The most recent classification of headaches (2013) separates primary headaches from secondary ones. Migraine and tension headaches are the most common primary headaches. What are their characteristics, and how can one tell them apart?
We asked Doctor Vincenzo Tullo, neurologist and Supervisor of the Headache Ambulatory of Humanitas LAB.
“Primary headaches are migraine, tension headache, cluster headache and other ones. In this group, migraine and tension headache are the most frequent ones”.

Migraine, not just headache

“Migraine is a kind of headache that presents a unilateral (or, sometimes, bilateral) pain lasting 4 to 72 hours, and also neurological signs and symptoms such as nausea, vomit, photophobia and phonophobia (feelings of unease in presence of light and noises). The pain is pulsating, medium-to-severe and crippling. Those who experience it have to stop their daily activities and take a painkiller to get a little better. Crises may last some days, with negative consequences on the quality of life. Migraine affects 14-16% of the population and requires specialized Headache Centers for these people”, Doctor Tullo explains.

Tension headache: common headache

“Tension headache is much more common than migraine. It is the common headache of a medium-intensity, bilateral and constrictive pain with no other symptoms. It lasts from 30 minutes to 7 days and it may depend on incorrect postures, stress, fatigue or personal predisposition, like with migraine.
Tension headache may be treated with over-the-counter drugs, but you have to go to a specialist if it becomes chronic. Migraines or tension headaches are chronic if they last more than 15 days per month over more than three months”, the specialist explains.

How is the diagnosis performed?

“Diagnoses should be performed in a dedicated Headache Center. In fact, in addition to a correct diagnosis, it is fundamental to exclude a secondary headache. We have to understand whether the patient is suffering from a primary headache (a standalone disease) or by a secondary one, where the headache is just a symptom of a disease that has to be pinpointed and treated.
Patients will get their diagnosis during a visit with a specialist, during which the neurologist will learn about the patients’ symptoms and pains. The doctor may also perform a neurological visit and radiological exams, such as CT scans and MRIs”, Doctor Tullo points out.

Primary and secondary headaches: the classification

Headaches are divided into primary and secondary ones.
Primary headaches are: migraine, tension headache, cluster headache and other ones (after coughing, physical exercise, sexual activity, cold or sleep; a rare form is the new daily persistent headache).
Secondary headaches are instead a symptom of cranic and/or cervical traumas, vascular issues (such as ictuses), non-vascular cranium diseases (such as CSF hypertension or hypotension), drugs (painkillers included), infections, ailments of the homeostasis (that happens with airplane travels, sleep apnea, dialysis, high blood pressure, fasting), ailments of eyes, ears, nose, teeth or mouth, psychiatric issues, and painful cranic neuropathies (such as trigeminal neuralgia and burning mouth syndrome).