The 3 Most Common Types of Chronic Headaches

How to Identify and Treat a Chronic Headache

Close-up of a woman suffering from a headache
Eric Audras/ONOKY/Getty Images

Chronic headaches are one of the most common types of chronic pain. They're right up there with back pain and nerve pain. Sometimes recurrent headaches are symptoms of other chronic pain diagnoses, such as chronic neck pain or fibromyalgia. Many people, however, suffer from chronic headaches without having any other major medical problems.

The three most common types of chronic headaches are migraines, tension headaches and cluster headaches.

The underlying causes for each type of headache vary, so pain manifests in very different and distinct ways. Medication is usually the treatment method of choice for chronic headaches, but a number of different complimentary and alternative treatments may also be effective.

1. Migraines

The exact cause of migraine headaches is still under debate, but researchers agree that they are neurological by nature. Formerly, migraines were thought to be caused by dilation of blood vessels in the brain, but more recent research suggests that they may be caused by changes in brain activity at the cellular level. A migraine can be triggered by external factors such as excessive heat or light, or internal factors like stress or hormonal fluctuations.

Migraines cause severe headache pain, often on one side of the head. Unlike other types of headaches, however, migraines are often accompanied by other symptoms that can include one or more of the following:

  • visual disturbances, such as auras or flashing lights
  • a metallic taste in the mouth
  • sensitivity to light
  • sensitivity to sound
  • nausea
  • vomiting
  • fatigue

Migraines can be treated with over-the-counter medication such as NSAIDs, but chronic and severe migraines may require prescription medication. These include tricyclic antidepressants and beta blockers.

A number of alternative treatments may help too, such as yoga and acupuncture.

2. Tension Headaches

A tension headache usually feels like a band of pressure around the head and may be accompanied by pain in the neck and shoulders. Researchers previously believed that tension headaches were caused by tightness or pain in the neck and shoulders, leading them to sometimes be referred to as muscle tension headaches. Newer research indicates that they may be caused by excessive input from the muscles in the head going to the pain control center in the spine.

How can you tell if your headache is a tension headache? Tension headaches are often felt all over the head and are frequently described as a dull pressure that feels more intense around the temples and the back of the neck. This type of headache, which has no neurological symptoms, can last anywhere from 30 minutes to several days.

While the exact cause of tension headaches is not certain, several factors are believed to be triggers, including:

  • alcohol
  • caffeine
  • overexertion or fatigue
  • smoking
  • nasal or sinus congestion
  • eye strain

Depending on the severity of a tension headache, over-the-counter or prescription doses of NSAIDs or other simple analgesics are often effective. Regular use of tricyclic antidepressants may keep tension headaches at bay. Complimentary treatments such as meditation and massage may also help to alleviate tension headache pain.

3. Cluster Headaches

Cluster headaches are the least common of the three. They're a bit of a medical mystery. They may be caused by vascular changes in the brain, or by a complex series of activation in certain areas of the brain. Cluster headaches differ from migraines and tension headaches because they occur in short bursts over a period of time.

This type of headache may feel sharp or have a burning sensation. Like migraines, they are neurological. However, their accompanying symptoms are much different. They include:

  • pain felt over or behind one eye
  • watery eyes
  • red or puffy eyes, especially on the painful side of the head
  • droopy eyelids
  • restlessness or agitation

Cluster headaches are short-lived, which means medication is not always effective. Local analgesics such as pain patches may help relieve cluster headache pain. Preventative medications include corticosteroids and antiepileptics, and some physicians use oxygen therapy. Some people find relief with dietary supplements such as melatonin. Before you take any dietary supplement, consult your doctor, as it may react with certain prescriptions and lead to complications.

Coping with Chronic Headaches

Like many other chronic conditions, chronic headaches can seriously disrupt your daily routine and quality of life. Many people who suffer from chronic headaches are forced to make lifestyle changes to accommodate headache pain. While medication and alternative treatments can provide major pain relief, it's important to be an advocate for your own health. Regardless of the type of headache you suffer from, stay on top of your pain and keep up with doctor's appointments.


Fumal, Arnaud and Schoenen, Jean. Tension-type Headache: Current Research and Clinical Management. Lancet Neurology, 2008; 7: 70–83.

May, Arne. Cluster headache: Pathogenesis, Diagnosis, and Management. Lancet 2005; 366: 843–55

National Institutes of Health. Medical Encyclopedia: Tension Headache. Accessed April 2, 2009.

Silberstein, Stephen D. Migraine. The Lancet. Volume 363, January 31, 2004. pp381-391.

Continue Reading