Types and Causes of Headaches

The term ‘Chronic Headache’ is used when a headache has persisted for longer than three months.  Headaches are divided into two broad types:

1. Primary Headaches

These are caused by problems with the pain-sensitive structures in the brain and its surrounding structures.  A ‘primary headache’ is not a symptom of an underlying disease.  These include:

2. Secondary Headaches

A secondary headache is a symptom of a disease that affects the pain-sensitive nerves of the head.  Many conditions cause secondary headaches:

  • Trauma (Concussion) 

  • Infections (Meningitis, encephalitis, sinusitis)

  • Blood vessel problems (Clots, aneurysms, dissections and stroke)

  • Osteoarthritis of the spine (Cervical Spondylosis) 

  • Hangover from alcohol or substance misuse

  • Medication Overuse Headaches (MOH)

  • High blood pressure

  • Psychological conditions (Panic attacks and anxiety) 

  • Reduced spinal fluid pressure (After a spinal injection or epidural procedure)

  • Brain tumours


For more information, click the link below:



Common Headaches

1.         Occipital neuralgia:   (See under Conditions list)

This type of headaches is localised to the back of the head and can travel forwards over the scalp to behind the eyes.  The bones and joints of the spine in the neck develop ‘wear and tear’ changes with age (cervical spondylosis) and these changes cause the headaches.



  • Simple over-the-counter medications such as paracetamol and ibuprofen might relieve these headaches. 



  • Prescription medications such as amitriptyline, gabapentin and pregabalin might also help.  These medications often help patients to sleep better. 


  • Acupuncture to the muscles of the neck and shoulders can sometimes relieve the pain.


  • Injections with local anaesthetic and steroid around the occipital nerve at the base of the skull can provide relief.  



2.         Tension headaches

These are caused by muscle contractions in the head and neck regions.  There are a variety of foods, activities, and stresses that cause these contractions.  These include:

  • Alcohol, caffeine and nicotine

  • Fatigue, eye strain, poor posture

  • Emotional stress



  • Again, simple over-the-counter medications such as paracetamol and ibuprofen might relieve tension headaches.  These should not be used regularly because they can cause “overuse” or “rebound” headaches. (See below.)


  • Prescription medications might include amitriptyline or one of the selective serotonin reuptake inhibitor (SSRI) antidepressants.


  • Injections with local anaesthetic into the muscles of the neck and shoulders (Trigger points) can reduce muscle contractions. These are usually done using an ultrasound device.


  • Acupuncture is a therapy that may reduce stress and tension by applying fine needles to specific areas of the body.


  • Relaxation techniques and stress management classes teach patients ways to cope with stress and how to relieve tension


  • Psychological therapies such as Cognitive Behavioural Therapy (CBT) teach patients to recognize situations that cause stress, anxiety, and tension.




3.         Migraine

 Patients with migraine usually have episodic attacks of headaches associated with multiple symptoms (nausea, vomiting, sensitivity to light and sound), and then return to health in between attacks. 



  • A Neurologist is probably the best clinician to deal with the diagnosis and treatment of migraine headaches.




4. Medication overuse headaches

The excessive use of pain medications can set off a cycle called ‘medication-overuse headaches’ (MOH). The repetitive doses stop helping the pain and instead cause headaches. 


Drugs that are associated with the development of chronic daily headaches include: 

  • Codeine and Paracetamol

  • The Triptan medications 

  • Caffeine

  • Ergotamine drugs



It is difficult to treat because of the cycle of events.  Stopping the medication causes withdrawal symptoms of headache. The pain medication will relieve these, and this perpetuates the cycle of medication overuse.

The only treatment is to stop the medication causing it. Some patients might require admission to hospital for detoxification under medical supervision.



Patient Information (PDFs)