Not All Headaches Are the Same
Understanding the Most Common Types and When Osteopathy May Help
What Is a Headache?
Headaches are one of the most common reasons people seek healthcare, affecting people of all ages and lifestyles. Although many people simply describe their symptoms as "a headache", headaches are actually a large and diverse group of conditions with different causes, symptoms and management strategies.
The International Classification of Headache Disorders (ICHD-3), developed by the International Headache Society, contains an extensive classification of headache disorders with hundreds of recognised diagnoses and subtypes. Fortunately, most people will never experience the vast majority of these. In everyday clinical practice, healthcare professionals are far more likely to assess a relatively small group of well recognised headache disorders, which are the focus of this article.
Understanding what type of headache you're experiencing is important because not all headaches are managed in the same way. Some headaches arise from neurological processes, while others may be related to the neck, jaw, sinuses or another underlying medical condition. This is why an accurate diagnosis is often the first step towards appropriate management.
Primary vs Secondary Headaches
Before discussing individual headache types, it helps to understand the difference between primary and secondary headaches.
Primary headaches
Primary headaches are conditions in their own right. In other words, the headache itself is the disorder rather than being caused by another underlying condition. The three most common primary headache disorders are:
• Migraine
• Tension-type headache
• Cluster headache
Although these headaches can be extremely painful and significantly affect quality of life, they are not caused by structural problems in the neck, brain or surrounding tissues. Each has its own characteristic pattern of symptoms and treatment approaches.
Secondary headaches
Secondary headaches occur because of another underlying condition. Some are relatively minor and self limiting, while others require prompt medical assessment.
Examples include headaches associated with:
• Disorders of the cervical spine (cervicogenic headache)
• Temporomandibular disorders (jaw dysfunction)
• Sinus disease
• Medication overuse
• Dehydration
• Hormonal changes
• Infection (such as meningitis)
• Raised intracranial pressure
• Cervical artery dissection and other vascular disorders
One of the most important parts of any healthcare assessment isn't simply identifying what treatment may help—it's recognising when a headache may represent something outside the clinician's scope and requires referral for further medical investigation. This is particularly important when headaches present with unusual features, rapidly changing symptoms or neurological signs.
Understanding Some of the Different Types of Headaches
Although there are hundreds of recognised headache disorders within the International Classification of Headache Disorders (ICHD-3), most people seeking care in general practice or musculoskeletal clinics present with a relatively small number of common headache types. While some have distinct features, there is often overlap between different headache disorders, which is why a thorough assessment is important rather than relying on symptoms alone.
Migraine
Migraines are much more than "just a bad headache." They are considered a primary headache disorder and can significantly impact a person's ability to work, exercise and carry out everyday activities.
Although our understanding of migraines has improved considerably over the past few decades, the exact mechanisms responsible are still not fully understood. Current research suggests migraines arise from complex interactions within the nervous system, involving altered pain processing and changes in how the brain responds to certain triggers, rather than simply being caused by changes in blood flow as was once thought.
A migraine commonly presents as a moderate to severe throbbing or pulsating headache, often affecting one side of the head, although both sides can be involved. Many people also experience nausea, vomiting, sensitivity to light (photophobia) and sound (phonophobia), while some experience visual or sensory disturbances known as an aura before the headache begins. Attacks typically last between 4 and 72 hours
and may be triggered by factors such as poor sleep, stress, hormonal fluctuations, dehydration or certain foods.
Can osteopathy help?
Because migraine is a complex neurological condition, osteopathic treatment isn't aimed at treating the underlying disorder itself. However, where associated neck stiffness, jaw dysfunction or muscle tension are contributing to a person's overall symptom burden, osteopathy may play a role as part of a broader multidisciplinary management plan.
Tension-Type Headache
Tension-type headaches are the most common primary headache disorder worldwide. They are often described as a dull, pressing or tightening sensation rather than a throbbing pain, with many people comparing the feeling to a tight band wrapped around the head.
Unlike migraines, tension-type headaches are usually mild to moderate intensity, commonly affect both sides of the head and are not typically aggravated by routine physical activity. While some people may have mild light or sound sensitivity, nausea and vomiting are generally absent. Episodes may last anywhere from 30 minutes to several days.
Can osteopathy help?
Where musculoskeletal factors appear to be contributing, osteopathic management may include education, exercise and hands-on treatment as part of an individualised treatment plan.
Cervicogenic Headache
Unlike migraines and tension-type headaches, a cervicogenic headache is classified as a secondary headache because it arises from structures within the cervical spine.
People commonly describe pain beginning in the upper neck or base of the skull before spreading towards the temple, forehead or around one eye. Symptoms are often one-sided, and neck movement or sustained neck positions may reproduce or aggravate the headache. Reduced neck mobility is also commonly present.
One important point to remember is that neck pain doesn't automatically mean someone has a cervicogenic headache. In fact, many people with migraine experience neck pain or stiffness before and during an attack. This overlap is one reason headaches can sometimes be difficult to diagnose and why healthcare professionals look at the entire clinical picture rather than relying on one symptom alone.
