Types of Migraine Guide

GUIDE TO TYPES OF HEADACHES

When it comes to types of headaches, many people think about three kinds – headaches, bad headaches, and migraines.  Turns out, there are more than 150 types of headaches disorders.  For example, a person with head pain may be suffering from a migraine with aura, a retinal migraine, chronic migraine, or even more specific, a familial hemiplegic migraine type 1.

Does one need to know all these types of headaches? No, not even headache specialists or researchers need to learn it by heart.  But it is helpful to have a high level understanding of the most common types of headaches and their associated symptoms so that your specialist can help diagnose your specific headache and provide accurate treatment options.

In more severe cases, you may have more than one type of headache such as a migraine with aura, a migraine without aura, and medication overuse headaches.  To be diagnose with a specific type of headache, you will have the symptoms of that headache several times.

The classifications were compiled by the International Headache Society and the guide was first published in 1988.  Now in its third revision, the classification has been refined by researchers.  The overwhelming classification guide is listed in its entirety below with input on short summaries of the major types of headaches.  This is an ongoing project.

 

Primary Headaches versus Secondary Headaches

The National Institutes of Health states that “Primary headaches occur independently and are not caused by another medical condition.”  Secondary headaches, on the other hand, are caused by an underlying sickness or condition such as a common cold, head injury, stress, or infection.

 

The Types of Headache List:

 

Primary Headaches

1. Migraine: A migraine is not just a bad headache, it is an extremely incapacitating collection of neurological symptoms such as visual disturbances, nausea, vomiting, sensitivity to light, dizziness, and numbness in the extremities of the face. Migraine attacks last between 4-72 hours. The Migraine Research Foundation states that migraine is the 3rd most prevalent illness in the world.  Migraine has two major subtypes – migraine without aura and migraine with aura

1.1 Migraine without aura: A recurring headache disorder lasting from 4-72 hours.  It will include pulsating, moderate to severe pain, and causes avoidance of activity such as walking.  The headache will have either nausea, vomiting, photophobia, and/or phonophobia.

1.2 Migraine with aura: Recurring migraines that also have one or more of the following aura symptoms – visual, sensory, speech, motor, brainstem, or retinal.  At least one of these symptoms spreads gradually over between a 5 to 60-minute time frame followed by the migraine headache.

Auras can happen with or without a migraine.  These have sometimes been called ocular migraine, optical migraine, visual migraine, retinal migraine, ophthalmic migraine, or visual aura.  Migraine with aura is the correct classification now.

1.2.1 Migraine with typical aura

1.2.1.1 Typical aura with headache

1.2.1.2 Typical aura without headache

There are many commonly used terms to describe visual symptoms associated with migraine.  These include: ocular migraine, optical migraine, visual migraine, retinal migraineophthalmic migraine, or visual aura.  All of these fall under the technical term migraine aura without headache.

1.2.2 Migraine with brainstem aura

1.2.3 Hemiplegic migraine: A rare but very severe type of migraine which causes motor weakness and may last weeks.  The paralysis may affect physical, visual, sensory, and/or speech.   The term “plegic” means paralysis.  When it runs in the family, it is known as a familial hemiplegic migraine (FHM)

1.2.3.1 Familial hemiplegic migraine (FHM)

1.2.3.1.1 Familial hemiplegic migraine type 1 (FHM1)

1.2.3.1.2 Familial hemiplegic migraine type 2 (FHM2)

1.2.3.1.3 Familial hemiplegic migraine type 3 (FHM3)

1.2.3.1.4 Familial hemiplegic migraine, other loci

1.2.3.2 Sporadic hemiplegic migraine

1.2.4 Retinal migraine: Repeated attacks of visual loss or disturbances in the eye during a migraine headache.  Can cause temporary blindness.

