Different Presentations of Headaches

The term headache refers to a number of different presentations of discomfort or pain in the head. Headaches may be unilateral (one sided) or bilateral (both sides). The duration and onset may be intermittent, episodic or constant. There are acute types of headaches which come on suddenly and often eases just as rapidly, and chronic headaches which may come on and persist for days or weeks or return frequently at the same spot.

Sometimes concomitant symptoms like nausea, vomiting, nasal congestion, watery eyes, eye pain, dizziness and even jaw or ear pain may be present. Headaches are not as well understood as one may think. There are some types of headaches with definitive causes, while with other types of headaches there may be several hypotheses as to the cause based on known risk factors.

Headache Areas of the Skull

The terms for different anatomical positions can be confusing. A simple way to identify the location of the headache is to look at the position in relation to the parts of the skull, particularly the cranium.

  • Top of the head = parietal; vertex is the top most part
  • Back of the head = occipital
  • Side of the head = temporal
  • Front of the head = frontal

This is a rather simplistic approach which may at times be misleading. For example, the area behind the ear still falls in the temporal region and not occipital. Whereas some may argue that the upper parts of the back of the head is the occipital region, it may actually be the parietal region. However, a basic understanding of the anatomical terms when discussing the location of pain is helpful.

In some cases the exact location of the pain cannot be identified. Patients will report that the pain is “everywhere” or on the “entire head”. This is known as a generalized headache. This term can sometimes be used for headaches where patients describe a halo type of headache around the head or a band running around the head. Another complaint is that the headache involves the entire head with certain parts being worse than others. This too can be considered as a generalized headache although the area with the most intense pain may provide a better indication of the cause.

Parts of the Human Skull (Picture from Wikimedia Commons)

Location in Different Types of Headache

Determining the type of headache depends on multiple factors apart from the location. The guide below is intended to indicate the most common location of pain in the different types of headaches and is not a diagnostic guide.

Tension-Type Headache

  • Pain radiates from back (occipital) to front (frontal).
  • Duller pain on parietal region with pressure on the vertex.
  • Pain like a band around the head.
  • May be accompanied by neck pain or stiffness.

Cluster Headache

  • Often one-sided (unilateral) pain.
  • Typically involves pain around or behind the eye on the affected side.
  • May be be accompanied by pain at the bridge of the nose, or on the affected side of the nose.

Migraine

  • Pain tends to affect one half of the head (unilateral) but can occur on both sides (bilateral).
  • Location may vary but often occurs on the frontotemporal region (frontal + temporal or front + side).

Ice Pick Headache

  • Pain can occur anywhere and even the location may change during attacks.
  • Tends to occur on the temporal (sides) or parietal (top) regions.

Cold-Stimulus Headache (Brain Freeze / Ice Cream Headache)

  • Affects the temporal region on both sides (bilateral / bitemporal)
  • May occur around or even behind the eye on one or both sides (unilateral / bilateral)

Chronic Paroxysmal Hemicrania

  • Pain may affect one half of the head.
  • Tends to be more prominent on the temples (temporal) and around the eye (periorbital).

SUNCT Headache

Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing

  • Pain typically around the eyes (periorbital).

Headache with Cough, Exertion, Intercourse

  • Pain tends to occur at the back of the head (occipital), on top of the head (parietal) or is generalized.

Headache Pain Based On Location

Headache Pain on the Top of the Head

  • Tension-type headache
  • Ice pick headache
  • Cough headache
  • Exertional headache
  • Coital (intercourse) headache

Headache Pain at the Back of the Head

  • Tension-type headache
  • Cervicogenic headache
  • Cough headache

Headache Pain on the Sides of the Head

  • Migraine
  • Ice pick headache
  • Cold-stimulus headache (brain freeze)
  • Chronic paroxysmal hemicrania

Headache Pain at the Front of the Head

  • Tension-type headache
  • Migraine
  • Eye strain
  • Sinusitis

Headache Pain Behind or Around the Eyes

  • Cluster headache
  • Chronic paroxysmal hemicrania
  • Cold-stimulus headache
  • SUNCT

 


Article reviewed by Dr. Greg. Last updated on December 4, 2011