Headache and Migraine Specialists

Headache &
Migraine Specialists

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Headache Classification

The International Headache Society has divided headaches into more than 300 distinct diagnoses. Whilst it is useful to distinguish between different presenting features of any medical or musculoskeletal condition, this can thankfully be simplified and most headaches fall into only a few main categories. Clinicians can find a full break down of all the headache classifications at the International Headache Society website. We have simplified this below for ease of reference by the patient.

Primary Headaches


Migraine seems to have some degree of genetic predisposition. Exactly how is not fully understood.

It is more common in women than men (3:1) and mostly in their reproductive years suggesting a hormonal influence. Interestingly the same part of the brain stem that receives input from the cervical spine is also sensitive to changing levels of oestrogen (usually falling levels) which is why menstrual migraine affects women at the start of the menstrual cycle.

Features of Migraine

  • Usually lasts between 4 and 72 hours
  • Moderate to intense pain
  • Pulsating or throbbing in quality
  • Often has associated nausea and or vomiting
  • Usually sensitivity to light and or sound (sometimes smell)
  • Migraines can be with or without “aura” which refers to the visual disturbance that may accompany or more usually precede the migraine pain.
  • Some patients also report reversible pins and needles, numbness or weakness in the hand, arm and or face
  • Usually affects one side of the head only
  • Chronic migraine is migraine that is experienced on more than 15 days in a month
  • Episodic migraine is less frequent

Tension Type Headache (TTH)

Usually lower intensity than a migraine

Described as tightness like a band or vice around the head rather than pulsating or throbbing.

Often arises from or spreads to the neck. This on its own does not necessarily mean that the neck is the primary problem as the cause and effect relationship is not established from the history alone. It does, however, suggest that a thorough examination of the neck is indicated and guidelines from the British Association for the Study of Headache (BASH) suggest that Physiotherapy should be a “first measure” for assessment and treatment for TTH. Also recommended is that this should be with a specialist Physiotherapist rather than with someone without specific training.

Features of TTH

  • Chronic TTH is classified when the headaches are present for more than 15 days per month (can be daily)
  • Episodic TTH is less frequent and less disabling
  • Associated with stress

Trigeminal Autonomic Cephaglias (TACs)

The most common of these is called Cluster Headache

Cluster headaches occur in clusters usually daily and for a period of 6-12 weeks which then repeat perhaps once or twice a year

More common in males than females (6:1)

Very intense pain often behind one eye

Attacks are often, but not always, at night time perhaps an hour or two after going to bed; patients wake with pain and are unable to sleep again until the symptoms subside

Associated with autonomic symptoms such as redness and or watering of the eye, blocked and or streaming nose and drooping of the eyelid

Other TACs include SUNCT (short lasting unilateral neuralgiform headaches with conjunctival injection and tearing) which is generally similar in severity to Cluster Headache but shorter lasting with lacrimation and redness in the eyes and Paroxysmal Hemicrania which is again similar but responds absolutely to a drug called indomethacin

Secondary Headaches

There are too many secondary headache classifications to list here but asides from serious medical pathology they mostly relate to headaches associated with substance withdrawal, substance abuse, medication over-use, headache associated with head and neck trauma such as whiplash and other headaches associated with disorders of the head, neck, cranium, teeth and face (including cervicogenic headache). Also listed here are headaches associated with infection and medical conditions such as epilepsy. For a full breakdown of these the reader should look at the classification system set up by the IHS

Cranial Neuralgias

The third category of headaches is described as cranial neuralgias, in other words head pain caused in some way directly by the cranial nerves.

Headache Classification by The International Headache Society. Primary Headaches Such as Migraine may have Genetic Predisposition. Chronic & Episodic Migraine. More Women than Men Suffer Migraine, Menstrual Migraine Caused by Falling Oestrogen Levels. Nausia. Vomiting, Sensitivity Light Sound Smell. Pins and Needles, Numbness or Weakness in the Hand, Arm or Face.

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Headache & Migraine Specialists, 49 Brookside, Hertford, Hertfordshire, SG13 7LJ
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