1.3 Chronic migraine: Chronic migraines are those defined as having 15 or more days per month for more than 3 months.

1.4 Complications of migraine

1.4.1 Status migrainosus

1.4.2 Persistent aura without infarction

1.4.3 Migrainous infarction

1.4.4 Migraine aura-triggered seizure

1.5 Probable migraine

1.5.1 Probable migraine without aura

1.5.2 Probable migraine with aura

1.6 Episodic syndromes that may be associated with migraine

1.6.1 Recurrent gastrointestinal disturbance

1.6.1.1 Cyclical vomiting syndrome

1.6.1.2 Abdominal migraine: A migraine that does not affect the head, but rather the abdomen and can last from a few hours up to 72 hours.  During attacks at least two of the following are symptoms: anorexia, nausea, vomiting, paleness.  This is mostly commonly found in children and symptoms do not remain between attacks.  Many children who suffer from abdominal migraine have migraine later in life.

1.6.2 Benign paroxysmal vertigo

1.6.3 Benign paroxysmal torticollis

2. Tension-type headache: ‘The common headache’ that is prevalent in anywhere from 30% to 78% of the population depending on different studies.  Mild to moderate pain is found in the scalp, neck, face, and jaw. Because of its prevalence, it has a high impact on society.  This headache is divided into episodic and chronic headaches.  Episodic tension-type headaches generally do not require medical help and can be addresses by the sufferer.  A chronic tension-type headache is a serious disorder that occurs more than 15 days a month and requires medical attention.

2.1 Infrequent episodic tension-type headache

2.1.1 Infrequent episodic tension-type headache associated with pericranial tenderness

2.1.2 Infrequent episodic tension-type headache not associated with pericranial tenderness

2.2 Frequent episodic tension-type headache

2.2.1 Frequent episodic tension-type headache associated with pericranial tenderness

2.2.2 Frequent episodic tension-type headache not associated with pericranial tenderness

2.3 Chronic tension-type headache

2.3.1 Chronic tension-type headache associated with pericranial tenderness

2.3.2 Chronic tension-type headache not associated with pericranial tenderness

2.4 Probable tension-type headache

2.4.1 Probable infrequent episodic tension-type headache

2.4.2 Probable frequent episodic tension-type headache

2.4.3 Probable chronic tension-type headache

3. Trigeminal autonomic cephalalgias: Short lasting but severe headaches

3.1 Cluster headache: Attacks occur in a series (these are the cluster periods) over weeks or a few months. Attacks usually occur on one side of the head or behind one eye.  They last from 15-180 minutes and will occur once every other day or up to eight times a day.  Accompanied by a sense of restlessness and agitation.

3.2 Paroxysmal hemicranias: Rare form of headache that feels similar to the cluster headache but doesn’t last as long.  Attacks last from 2-30 minutes.  Onset usually occurs at adulthood.

3.3 Short-lasting unilateral neuralgiform headache attacks

3.3.1 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT): Moderate or severe attacks causing head pain lasting from seconds to minutes.  Occur at least once a day.  Feels like single stabs, a series of stabs, or a saw-tooth pattern.

3.3.1.1 Episodic SUNCT

3.3.1.2 Chronic SUNCT

3.3.2 Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)

3.3.2.1 Episodic SUNA

3.3.2.2 Chronic SUNA

3.4 Hemicrania continua: Persistent pain on the same side of the face that is present for more than three months.  Pain will increase and decrease over the time period, but it is present.  Accompanied by a sense of restlessness or agitations, or aggravation by pain or movement.