Can osteopathy help?
Because cervicogenic headaches originate from the cervical spine, osteopathy may play an important role in addressing contributing musculoskeletal factors through education, exercise and hands-on treatment where appropriate.
Cluster Headache
Cluster headaches are much less common than migraines or tension-type headaches but are among the most severe headache disorders.
The pain is typically extremely intense, occurring around one eye or temple, and is often accompanied by symptoms such as tearing, redness of the eye, a blocked or runny nose, eyelid drooping or facial sweating on the affected side. Attacks generally last between 15 minutes and 3 hours and often occur in clusters over weeks or months, sometimes waking people from sleep.
Can osteopathy help?
Cluster headaches require medical diagnosis and management. Osteopathy may assist with co-existing musculoskeletal complaints but is not considered a primary treatment for the headache disorder itself.
Temporomandibular Disorder (TMD)-Related Headache
Not all headaches originate from the head or neck. In some people, pain may be associated with dysfunction of the temporomandibular joint (TMJ) or the muscles involved in chewing.
People with TMD-related headaches often report pain around the temples, jaw or ears, sometimes accompanied by jaw clicking, locking, difficulty chewing or tenderness through the jaw muscles. Symptoms may be aggravated by chewing, clenching or grinding the teeth.
Can osteopathy help?
Where jaw dysfunction is contributing to symptoms, osteopathic management may focus on the jaw and surrounding musculoskeletal system, often alongside collaboration with a dentist or GP when appropriate.
Can Neck Pain Cause a Headache?
One of the most common questions we hear in the clinic is, "Can my neck actually be causing my headaches?" The short answer is sometimes—but not always.
The relationship between the neck and headaches is often more complex than people realise. For example, cervicogenic headaches genuinely originate from structures within the cervical spine, meaning the neck is considered the source of the headache. However, many people with migraines also experience neck pain or stiffness before or during an attack, even though migraines are thought to arise from complex neurological processes rather than a problem originating in the neck itself.
This overlap highlights why headaches shouldn't be diagnosed based on location alone. Just because your pain starts at the base of your skull or your neck feels tight doesn't necessarily mean you have a cervicogenic headache. Likewise, having neck pain doesn't automatically mean your neck is the cause of your symptoms.
Instead, healthcare professionals consider the entire clinical picture. This includes the pattern of symptoms, what aggravates or eases the headache, how long episodes last, associated symptoms such as nausea or light sensitivity, and findings during the physical examination. Looking at all of these factors together allows clinicians to make a much more accurate diagnosis than relying on any single symptom in isolation.
When Should You Seek Urgent Medical Attention?
Fortunately, the vast majority of headaches are not caused by serious underlying disease. However, there are certain situations where a headache should be assessed urgently by a medical professional.
Seek immediate medical attention if you experience:
• A sudden, severe headache often described as the "worst headache of your life." • A headache following significant head or neck trauma.
• A headache associated with fever, neck stiffness, rash or confusion.
• New weakness, numbness, difficulty speaking or vision changes.
• Persistent vomiting, altered consciousness or seizures.
• A progressively worsening headache that is different from your usual pattern.
• A new severe headache associated with sudden neck pain, particularly following trauma or unusual neck movement.
These symptoms may indicate conditions such as infection, bleeding, vascular disorders or other neurological conditions that require urgent medical assessment. They are outside the scope of osteopathic management and should not be ignored.
How Can Osteopathy Help?
The role of an osteopath isn't simply to provide hands-on treatment—it's to help determine whether musculoskeletal factors may be contributing to your symptoms and whether osteopathic care is appropriate in the first place.
A comprehensive osteopathic assessment may include discussing your headache history, screening for red flags, assessing movement of the neck, jaw and upper back, evaluating muscle tenderness and considering lifestyle factors such as sleep, stress, work habits and physical activity.
If your presentation appears to have a significant musculoskeletal component, management may include a combination of hands-on treatment, exercise rehabilitation, education and advice aimed at improving movement, reducing contributing factors and helping you return to your normal activities.
Equally important is recognising when osteopathy is not the most appropriate management option. If your symptoms suggest a headache requiring further medical investigation or specialist care, referral to your GP, neurologist, dentist or another healthcare professional may be the most appropriate course of action. Good
healthcare isn't just about knowing what to treat—it's also about recognising when referral is in your best interests.
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Written By Dr. Matthew Keys (B.Sci(Osteo), M.H.S (Osteopathy)) - Associate Osteopath, Osteopathic Movement, South Yarra.
References
Headache Classification Committee of the International Headache Society. (2018). The International Classification of Headache Disorders (3rd ed.). Cephalalgia, 38(1), 1–211.
International Headache Society. (2024). ICHD-3: International Classification of Headache Disorders.
National Institute for Health and Care Excellence. (2021). Headaches in over 12s: diagnosis and management (CG150).