The most recent classification of headaches (2013) distinguishes between primary and secondary headaches. Among primary headaches, migraine and tension headaches are the most common, but what characteristics do they have and how do they differ?

We talk about this topic with Dr. Vincenzo Tullo, neurologist and head of the Headache Outpatient Clinic at Humanitas LAB.

“Primary headaches are migraine, tension headaches, cluster headaches and other primary headaches. Migraine and tension headaches are the most frequent of these.


Migraine: not just a headache

“Migraine is a type of headache characterized by unilateral pain (but it can also be bilateral), lasting 4 to 72 hours, and accompanied by neurovegetative signs and symptoms such as nausea, vomiting, photophobia and phonophobia (light and noise annoyance). The pain is pulsating, of medium strong intensity and disabling: those who suffer from it are forced to interrupt their activities and need an analgesic to see an improvement. Crises can last for as long as a few days, with significant repercussions on the quality of life. Migraine affects about 14-16% of the population and requires that these subjects be followed in specialized Headache Centers,” explains Dr. Tullo.


Tension headache: the common headache

“Tension headache is much more frequent than migraine, it is the common headache, which is characterized by a pain of medium intensity, bilateral and coercive, but it is not associated with other symptoms. It lasts 30 minutes to 7 days and can be linked to incorrect postures, stress or severe fatigue, and also plays a role in personal predisposition, similar to migraine.

It can be managed with over-the-counter medicines, but if it becomes chronic, you should consult a specialist. We indicate a chronic migraine or tension headache that occurs for more than 15 days in a month for more than three months,” explains the specialist.


How is it diagnosed?

“For the diagnosis it is advisable to contact a specialized Headache Centre, besides receiving a correct diagnosis that includes the definition of the type of headache from which the patient suffers, it is in fact essential to exclude a secondary cause. It is necessary to understand whether we are dealing with a primary headache, and therefore a separate pathology, or a secondary headache in which a form of headache is a symptom of the presence of another, which must be investigated and addressed.

The diagnosis is made during a specialist examination in which the neurologist will listen to the symptoms reported by the patient and the characteristics of the pain and, where necessary, will carry out a neurological examination and any radiological examinations, such as CT and MRI,” says Dr. Tullo.


Primary and secondary headaches: the classification

Headaches are divided into primary and secondary headaches.

Primary headaches are: migraine headaches, tension headaches, cluster headaches and other primary headaches (coughing, physical activity, sexual activity, cold, hypnic or nocturnal, new daily persistent headache, a rare form).

The secondary headaches instead are: headache from head injury and/or cervical trauma, vascular disorders (such as stroke), non-vascular skull disorders (such as hypertension or liquor hypotension), use of substances (including painkillers), from infections, metabolic homeostasis disorders (such as headache from air travel, sleep apnea, dialysis, hypertension, fasting); from eye, ear, nose, tooth and mouth disorders; from psychiatric disorders and from painful cranial neuropathies (such as trigeminal neuralgia and burning mouth syndrome).