3.5 Probable trigeminal autonomic cephalalgia

3.5.1 Probable cluster headache

3.5.2 Probable paroxysmal hemicrania

3.5.3 Probable short-lasting unilateral neuralgiform headache attacks

3.5.4 Probable hemicrania continua

4. Other primary headache disorders

4.1 Primary cough headache

4.1.1 Probable primary cough headache

4.2 Primary exercise headache

4.2.1 Probable primary exercise headache

4.3 Primary headache associated with sexual activity

4.3.1 Probable primary headache associated with sexual activity

4.4 Primary thunderclap headache

4.5 Cold-stimulus headache

4.5.1 Headache attributed to external application of a cold stimulus

4.5.2 Headache attributed to ingestion or inhalation of a cold stimulus

4.5.3 Probable cold-stimulus headache

4.5.3.1 Headache probably attributed to external application of a cold stimulus

4.5.3.2 Headache probably attributed to ingestion or inhalation of a cold stimulus

4.6 External-pressure headache

4.6.1 External-compression headache

4.6.2 External-traction headache

4.6.3 Probable external-pressure headache

4.6.3.1 Probable external-compression headache

4.6.3.2 Probable external-traction headache

4.7 Primary stabbing headache

4.7.1 Probable primary stabbing headache

4.8 Nummular headache

4.8.1 Probable nummular headache

4.9 Hypnic headache

4.9.1 Probable hypnic headache

4.10 New daily persistent headache (NDPH):  A daily headache in which the individual can remember when the headache began.  Present for over three months.

4.10.1 Probable new daily persistent headache

 

SECONDARY HEADACHES

5. Headache attributed to trauma or injury to the head and/or neck

5.1 Acute headache attributed to traumatic injury to the head

5.1.1 Acute headache attributed to moderate or severe traumatic injury to the head

5.1.2 Acute headache attributed to mild traumatic injury to the head

5.2 Persistent headache attributed to traumatic injury to the head

5.2.1 Persistent headache attributed to moderate or severe traumatic injury to the head

5.2.2 Persistent headache attributed to mild traumatic injury to the head

5.3 Acute headache attributed to whiplash

5.4 Persistent headache attributed to whiplash

5.5 Acute headache attributed to craniotomy

5.6 Persistent headache attributed to craniotomy

6. Headache attributed to cranial or cervical vascular disorder

6.1 Headache attributed to ischaemic stroke or transient ischaemic attack

6.1.1 Headache attributed to ischaemic stroke (cerebral infarction)

6.1.2 Headache attributed to transient ischaemic attack (TIA)

6.2 Headache attributed to non-traumatic intracranial haemorrhage

6.2.1 Headache attributed to non-traumatic intracerebral haemorrhage

6.2.2 Headache attributed to non-traumatic subarachnoid haemorrhage (SAH)

6.2.3 Headache attributed to non-traumatic acute subdural haemorrhage (ASDH)

6.3 Headache attributed to unruptured vascular malformation

6.3.1 Headache attributed to unruptured saccular aneurysm

6.3.2 Headache attributed to arteriovenous malformation (AVM)

6.3.3 Headache attributed to dural arteriovenous fistula (DAVF)

6.3.4 Headache attributed to cavernous angioma

6.3.5 Headache attributed to encephalotrigeminal or leptomeningeal angiomatosis (Sturge Weber syndrome)

6.4 Headache attributed to arteritis

6.4.1 Headache attributed to giant cell arteritis (GCA)

6.4.2 Headache attributed to primary angiitis of the central nervous system (PACNS)

6.4.3 Headache attributed to secondary angiitis of the central nervous system (SACNS)

6.5 Headache attributed to cervical carotid or vertebral artery disorder

6.5.1 Headache or facial or neck pain attributed to cervical carotid or vertebral artery dissection

6.5.2 Post-endarterectomy headache

6.5.3 Headache attributed to carotid or vertebral angioplasty

6.6 Headache attributed to cerebral venous thrombosis (CVT)

6.7 Headache attributed to other acute intracranial arterial disorder

6.7.1 Headache attributed to an intracranial endovascular procedure

6.7.2 Angiography headache

6.7.3 Headache attributed to reversible cerebral vasoconstriction syndrome (RCVS)

6.7.3.1 Headache probably attributed to reversible cerebral vasoconstriction syndrome (RCVS)

6.7.4 Headache attributed to intracranial arterial dissection

6.8 Headache attributed to genetic vasculopathy

6.8.1 Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL)

