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Understanding Primary and Secondary Headaches and Their Treatment

An increasing number of Americans and people from across the globe are reporting cases of headache and chronic facial pain. Primary headaches, such as facial pain and migraine are more common than secondary headaches, which may be due to a tumor or sinusitis. While primary headaches occur for no particular reason, secondary headaches are usually an implication of an underlying disease. In this post, we will discuss both types of headaches and their treatment options, in detail.

Primary Headaches

Most individuals complaining about headache & facial pain have one of the following three primary headache syndromes – migraine, tension or cluster headache.

Migraine Headache

A migraine is a throbbing pain, three times more common in women. Approximately 25 percent patients with symptoms of photophobia, nausea and aura have a classic migraine. The physician mostly prescribes the first-line agents – Nonsteroidal anti-inflammatory drugs (NSAIDs) for acute migraine attacks. If these medicines don’t improve the condition of the patient, specific medication such as dihydroergotamine is prescribed. Individuals suffering from chronic migraine problem might take preventative agents such as anticonvulsants and beta blockers. Triptan agonists can also be used such as imitrex or relpax for active migraines.

Tension Headache

Tension headaches mostly are a bilateral and non-pulsatile, mild to moderate pain. Stress is the most common trigger of a tension headache and physical activity could provide relief to the patient. Anxiety and depression also play an important role in a tension headache. While an analgesic is recommended to treat an acute attack, the physician might prescribe antidepressant medication for frequent tension headache. Counseling and stress management are beneficial to treat the problem.

Cluster Headache

A cluster headache could go on for a few minutes to hours, with the patient encountering several unilateral temporal headaches.There can be unilateral rhinorrhea or nasal drainage. The pain occurs in grouped manner over periods of weeks and months. It is a common problem in men aged 30-40 years. The treatment for acute cluster headache involves oxygen therapy at 7-12 L/min for 15+ minutes or certain anti-seizure medications like carbamezapine.

Understanding Secondary Headache

Primary headaches are more common than secondary headaches, but are not life-threatening. Secondary headaches could lead to serious complications and over 90 percent of the headaches are primary, while less than 10 percent are secondary.

Secondary headaches usually are the result of another disorder and is reduced or resolved within three months of treatment or spontaneous remission of the causative disorder. Head and neck trauma and sinusitis are some common reasons for a secondary headache.

Head and Neck Trauma

Head and neck trauma could lead to different types of headaches and there’s a higher risk of the problem in women and elderly. The common types of head and neck trauma headache are:

  • Post-craniotomy headache
  • A headache because of whiplash injury
  • A headache because of intracranial haematoma

Physicians mostly recommend a symptomatic treatment for a post-traumatic headache as there are no medicines that could alter the underlying disturbances in the patient’s brain. It is always better to consult the doctor to discuss the course of medication.


Sinusitis can trigger underlying migraine headaches. Millions of Americans suffer from acute and chronic sinusitis, which could lead to a severe headache. The patient usually experiences a deep and constant pain in forehead, cheekbones and bridge of the nose. Sudden head movement and straining intensify the pain. Many assume chronic headaches to be sinus headaches, it is, therefore, essential to determine if sinuses are the actual reason behind the pain. If a headache is because of a sinus blockage, the patient is likely to suffer from fever. The physician might recommend CT and MRI scan in some of the cases. The first course of treatment of a sinus headache involves antibiotics, antihistamines such as Benadryl and decongestants. Use of nasal decongestants is recommended only for up to three days. Nasal steroids can also be used to decrease nasal cavity edema.

Last Few Words

The severity of pain is not a differentiator between primary and secondary headaches. If the patient feels that a headache is unusual, rather than taking painkillers and other medication that could do more harm and increase the severity of the problem, it is always advisable to consult a doctor. If you or someone you know has been experiencing headache and chronic facial pain, you may get in touch with the doctors at the My Houston Surgeons for a no-obligation consultation.

We’re here to help

If you are frustrated by frequent sinus infections, persistent nasal congestion, or other sinus symptoms, Dr. Arjuna Kuperan and the team at Houston Advanced Nose & Sinus can help. Contact us today with any questions or to schedule your consultation.

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