Headaches – Beyond the 3rd Type

Part 4 of a 4 Part Series by Maryland Pain and Wellness

Headache disorders are recognized throughout the medical community and organizations as disorders that effect a large number of people. This series about headaches began with a World Health Organization list of the four types of headaches that are the most common throughout the world. There is a consensus among researchers, scientists, physicians, and organizations that the migraine, tension type headaches (TTH), and cluster headaches rank among the top three. The disagreements begin when trying to fill the fourth spot in a list of four. 

Number 4 on the WHO list of headache types is medication overuse headache (MOH). WebMD puts Less Common Headaches on their list and uses the category to detail headaches that include:

• Sinus Headaches – “With sinus headaches, you feel a deep and constant pain in your cheekbones, forehead, or on the bridge of your nose. They happen when cavities in your head, called sinuses, get inflamed.”
• Posttraumatic Headaches – the result of a head injury
• Exercise Headaches – “the muscles in your head, neck, and scalp need more blood. Your blood vessels swell to supply them. The result is a pulsing pain on both sides of your head that can last anywhere from 5 minutes to 48 hours.” 1
• Hemicrania Continua – According to Cleveland Clinic – “Hemicrania continua is a headache disorder. It causes constant pain in one side of the face and head. Unlike other headache disorders, environmental or lifestyle factors don't trigger hemicranial headaches” 

On each list there are a mini list after the top three headache types which normally include migraine, TTH, and cluster headaches. Harvard Health Publishing an outlet of Harvard Medical School adds, the “ice cream headache” and the high blood pressure headache. These two are at opposite ends of the spectrum as far as seriousness, the ice cream headache is fleeting, while the blood pressure headache needs treatment and constant monitoring. 

Watch, Warning, or Action List

Each type of headache comes with its own particular pain. The pain threshold of every individual is unique to themselves. While some can bear pain and continue with daily life others cannot. Even when a pain is bearable and does not interrupt daily routine it needs to be on the watch list for changes and effects. Going back to the number 4 headache type on the WHO List, overusing medications can cause a new pain in the form of the medication overuse headache (MOH). 

Other than the fleeting headache like the ice cream headache where cause and effect is obvious, pain from other types of headaches that are more than occasional should be evaluated by a Pain Management Physician. Skilled at diagnosing, pinpointing, and treating pain the Pain Management Specialist can interpret signs that put pain on the watch, warning, or action list. 

A headache is the body speaking out like the extreme weather warning that interrupts programming. The pain of a headache is interrupting daily life for a reason. It could be minor, or it could be serious. 

In April 2022 there are two new additions to the list of headaches that need attention. Both a result of SARS-CoV-2 and are both clinically similar and dissimilar. The COVID Headache is a symptom of the disease while it is active infecting the body. The Long Covid Headache is occurring after recovery and has become a chronic source of pain for some who have recovered from COVID. More patients are presenting to the Pain Management Doctor with distinct types of long COVID headaches.