 10 minutes, or by taking a hot bath or shower to help relax any tense muscles. If your tension headaches become chronic in nature, then your doctor may also want to refer you for medical imaging tests, such as a CT Scan or MRI, to rule out any other possibilities that could be contributing to your headaches, such as a brain tumour.

Behind tension headaches are migraines, with a global prevalence of nearly 15% (approximately every 1 in 7 people.) Migraines typically affect just one side of the head, though in some cases may affect the whole head, and are characterized as intense throbbing pain. They can be acute or chronic in nature. Prior to developing a migraine, you may experience visual or sensory disturbances – also known as an aura. These disturbances can include the feeling of pins and needles or numbness, partial temporary loss of vision, muscle weakness, and difficulty speaking. A number of factors may trigger migraines, such as hormonal changes in women, certain foods and food additives, skipped meals, dehydration, beverages (such as caffeine, or caffeine withdrawal), disrupted sleep, noise, bright lights, certain scents, and stress or anxiety. The best way to stop migraines from occurring is to try and identify your known triggers. If you develop a migraine after eating a certain food, try eliminating that food from your diet to see if you still develop migraines or if their severity decreases. In many cases, someone with a migraine will need to rest in a dark room until the pain of the migraine subsides. Again, OTC medications like Ibuprofen and Acetaminophen can help to reduce the pain of migraines. However, if you have chronic migraines, overuse of these medications may actually result in medication-overuse headaches or rebound headaches, therefore other treatment methods should be looked into which can include preventive medications.

Cluster headaches, which are a less common type of headache (affecting just 1 out of every 1,000 people) are defined as short but debilitating one-sided headaches/pain that occur every day for weeks or even months at a time, and usually reach their peak level of pain as quickly as 5 to 10 minutes after initial onset. A cluster headache occurs when the trigeminal-autonomic nerve pathway in the base of your brain becomes activated. The trigeminal nerve itself is located near the eye and branches to your forehead, across your cheek, down the jaw line and above the ear – and, when activated, is what causes you to experience pain. This pain is often felt in or near the eye and can also extend to other areas such as the face, head, neck and shoulders. The pain is described as discomfort or a burning sensation, and you may also experience other symptoms such as a swollen or drooping eye, eye redness, runny or congested nose, sweating, and light sensitivity. Cluster headaches can affect anyone, although they tend to affect more men than women, and usually happen before the age of 30. They can be triggered by things like cigarette smoke, alcohol, and certain odours. Triptans, such as Zolmitriptan and Sumatriptan, are among some of the most common medications used to treat cluster headaches, as well as preventive medications such as Gabapentin and Topiramate, or a short duration of a corticosteroid known as Prednisone. These preventive medications work to stop headaches before they start, as well as lessen the severity of the attacks. It is important to note that preventive medications take some time before they start to work, and you may be a candidate for occipital nerve blocks in order to get some temporary relief until the effects of the medication set in.

Sinus headaches are a common type of secondary headache that can occur as a result of coming down with a common cold or sinus infection. When you are sick, the sinuses become inflamed and swollen, which causes pressure to build within the sinus cavities and can ultimate lead to both facial pain and headaches. To confirm whether or not a sinus infection is the culprit, your doctor will typically refer you for an X-ray to get a better look at the sinuses. If it is determined you have a sinus infection, you will need to take a course of antibiotics. For sinus infections and sinus headaches that are recurring, you may ultimately be referred to an ENT (ear, nose throat specialist) for further evaluation. In some cases surgery may be required to correct a sinus problem, such as a deviated septum or polyps, both of which can contribute to recurring sinus infections and sinus headaches.