Tension-type headaches or TTHs are the most common type of headaches and are often self-treated, and are different from migraines . TTH occurs in roughly 68% of men and more than 88% of women in the United States. They are more likely to occur in a patient’s 30s, particularly in higher educated Caucasians. Symptoms of Tension-Type headaches Tension-type headaches are defined as pain in the head, scalp, neck or even shoulders. THH can last anywhere from 30min to up to 7 days. The pain has been described as a relentless tightening, occurring on both sides of the body, especially in the forehead, temples or back of the head. These pains are often dull and result in a sensitivity to touch the areas experiencing pain. This pain is typically mild to moderate and is unaffected by physical activity. These headaches may be accompanied by discomfort related to light (photophobia) or sound (phonophobia). Causes of Tension-Type headaches Tension-type headaches are caused by tension or tightness of the muscles in their areas. TTH is associated with chronic muscle issues. It is believed that people that experience TTH may be more sensitive to pain in the muscles around the head. However, CTTH is thought to be due to dysfunction of pain regulation by the central nervous system.

Pain experienced across the face or near the eyes in response to nasal congestion is considered to be a sinus headache. These headaches are typically accompanied by a stuffy nose, the pressure in the face, teary eyes, nausea or hyperresponsiveness to light. However, because there is no clear definition of sinus headaches, these headaches are often misdiagnosed as migraines. Sinus headaches are more common during major changes in the weather. What are Sinus Headaches? Sinus headaches are considered a response to inflammation or infection that should be verified by imaging and treated with antibiotics. Surprisingly, headaches are not symptoms of chronic sinus inflammation (sinusitis) unless there is also an infection present. Misdiagnosis of Sinus Headaches These headaches are often confused with migraines as the symptoms may be similar . Most patients self-diagnose and treat these “sinus headaches” with irrelevant treatments. Unfortunately, due to the high level of misdiagnosis of sinus headaches as migraines, these patients risk making their headaches worse. Even many physicians misdiagnose sinus headaches as migraines. Not surprisingly, many patients are dissatisfied with the treatments available for sinus headaches, likely due to misdiagnosis followed by ineffective treatment.

A rare headache that is often confused with tension headaches is new daily persistent headaches or (NDPHs). This type of a headache is relatively new. It was described in 1986 by Dr. Vansat. These are headaches that occur every day continuously for at least 3 months. Causes of New Daily Persistent Headaches The cause of NDPH is not well-defined. NDPH develops suddenly and in people that do not have a history of headaches. About 1 in 3 people experience an extreme illness such as influenza prior to its development. Another smaller subset underwent a stressful event or surgery prior to NDPH. However, 50% did not have a specific cause for the pain. Symptoms of  New Daily Persistent Headaches NDPHs occur anywhere on the head on both sides. Half of NDPHs have migraine characteristics such as hypersensitivity to light and noise and nausea . The other half is similar to tension-type headaches. Despite their differences, there is little that can be done to treat the pain for either NDPH. Most patients develop NDPH in their mid-thirties. Women are twice as likely to develop a headache as men. Testing for Other Causes Most testing surrounding NDPH is done to rule out any specific cases or more severe illnesses from which the headaches may have arisen, specifically brain damage or bleeding is examined using various imaging techniques.

Extended use of medication to treat pain can actually make headaches worse. Though less common than migraines , the effects can be even more harmful and affect the quality of life and performance of normal daily activities. These headaches are also very expensive to treat. Medication overuse headaches are headaches that occur more than 15 days per month along with overuse (if medication is taken more than 10 or 15 days per month) of a pain medication for more than 3 months. People that experience medication overuse headaches These headaches typically do not occur in individuals taking medication for chronic pain in other areas of the body. Most patients have a pre-existing headache disorder and take medication to relieve the headache pain specifically. Nearly 63 million people globally suffer from medication overuse headaches. It also is more likely to occur in women than in men in most countries. Medications that cause medication overuse headaches The most common culprits of these specific headaches are over the counter pain medications, specifically paracetamol and ergotamine. Headaches from overuse of triptans and NSAIDs are also on the rise. Although headaches do not appear to result from opioid use, they are not recommended to treat headache pain as it can change episodic headaches into chronic headaches.

Cluster headaches are defined as short (15-180 min), unilateral, intense headaches occurring around or above the eye or along the sides of the head behind the ears. These can occur up to 8 times a day. These headaches get their name from the fact that they occur or cluster around the same time of the day. Like with most headaches, there is an episodic form and a chronic form. The episodic form will typically occur over a few days or a few weeks and then resolve on its own. Although rare, chronic cluster headaches have occurred and experience these headaches daily. The pain is so intense that it often wakes patients that experience them at night from their sleep. Defining characteristics Patients with these headaches experience 5 headaches with the following conditions on the same side of the head as the pain: redness or tearing up of the eye on the same side, nasal congestion, swollen eyelid, facial sweating and pupil constriction and/or eye drooping. The pain is mostly experienced around the eye or along the sides of the head. However, it can also be experienced in the upper teeth. Jaw, forehead, or cheek for 50% of the time. It has also been reported to occur in the ears, lower jaw, neck and shoulders.