6.8.2 Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes (MELAS)

6.8.3 Headache attributed to another genetic vasculopathy

6.9 Headache attributed to pituitary apoplexy

7. Headache attributed to non-vascular intracranial disorder

7.1 Headache attributed to increased cerebrospinal fluid pressure

7.1.1 Headache attributed to idiopathic intracranial hypertension (IIH)

7.1.2 Headache attributed to intracranial hypertension secondary to metabolic, toxic or hormonal causes

7.1.3 Headache attributed to intracranial hypertension secondary to hydrocephalus

7.2 Headache attributed to low cerebrospinal fluid pressure

7.2.1 Post-dural puncture headache

7.2.2 CSF fistula headache

7.2.3 Headache attributed to spontaneous intracranial hypotension

7.3 Headache attributed to non-infectious inflammatory disease

7.3.1 Headache attributed to neurosarcoidosis

7.3.2 Headache attributed to aseptic (non-infectious) meningitis

7.3.3 Headache attributed to other non-infectious inflammatory disease

7.3.4 Headache attributed to lymphocytic hypophysitis

7.3.5 Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL)

7.4 Headache attributed to intracranial neoplasia

7.4.1 Headache attributed to intracranial neoplasm

7.4.1.1 Headache attributed to colloid cyst of the third ventricle

7.4.2 Headache attributed to carcinomatous meningitis

7.4.3 Headache attributed to hypothalamic or pituitary hyper- or hyposecretion

7.5 Headache attributed to intrathecal injection

7.6 Headache attributed to epileptic seizure

7.6.1 Hemicrania epileptica

7.6.2 Post-ictal headache

7.7 Headache attributed to Chiari malformation type I (CM1)

7.8 Headache attributed to other non-vascular intracranial disorder

8. Headache attributed to a substance or its withdrawal

8.1 Headache attributed to use of or exposure to a substance

8.1.1 Nitric oxide (NO) donor-induced headache

8.1.1.1 Immediate NO donor-induced headache

8.1.1.2 Delayed NO donor-induced headache

8.1.2 Phosphodiesterase (PDE) inhibitor-induced headache

8.1.3 Carbon monoxide (CO)-induced headache

8.1.4 Alcohol-induced headache

8.1.4.1 Immediate alcohol-induced headache

8.1.4.2 Delayed alcohol-induced headache

8.1.5 Headache induced by food and/or additive

8.1.5.1 Monosodium glutamate (MSG)-induced headache

8.1.6 Cocaine-induced headache

8.1.7 Histamine-induced headache

8.1.7.1 Immediate histamine-induced headache

8.1.7.2 Delayed histamine-induced headache

8.1.8 Calcitonin gene-related peptide (CGRP)-induced headache

8.1.8.1 Immediate CGRP-induced headache

8.1.8.2 Delayed CGRP-induced headache

8.1.9 Headache attributed to exogenous acute pressor agent

8.1.10 Headache attributed to occasional use of non-headache medication

8.1.11 Headache attributed to long-term use of non-headache medication

8.1.12 Headache attributed to exogenous hormone

8.1.13 Headache attributed to use of or exposure to other substance

8.2 Medication-overuse headache (MOH)

8.2.1 Ergotamine-overuse headache

8.2.2 Triptan-overuse headache

8.2.3 Simple analgesic-overuse headache

8.2.3.1 Paracetamol (acetaminophen)-overuse headache

8.2.3.2 Acetylsalicylic acid-overuse headache

8.2.3.3 Other non-steroidal anti-inflammatory drug (NSAID)-overuse headache

8.2.4 Opioid-overuse headache

8.2.5 Combination-analgesic-overuse headache

8.2.6 Medication-overuse headache attributed to multiple drug classes not individually overused

8.2.7 Medication-overuse headache attributed to unverified overuse of multiple drug classes

8.2.8 Medication-overuse headache attributed to other medication

8.3 Headache attributed to substance withdrawal

8.3.1 Caffeine-withdrawal headache

8.3.2 Opioid-withdrawal headache

8.3.3 Estrogen-withdrawal headache

