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What is the difference between a primary and secondary headache?

A primary headache is a headache that is due to the headache condition itself and not due to another cause. A secondary headache is a headache that is present because of another condition such as a sinus headache from sinusitis.

The three types of primary headache are:

  1. Migraine
  2. Tension
  3. Cluster

Types of secondary headaches are:

  1. Sinus headache. By definition, this type of headache should resolve when the course of antibiotics is completed.
  2. Medication overuse headache. By definition, this type of headache should resolve when the medication being overused is discontinued, e.g. Vicodin (hydrocodone) or Fioricet (butalbital).
  3. Headaches from illness such as meningitis.
  4. Post-traumatic headache from the trauma event such as a snow-boarding accident.
  5. Spinal headache. This type of headache is common after an epidural is given such as during labor.
  6. Brain tumor or aneurysm headache.
  7. Cervicogenic headache. This type of headache is related to the underlying neck condition such as degenerative disc disease of the cervical vertebrae.

How we can be sure if a headache is primary or secondary?

Answer: By taking a detailed and thorough headache history when evaluating a patient. I am convinced that the history is the key to headache diagnosis. Keeping a headache diary or journal can provide valuable information as you and your health care provider work together to diagnose and treat your headaches.


A useful way to differentiate between primary and secondary headaches is to look at the following list of questions which is sometimes referred to as the “SNOOP” list:

  1. Systemic Signs or Symptoms: Look for the presence of fever, weight loss, history of cancer, abnormal blood tests; this could point to meningitis, cancer, or illness to be the cause of the headache.
  2. Neurologic Exam: if the neurologic exam is abnormal, then a secondary headache should be ruled out. Examples of an abnormal neurological exam include abnormal speech, abnormal gait, confusion, and dizziness.
  3. Onset: if onset of headache is sudden then a secondary headache such as an aneurysm or a bleed should be suspected. Onset less than 2 weeks could indicate an illness such as meningitis. If the onset was greater than 6 months ago, then this is reassuring and points to a benign headache condition.
  4. Onset: if less than age 5 or new onset greater than 50 years old then a secondary headache should be ruled out and if older than 50, may require an MRI of the brain. It is unusual for someone who never had migraines to develop them for the first time after the age of 50.
  5. Progressive: this would refer to a headache pattern that is progressively worsening over time. Even migraine patients can develop a secondary headache such as a tumor or aneurysm so a progressive pattern of worsening headaches in a known migraine individual may require a work-up such as an MRI or spinal tab or blood work.

Reassuring history that indicates a primary headache includes:

  1. Stable pattern of headache for over 6 months
  2. Predictable triggers for headache
  3. The individual feels fine in between headache attacks

It is always important to have your headaches correctly diagnosed. Also, if you are experiencing a fundamental change in the pattern or severity of your headaches, see your health care provider for a careful assessment.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Judy Davis Clark
    8 years ago

    I’ve been dealing with migraines since I’ve been 12. I’m currently 26, if I live to see June 7th, I’ll be 27. There are times where I’m walking, and it’s like I lose my footing or have the feeling that I’m about to fall. I have even gotten to the point where I’m standing in the house or outside, and I feel lightheaded, dizzy, and numbness in my hands and feet. I’m totally scared! I don’t know what to do. I have four daughters, and I want to make sure that I’ll be there for them. Just sometimes, I can’t physically do anything. Can someone help?

  • Judy Davis Clark
    8 years ago

    thanks buddy

  • Jason Hill
    8 years ago

    Vertigo, maybe? Go see the doctor.

  • Donna Elcewicz
    8 years ago

    My 16 year old son has had migraines since age 6. Since seeing the Chiropractor he was able to get off most of his meds and now takes mag, B2, cyproheptadine. 10 days ago he started with severe migraine that has been unbreakable for the most part. Three ER visits and a hospital admission have not really helped. We don’t know where to turn.

  • Donna Elcewicz
    8 years ago

    Hi Sue I found your reiki site:)

  • Susan Clough
    8 years ago
  • Susan Clough
    8 years ago

    do you know anyone who does reiki? Accupuncture? Western medicine does not seem to be helping

  • Diana Lee
    8 years ago

    This is very helpful information. I think there is a lot of confusion about how migraines and other headache disorders are diagnosed, particularly among newcomers to these conditions.

  • Kim Salay Chajkowski
    8 years ago

    Great article, I suffer from Primary and secondary headaches and sometimes it can just be overwhelming…thank you for understanding.

  • Deanna Hoelscher
    8 years ago

    that was informative…most of mine seem to be primary headaches but i do have secondary ones due to bp issues and a spinal issue with my neck.

  • Jennifer Bradley Bundy
    8 years ago

    Interesting article.

  • Migraine.com
    8 years ago

    Dr. Hutchinson provides a summary of primary vs secondary headache including an overview of the “SNOOP” list.

  • Karen Middleton Hewitt
    8 years ago

    Will insurance cover botox for migraines?

  • Tina Maroon
    8 years ago

    Yes botox is what helps me too along with some other things. I have just recently undergone iv infusion therapy too. It has helped alot.

  • Jeff Nelson
    8 years ago

    Botox injections… Research them on Google. It was the only thing that helped my ex-wife.

  • Migravent
    8 years ago

    It can get very frustrating when medications continue to fail…but you’ll eventually find something that works. Keep your head high!

  • De'Anna Barnes
    8 years ago

    So many medicines, so many faliures in treatment, try this med if it dont work then we will try this…it gets old and frustrating!!

  • Migraine.com
    8 years ago

    Hi Teresa – It’s important to know what type of headache you are experiencing since even migraine sufferers can experience other types of headache, such as Medication Overuse Headache. Treatment for these headaches can differ from how you treat a migraine, so proper identification could bring you faster relief! Sometimes it is difficult to do this but following Dr. Hutchinson’s tips can help.

  • Teresa Mcmillan
    8 years ago

    who cares-it’s a migraine-you are taken over by something in your head and it hurts sooo veryyy bad

  • Hollie Carroll-Karp
    8 years ago

    I wake up with a minor headache every morning, then I want to say at least 5 times a month it will turn into a FULL blown migraine. I cant function and my kids suffer for it.. Imitrex is the only thing working right now.

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