What Is a Secondary Headache?

Does your head hurt? If so, you aren’t alone. Headaches are one of the most common health problems. On any day, they affect half of adults worldwide.

Often, they go away on their own, or with the help of acetaminophen or other over-the-counter drugs. Sometimes, though, the pain is so intense or lasts so long, you need to see your doctor.

Two Kinds of Headaches

To figure out what makes your head ache, it helps to know the two major types of this kind of pain.

Primary headaches: With these, the headache is the condition. You know them as tension headaches, migraines, or cluster headaches, among others. They start in the nerves and blood vessels, or face and neck muscles. Triggers include certain foods, alcohol, changes in sleep habits, and stress. Nine in 10 headaches are primary ones.

Secondary headaches: For this type, another disease or condition is the cause. The headache is a symptom. The reasons can range from something as simple as using pain medication too often to a severe problem such as a tumor.

Symptoms

It’s probably a secondary headache if:

  • It’s the worst headache you ever hard.
  • It’s the first headache you ever had.
  • It came on quickly with no warning.
  • The pattern changes.
  • It started before you were 5 or after you were 50.
  • You have cancer or HIV.
  • You’re pregnant.
  • You have another health condition that can bring it on.
  • The headache causes fainting or seizures.
  • You get the headache after you exercise, have sex, or squeeze your body.
  • You’re weak on one side of the body, you pass out, have trouble walking, or have other neurological symptoms that worry you.

If you have any of these symptoms, it’s time to go to the doctor.

Causes of Secondary Headaches

This type of headache is caused by another medical condition. In other words, the headache is a symptom. This can include:

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Types of Secondary Headaches

Post-Traumatic Headache: These usually start 2-3 days after a head injury. You’ll feel:

  • A dull ache that gets worse from time to time
  • Vertigo
  • Lightheadedness
  • Trouble concentrating
  • Memory problems
  • Tiring quickly
  • Irritability

This type of headache could last for a few months. But if it doesn’t get better within a couple of weeks, call your doctor.

Rebound headache: When you overuse pain drugs to treat a headache for too long, it can cause a headache.

Thunderclap headache People often call this the first worst headache of your life. It comes out of nowhere, lasts about 5 minutes, then goes away. Causes of this type of headache include:

  • Blood vessel tear, rupture, or blockage.
  • Head injury
  • Hemorrhagic stroke, which comes from a ruptured blood vessel in your brain
  • Ischemic stroke, which comes from a blocked blood vessel, a blood clot, or plaque
  • Narrowed blood vessels surrounding the brain
  • Inflamed blood vessels
  • Blood pressure changes in late pregnancy

Diagnosis

It can be tricky to tell primary and secondary headaches apart.

To diagnose you, the doctor will first ask you lots of questions. Then she’ll check your vital signs. This includes your blood pressure, heart rate, temperature, and weight. She’ll also look into your eyes. Next, she’ll do a neurological exam of your head, neck, and nervous system. She’ll also look to see if your muscles are strong and reflexes are normal.

Your doctor might also do:

  • Blood tests: These can check for other conditions
  • Imaging tests: They might include:
    • Sinus X-rays: To check for congestion
    • Magnetic resonance imaging (MRI): To make a picture of the inside of your brain
    • Computed tomography scan (CT scan): This also creates an image of your brain.

Other tests may include bloodwork to rule out other conditions or a spinal tap to look for signs of infection or bleeding around your brain.

When to See a Doctor

  • If you have a thunderclap headache. Go to the ER.
  • Your headache changes when you go from standing up to lying down, or vice versa.
  • You get a headache when you cough, sneeze, or strain.
  • It’s a new headache, especially if you’re over 50 years of age, or you have a health condition like cancer or a blood clotting disorder.
  • You have headaches way more often, or they change a lot in other ways.
  • Your headache is always in the same place.
  • You’re weak on one side of the body, you pass out, have trouble walking, or have other neurological symptoms that worry you.
  • The headache never goes away.
  • You have fever, chills, weight loss, or night sweats.

If any of these headache “red flags” are present, your doctor will want to see you.

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How Are Secondary Headaches Treated?

The first step is to treat the cause of your headache. That often makes the pain go away. But your doctor may also address it with over-the-counter or prescription drugs.

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on September 24, 2018

Sources

SOURCES:

American Family Physician: “Approach to Acute Headaches in Adults,” “Evaluation of Acute Headaches in Adults.”

Cleveland Clinic: “Headaches in Adults,” “Headache Treatment: Overview.” 

Headache: “Pearls: Headache.”

Mayo Clinic: “Rebound headaches,” “Sinus headaches.”

American Migraine Foundation: “Headache ‘Red Flags’: When to See Your Doctor,” “Secondary Headaches,” “Thunderclap Headaches,” “When to Go to the Emergency Room for a Headache or Migraine.”

Johns Hopkins Medicine: “Headache.”

Texas A&M University Health Science Center: “Common Causes of Daily Headaches.”

News Release, Johns Hopkins Medicine.

UpToDate: “Evaluation of headache in adults,” “Patient education: Headache causes and diagnosis in adults (Beyond the Basics).”

Kathleen Digre MD, fellow, American Academy of Neurology; president, American Headache Society.

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