Clarksville TN Chiropractor Discusses Different Types of Headaches
Headaches come in different types, and three of the best known are tension-type headache, migraine and cluster headache. They range from mild to severe, and most of them aren't dangerous. A few are. Reading about your own symptoms is exactly when people talk themselves out of getting help, so the warning signs come first.
Which headache warning signs need urgent medical attention?
Get emergency medical care right away for any of these, and please don't wait to see us first:
- 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.
These need a prompt visit to a medical doctor:
- 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
No list catches everything, and the timings here are approximate. You don't have to match anything on it before you get help. If something about your headache worries you, that's reason enough.
What are the different types of headaches?
Doctors split headaches into two groups. Primary headaches are the condition itself. Secondary headaches are a symptom of something else. Tension-type headache, migraine and cluster headache are all primary. The descriptions below follow the International Classification of Headache Disorders, third edition (ICHD-3), the reference doctors use to classify headaches.
There's also cervicogenic headache, which is pain referred to the head from a structure in the neck. It's the type most relevant to a chiropractic exam, and our headache tips page covers it.
Tension-type headache
This is 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 feel instead of throbbing, mild or moderate intensity, and not getting worse with ordinary physical activity like walking or climbing stairs. It comes without nausea or vomiting, and with no more than one of light sensitivity or sound sensitivity.
Migraine
Untreated, a migraine attack lasts between four hours and three days. As with tension-type headache, ICHD-3 asks for at least two of four features, not all of them: pain on one side, a pulsing quality, moderate or severe intensity, and getting worse with routine physical activity, or making you avoid it. That last one is one of the more useful ways to tell migraine from tension-type headache, which typically isn't made worse by activity. An attack also brings at least one of these: nausea or vomiting, or both light and sound sensitivity.
Some people get an aura: fully reversible symptoms that can be visual, sensory, or affect speech and language, and less often motor, brainstem or retinal. Here too the definition works as a threshold. It isn't a portrait of one typical aura. 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 headache follows the aura within an hour. An aura can also happen with no headache after it at all.
Cluster headache
Cluster headache is uncommon, and it's severe. The pain is one-sided, around or behind the eye or at the temple, and lasts between fifteen minutes and three hours untreated. During a cluster period it can strike anywhere from once every other day to eight times a day.
What sets it apart is what comes with the pain, on the same side as the headache: a red or watering eye, a blocked or runny 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 instead of wanting to lie still, which is close to the opposite of what's typical in migraine.
Why do the types of headaches overlap?
ICHD-3 is direct about this, in substance: among the primary headache disorders, the diagnostic problem that comes up most often is telling tension-type headache apart from mild migraine. It gets harder because people with frequent headaches often have both at once.
Each of these definitions also ends with a clause we left out above: a pattern only counts as that type of headache if it's not better accounted for by another diagnosis. That clause does real work. It's why a headache can tick every box above and still be something else, and why a good match with one of the types never cancels out the warning signs at the top of the page.
The descriptions help you notice whether your headaches follow a pattern, and put it into words for someone who can examine you. They can't sort your headache for you. A headache that doesn't match any of them still needs an explanation, and the categories don't tell you the cause: a secondary headache can imitate any of them. It's also why a first visit with us starts with your health history and your symptoms, before anyone looks at your neck.
Where does a chiropractic exam fit with headaches?
A chiropractic exam looks into one specific, limited question: is the neck contributing to a headache pattern? It looks at how the upper neck joints move and where they're tender, at posture and sustained loading, and at whether the neck can bring the headache on or ease it. If the picture doesn't fit a neck-related headache, or anything from the warning lists is present, we'll tell you so and refer you for the right medical evaluation instead of starting a course of treatment.
For more, our headache tips and what an exam looks for and how chiropractic care approaches headaches pick up where this page leaves off. And if headaches keep coming back and you want to know if your neck is part of it, contact our Clarksville office to set up an exam and talk through headache treatment options.
Follow the evidence
Research, with context.
Selected published sources behind what we've written, each with what it found and what it can't tell us. We give you both halves because no paper can diagnose you or predict how your own care will go.
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 can't tell usParticipants weren't blinded, and the combined approach wasn't significantly superior. The findings are about headache that starts in the neck (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 can't tell usIt was a small trial. Its secondary outcomes don't overturn the main result, and a trial this size is too small to show how often rare serious harms happen.
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
Our editorial policy explains how to read these sources and what our clinical-review labels mean.