Headache is a very common problem that can become disabling if its intensity or frequency is high.

While the most common types of headaches are not due to disease and therefore not dangerous, others are symptomatic of underlying conditions that require medical treatment.

There are over 150 types of headaches with their own causes and symptoms. If we want to find out how we can solve our headaches, a first essential step is to identify which headache we suffer from.

What are the causes of the pain?

The sensation of pain is usually caused by injury to tissues that trigger the cells known as nociceptors. These receptors pick up mechanical, thermal and chemical signals that indicate possible damage to the body.

However, neither the damage to the cells nor the reaction of the nociceptors are direct causes of the sensation of pain, but it is largely influenced by non-biological variables such as experience or emotion.

When it reaches the nervous system, nociceptive stimulation joins our thoughts, memories and feelings before the pain occurs. Thus, the final sensation depends on both external factors and our own mind .

Headache in particular is often influenced by factors such as muscle tension, vascular problems or the body’s idiosyncratic response to stress, certain substances or medical disorders. However, the causes and characteristics of headaches depend largely on the specific type of headache.

Primary headaches

According to the International Classification of Headaches there are more than 150 types of headaches that can be divided into three main categories: primary, secondary and other headaches .

Unlike secondary headaches, primary headaches occur in the absence of physical disorder and are therefore not dangerous.

1. Tension headache

Tension-type headache is the most common of all . These headaches are caused by muscle tension; this can be due to stress or physical causes, such as intense and continuous contraction of the neck or jaw muscles.

This type of headache usually manifests itself as constant tension or pressure on both sides of the head. In severe cases, even touching the affected muscles can cause pain.

Tension headaches usually cause milder pain and are therefore less disabling than migraines and other types of headache, but there is a high risk that episodic tension headache will become chronic, with attacks occurring all or most days.

2. Migraine

Migraines are headaches caused by the activation of neurons in the cerebral cortex . Some experts also attribute them to the narrowing of blood vessels in the brain, which would cause blood and oxygen not to reach the brain properly. However, the vascular hypothesis of migraine has lost support in the recent past.

This type of headache produces more intense pain than most tension headaches. Migraines usually consist of prickly or pulsating sensations on one side of the head.

The stimuli that trigger migraine vary greatly depending on the person: it may be due to stress, effort, lack of sleep, intense lighting, consumption of certain foods…

We distinguish between migraines with aura and migraines without aura . Migraines without aura are the most common and appear suddenly, whereas migraines with aura are preceded by visual, sensory, linguistic and motor symptoms.

3. Trigeminal-autonomic headache

The trigeminal nerve receives the sensations captured by many muscles in the head, such as those in the face, eyes, mouth or jaw. Headaches that mainly involve the reflex action of the trigeminal are known as “trigeminal-autonomic” . Furthermore, they make up one of the most painful and difficult types of headache to manage, as they are not so much related to the circulation as to certain alterations in the nerve.

The symptoms of this type of headache are very similar to those of migraine, so they usually affect only half of the head and consist of throbbing pain. However, the intensity of the pain is greater than that of migraines.

Trigeminal-autonomic headache includes syndromes such as cluster headache, a very painful type of headache that affects the eye and temple region and is associated with symptoms such as nasal congestion, tearing and facial sweating.

4. Tuxigenic headache

Although it is rare in the general population, tusigenic headache occurs in a significant proportion of the people who go to the doctor as a result of a severe cough .

Some common symptoms of Tusigenic Headache are nausea, dizziness and sleep disorders. These headaches are triggered by coughing fits and can be very brief or last more than an hour.

5. By physical effort

The classification of “physical stress headache” is that the symptoms are not due to any intracranial cause, but simply to the practice of very intense exercise . Abnormal blood flow can cause parts of the nervous system to suffer

It occurs more frequently in places where it is very hot or at a high altitude, and the pain involved is usually of a pulsating nature.

On the other hand, performing a task that requires constant effort of the same kind may cause this symptom to appear, which is a way of warning that we should stop as soon as possible.

6. By sexual intercourse

Primary headache associated with sexual activity is attributed to loss of cerebrospinal fluid that causes a drop in intracranial pressure . The pain occurs on both sides of the head and intensifies as the person becomes aroused, peaking when they reach orgasm.

This is a problem that has to do with attention management, difficulties in relaxing, and the performance of continuous physical efforts.

7. By cryostimulus

“Cryostimulus headache” is the official name of the classic headache produced by contact with something very cold , either because it touches the outside of the head, because it is inhaled or because it is ingested, as happens with ice cream. Cryostimulus headaches tend to be stabbing, one-sided and short-lived.

8. Hypnical headache

“Wake-up” headaches appear only during sleep, causing the person to wake up . It usually affects people over 50 and tends to be persistent. They share some characteristics with migraine, such as the feeling of nausea.

Secondary headaches

Secondary headaches are the result of conditions, such as vascular disorders or brain damage , that are symptomatic of pain and may require specific treatment depending on the underlying cause.

1. For trauma

Blows to the skull or neck, such as those produced by traffic accidents, can cause temporary or chronic headaches (if they last more than three months since the trauma).

Not only can blows cause traumatic headaches, but these can also be due to other causes, such as explosions and the presence of foreign bodies in the head.

These headaches usually occur in conjunction with other symptoms caused by the same trauma, such as problems with concentration or memory, dizziness, and fatigue.

2. For vascular disorder

This type of headache is the result of cerebrovascular problems such as ischemic stroke, cerebral haemorrhage , aneurysm or congenital arteriovenous malformation. In these cases the headache is usually less relevant than other consequences of the vascular accident.

3. For substance use or abstinence

The abuse or inhalation of substances such as alcohol, cocaine, carbon monoxide or nitric oxide can also cause and aggravate headaches. Suppression of commonly used substances, such as alcohol and drugs, is another common cause of headaches.

4. By infection

Some common causes of this type of headache are meningitis and bacterial or viral encephalitis , parasitosis and systemic infections. Although in most cases the headache goes away once the infection has been cured, sometimes it may persist.

5. For mental disorder

Sometimes headaches are categorised as secondary to psychiatric disorders if there is a temporal and causal relationship between both phenomena. However, in these cases the pain seems to have a psychogenic rather than a biological origin.

In this sense, the International Classification of Headaches gives special importance to psychotic and somatization disorders, consisting of the presence of physical symptoms in the absence of identifiable medical pathology.