Understanding Headaches

Zili Acupuncture, Physiotherapy

Headaches are an almost universal experience, but not well understood. There are many types of headaches and different causes to them. Let’s explore some of the more common types of headaches to understand why sometimes we have them and in the next blog, how they are managed.


Primary Headaches

Primary headaches, as classified by the International Headache Society, are divided into four types: tension-type, migraines, cluster, and other types of primary headaches. These are headaches that are not caused by a secondary source or condition.


Tension Type Headaches – MOST COMMON TYPE

Tension-type are the most common type of primary headaches. Studies indicate its prevalence in the general population to be between 30% to 78%. They typically occur on both sides of the head, forehead, or down both sides of the back of the neck. Pain associated with tension-type headache is described as dull, pressing and tightening. They range from mild to moderate and can occur on a daily basis in severe, chronic cases.

The exact causes of tension headaches are not well understood. Research has shown the main factors are autonomic nervous system changes resulting in increased sensitivity to pain, brain chemical imbalances, and myofascial tightness.


Migraines are chronic, episodic headaches with symptoms lasting 4 to 72 hours and occur 1-4 times a month. Those who experience migraines more than 15 times a month are classified as suffering from Chronic Migraines. It affects females more than males by a 3:1 ratio.

Pain is mostly on one side of the head and accompanied by autonomic symptoms, such as nausea, sensitivity to light, etc. The pain is described as throbbing and pulsating, with various triggers, but usually not with neck movement(s).

Migraines are caused by disorders in the central nervous system (the brain and the spinal cord) and affect the surrounding peripheral nerves and blood vessels. Specifically, they cause blood vessels in the skull to constrict, and blood vessels outside the skull to dilate. This results in decreased oxygen delivery to the brain and may be responsible for the associated aura-type migraines and neurological deficits.

Some migraines also occur during the menstrual cycle, called ‘menstrual migraines’.

Cluster Headaches

This type is the rarest but most painful type of headaches, reported to be affecting between 1%-4% of the population. Described as a severe pain localized to around one eye socket, eye tearing (not ‘ripping’ tearing but ‘crying’ tears), drooping eyelids, and nasal congestion, on the same side. Pain can last between 15 minutes to 2 hours. Pain can be slightly alleviated with physical movements. Patients often prefer being in a standing posture rather than lying down or sitting, as it may be difficult to stay still when an episode occurs.

Various factors contribute to cluster headaches. If you have a cluster headache that is poorly managed, it is recommended to undergo an MRI to rule out other causes of the pain.

Studies have shown that during a cluster headache episode, there is an activation of the trigeminal vascular system and the posterior hypothalamus, as well as many changes in the body’s hormone levels.

There are various triggers including certain smells, bright lights, lack of oxygen, nitroglycerin and alcohol. It is important to identify triggers to the headache, in order to avoid them and slowly build tolerance to these triggers.

Other Primary Headaches

There are many other types of primary type headaches, including chronic daily headaches, exertional headaches, cough headaches and coital cephalagia (headache from sexual activity).

In all cases of ongoing headaches that do not resolve, your MD should be consulted to rule out other serious pathology that could be causing the headache, such as subarachnoid hemorrhage, cerebral infarctions and tumors.
Before you go and imagine the worst case scenario, keep in mind that these causes of headaches are rare 🙂

Types of headaches


Secondary Headaches

Secondary headaches are headaches that occur due to secondary sources or conditions. They are loosely divided into those caused by head/neck trauma (known as cervicogenic headaches), those caused by cranial or vascular disorders, and those with other causes. The latter includes headaches from infections, substance withdrawal, and pain referred from other disorders of the head, such as the eyes, ears, sinuses, teeth, jaw and other cranial structures.

Cervicogenic Headaches – MOST COMMON & MOST TREATABLE

Cervicogenic headaches are the most common type of secondary headache, but also the most treatable without pharmaceutical or surgical intervention. They are caused by various dysfunctions in the neck, including the cervical spine, the surrounding soft tissues, and nerves. Often there is a mobility issue in the cervical joint(s) such as hypo- (stiff) or hyper- (loose), tightness and/or weakness in the neck muscles.

This type is usually unilateral (affecting one side) and exacerbated with neck or head movements.

cervicogenic pain

Vascular Headaches

Headaches can also be caused by vascular conditions, such as vertebral artery insufficiency and strokes. It is thus important to rule out a headache as being vascular in nature.


Other Secondary Headaches

Sinus pain, jaw dysfunctions and withdrawal symptoms can lead to other types of secondary headache. Altitude sickness can also be classified as a secondary type of headache.

That’s a ‘short’ explanation on few types of headaches and causes. But do not worry! It’s not a doom-and-gloom for headache sufferers!!! There are causes of headaches that can be addressed and some conservative management options available. Stayed tuned for my next blog on management options of headaches.

Talk to your Vancouver physiotherapist if you think you have a primary or secondary headache to see if treatment is right for you. At Van Sports and Physiotherapy, we have therapists who are experienced in managing and treating headaches; give us a call (604.661.8878) or an email ( if you have any questions!