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  • Writer's pictureByon8 Team

Headache among adults: The basics and beyond

Updated: Mar 17, 2022

Author: Blaise Ntacyabukura, MD, MMedSc

First and foremost, headaches are very common and can be primary or secondary. A primary headache is a result of problems with pain-sensitive structures in the head, while a secondary headache is a result of an underlying disease. Even though the pain from primary headaches could be disabling, it is not dangerous as the secondary headaches. So, how would you know that you are having a primary or a secondary headache? This article will describe the main characteristics of primary and secondary headaches, their risk factors, and some tips on how to approach each.

Primary headaches:

As the table below illustrates, nearly 90 percent of all primary headaches fall under the following categories: Migraine, Tension-type, and Cluster headache.


Migraine headache

Tension headache

Cluster headache


On one side in 60 to 70%, forefront or generalized in 30%

Both sides

Always on one side, usually begins around the eye or the temple


Gradual in onset; throbbing; moderate or severe intensity; aggravated by routine physical activity

Pressure or tightness which periodically change in intensity

  • Pain begins quickly, reaches maximum intensity within minutes;

  • Pain is deep, continuous, excruciating, and explosive in quality


4 -72 hours

30 minutes to 7 days

15 minutes to 3 hours

Other symptoms

  • Nausea, vomiting, fear of light, fear of noise, low productivity at work/study;

  • Patient may have an aura (usually visual, but can involve other senses or cause speech or weakness).


Shedding tears on the same side as the pain, with red eyes; stuffy nose; free discharge of a thin nasal mucus; sweating; restlessness or agitation; sensitivity to alcohol


  • Migraine is a disorder of recurrent attacks. It is triggered by factors such as stress, menstruation, visual stimuli, weather changes, fasting, wine, and sleep disturbances.

  • Tension-type headache attack is often mild to moderate intensity and occurs without other symptoms. No specific triggers have been described.

  • Cluster headache makes severe attacks very often, one lasting between 15 to 180 minutes. Cluster headache may sometimes be confused with a life-threatening headache since the pain from a cluster headache can reach full intensity within minutes. However, cluster headache is transient, usually lasting less than one to two hours.

A primary headache usually responds to regular pain killers such as Panadol or acetaminophen.

Secondary headache

Secondary headaches are caused by an underlying condition. As discovering an underlying condition could be challenging, our doctor will explore many factors including the few mentioned below:

  • Age at onset

  • Frequency, intensity, and duration of an attack

  • Number of headache days per month

  • Time and mode of onset

  • Quality, site, and radiation of pain

  • Associated symptoms and other abnormalities

  • Family history of migraine

  • Precipitating and relieving factors

  • Exacerbation or relief with change in position (eg, lying flat versus upright)

  • Effect of activity on pain

  • Relationship with food/alcohol

  • Response to any previous treatment

  • Review of current medications

  • Any recent change in vision

  • Association with recent trauma

  • Any recent changes in sleep, exercise, weight, or diet

  • State of general health

  • Change in work or lifestyle (disability)

  • Change in method of birth control (women)

  • Possible association with environmental factors

  • Effects of menstrual cycle and exogenous hormones (women)

  • Blood pressure and pulse

  • Examination to listen for bruit at neck, eyes, and head

Danger signs:

The following features can serve as warning signs of possible serious underlying disease. Thes red flags listed below are worth to be noted and exa


  • Systemic symptoms include fever

  • History of any form of cancer

  • Decreased consciousness)

  • A sudden or abrupt onset

  • Older age (onset after age 50 years)

  • Positional headache

  • Precipitated by sneezing, coughing, or exercise

  • Pregnancy or puerperium

  • Painful eye with the shedding of tears

  • The post-traumatic onset of headache

  • HIV

  • Painkiller overuse

You need an emergency evaluation if;

  • You have a thunderclap or explosive headache, defined as a very severe headache of sudden onset (ie, that reaches maximal intensity within a few seconds or less than one minute after the onset of pain)." Thunderclap headache requires urgent evaluation as such headaches may be announcers of bleeding in the brain.

  • You have a new onset of neck pain associated with weakness of one part of the face.

  • You have a severe headache with fever, confusion, with or without neck pain.

  • Your headache with associated with paralysis with or without nausea and vomiting

  • Your headache is associated with visual impairment.

Secondary headaches require evaluation with medical professionals since pain killers could only address the consequences and not the cause which is the underlying condition. For an instant, affordable, and most secure consultation with medical doctors, use the BYON8 platform, the service is available 24/7.

Until next time – Stay safe


[1] Secondary Headache Syndromes

[2] The International Classification of Headache Disorders, 3rd edition. (2018).

[3] The American Migraine Study II

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