Headaches are extremely common. Over one third of men and one half of women experience tension-type headaches. One in seven adults experience migraines. Headache disorders are frequently disabling. Headaches require accurate diagnosis and then appropriate treatment.


The International Headache Society classifies headaches into:

  1. The Primary Headaches:
    • Migraine (with or without aura)
    • Tension-Type Headache (Tension Headache)
    • Trigeminal Autonomic Cephalalgias (Cluster headache, Hemicrania, SUNCT, etc.)
    • Other primary Headache disorders:
      • Including: Thunderclap headache, Primary exercise headache and New Daily Persistent Headache among others
  1. The Secondary Headaches are those associated with:
    • Trauma or injury to the head and/or neck (whiplash, head injury)
    • Cranial or Cervical vascular disorders
    • Non-vascular intracranial disorders
    • Substance use or withdrawal
    • Infection
    • Disorders of blood clotting
    • Other disorders of the head, neck, mouth and sinuses
    • Psychiatric disorders
  2. Other Painful cranial neuropathies and other facial pains (neuropathic pain):
    • Trigeminal neuralgia
    • Occipital neuralgia
    • Burning mouth syndrome
    • Central post-stroke pain

This classification system is useful for researchers and medical specialists but may not be of use to the sufferer who just knows they are in pain.


Signs and Symptoms

Pain can be felt in the back of the head (occiput), the top of the head (vertex), the front of the head, the temple region, behind one or both eyes, or a combination of these. The pain may be isolated to the face or part of the face or scalp or associated with neck pain and tension. Some types of headache are associated with other symptoms such as nausea, vomiting or can be preceded by an aura. The pain may be affected by coughing, sneezing or many day-to-day activities. It is important to identify if there are associated “red flag” features such and altered consciousness, fever or loss of power down one side of the body.

Some headaches may be associated with pathologies in the neck like whiplash or facet joint arthritis. This can be known as cervicogenic headaches. Some migraine sufferers will respond to modern techniques like botulinum toxin injection therapy or minimally invasive surgery such as spinal cord stimulation.



By the time a headache sufferer has been referred to a specialist pain management service they have often suffered for many years and have tried many therapies. However, they should not give up hope as new approaches to pain and new applications of old therapies are available.

When a headache becomes chronic or is too severe to live with, you may need some help from the specialists at QPain.

Headache treatment may involve:

Often the best treatment is a combination of all of these and can be termed multimodal or multidisciplinary treatment. You may benefit from involvement in a pain management program to improve quality of life and function. QPain specialists can arrange a program for you.