8.3.4 Headache attributed to withdrawal from chronic use of other substance

9. Headache attributed to infection

9.1 Headache attributed to intracranial infection

9.1.1 Headache attributed to bacterial meningitis or meningoencephalitis

9.1.1.1 Acute headache attributed to bacterial meningitis or meningoencephalitis

9.1.1.2 Chronic headache attributed to bacterial meningitis or meningoencephalitis

9.1.1.3 Persistent headache attributed to past bacterial meningitis or meningoencephalitis

9.1.2 Headache attributed to viral meningitis or encephalitis

9.1.2.1 Headache attributed to viral meningitis

9.1.2.2 Headache attributed to viral encephalitis

9.1.3 Headache attributed to intracranial fungal or other parasitic infection

9.1.3.1 Acute headache attributed to intracranial fungal or other parasitic infection

9.1.3.2 Chronic headache attributed to intracranial fungal or other parasitic infection

9.1.4 Headache attributed to brain abscess

9.1.5 Headache attributed to subdural empyema

9.2 Headache attributed to systemic infection

9.2.1 Headache attributed to systemic bacterial infection

9.2.1.1 Acute headache attributed to systemic bacterial infection

9.2.1.2 Chronic headache attributed to systemic bacterial infection

9.2.2 Headache attributed to systemic viral infection

9.2.2.1 Acute headache attributed to systemic viral infection

9.2.2.2 Chronic headache attributed to systemic viral infection

9.2.3 Headache attributed to other systemic infection

9.2.3.1 Acute headache attributed to other systemic infection

9.2.3.2 Chronic headache attributed to other systemic infection

10. Headache attributed to disorder of homoeostasis

10.1 Headache attributed to hypoxia and/or hypercapnia

10.1.1 High-altitude headache

10.1.2 Headache attributed to aeroplane travel

10.1.3 Diving headache

10.1.4 Sleep apnoea headache

10.2 Dialysis headache

10.3 Headache attributed to arterial hypertension

10.3.1 Headache attributed to phaeochromocytoma

10.3.2 Headache attributed to hypertensive crisis without hypertensive encephalopathy

10.3.3 Headache attributed to hypertensive encephalopathy

10.3.4 Headache attributed to pre-eclampsia or eclampsia

10.3.5 Headache attributed to autonomic dysreflexia

10.4 Headache attributed to hypothyroidism

10.5 Headache attributed to fasting

10.6 Cardiac cephalalgia

10.7 Headache attributed to other disorder of homoeostasis

11. Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure

11.1 Headache attributed to disorder of cranial bone

11.2 Headache attributed to disorder of the neck

11.2.1 Cervicogenic headache

11.2.2 Headache attributed to retropharyngeal tendonitis

11.2.3 Headache attributed to craniocervical dystonia

11.3 Headache attributed to disorder of the eyes

11.3.1 Headache attributed to acute glaucoma

11.3.2 Headache attributed to refractive error

11.3.3 Headache attributed to heterophoria or heterotropia (latent or persistent squint)

11.3.4 Headache attributed to ocular inflammatory disorder

11.3.5 Headache attributed to trochleitis

11.4 Headache attributed to disorder of the ears

11.5 Headache attributed to disorder of the nose or paranasal sinuses

11.5.1 Headache attributed to acute rhinosinusitis

11.5.2 Headache attributed to chronic or recurring rhinosinusitis

11.6 Headache attributed to disorder of the teeth or jaw

11.7 Headache attributed to temporomandibular disorder (TMD)

11.8 Head or facial pain attributed to inflammation of the stylohyoid ligament

11.9 Headache or facial pain attributed to other disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure

12. Headache attributed to psychiatric disorder

12.1 Headache attributed to somatization disorder

12.2 Headache attributed to psychotic disorder

 

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