What Is the Difference Between a Primary and Secondary Headache?

There is a wide variety of reasons you may develop a headache, from headache disorders to medicine side effects to symptoms of other health issues. Experts divide headaches into two categories: primary and secondary.1

Primary headaches are caused by a headache or head pain conditions. Secondary headaches are a result of other conditions or disorders. Migraine is considered a primary headache.1

What are primary headaches?

Primary headaches happen when the pain receptors in and around your brain are overstimulated. This can involve chemicals that send signals in your brain (neurotransmitters), blood vessels in your head, or the muscles of your head and neck.1

The most common primary headache types are:1,2

  • Migraine (with or without aura)
  • Cluster headache – A form of trigeminal autonomic cephalalgia. These are very intense headaches that affect only one side of the head, usually around one eye.
  • Tension headache – These are caused by tension in the muscles that wrap around the neck and skull.

Some primary headaches can also be triggered by lifestyle or environment. For example, many people with migraine report triggers like certain foods, alcohol, stress, or lack of sleep.1

What are secondary headaches?

A secondary headache is a symptom of another disorder. These can be caused by a wide variety of conditions such as:2

  • Infections, including sinus infection or meningitis (an infection of the linings around the brain)
  • Head trauma
  • Vascular issues, including blood clots or tearing of an artery
  • Pressure on the brain, including collections of fluid or solid tumors
  • Lifestyle factors, including those that lead to dehydration or hangover

Other secondary headaches include medicine overuse headaches and spinal headaches. The first happens when you use pain medicine too often so you develop a headache when you take more pain medicine. These headaches often stop when you stop taking the medicine.1

Spinal headaches are caused by low cerebrospinal fluid (CSF) levels. CSF floats around your brain and spinal cord. In rare cases, people develop a CSF leak after a spinal tap procedure or spinal anesthesia (like an epidural).1

How can I tell the difference?

It is important to focus on what your headaches feel like, what triggers them, and how often they happen. Your doctor will likely ask you many questions about these factors.2

They will also ask whether you have any other symptoms and what your lifestyle is like. They also may ask if anyone else in your family has had headaches. This information can help your doctor determine what is causing your headache.2

When should I talk to my doctor?

You should always call your doctor if you are concerned about what you are feeling. If headaches are affecting your quality of life, it is important to speak to your doctor right away. There are also some general “red flags” to look out for. These include:2

  • A new headache in an older person, particularly if they do not have a history of headaches
  • A change in function such as slurred speech, blurry vision, or loss of consciousness
  • A headache that feels different from your usual headaches
  • Associated symptoms like fever, rash, or a stiff neck
  • A headache that started after coughing, exercising, or bearing down on the toilet
  • A headache while you are pregnant or within the first 6 weeks after giving birth
  • A sudden, severe headache

Each of these situations may signal a concerning cause for your headaches that needs medical treatment.

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