Classification (types) of headache

Over the years, various classifications of headaches have been proposed, but some of them did not satisfy clinicians, while others did not satisfy scientists studying the pathophysiological mechanisms of the occurrence and development of cephalgia.

In 1988, the International Headache Society proposed a universal classification, which became the most convenient not only for specialists, but also for doctors of any profile. It covers a large list of diseases in which one of the leading symptoms is headache. This allows it to include syndromes that are not specifically identified, but accepted in domestic practice, for example, vegetative-vascular dystonia (VVD), myofascial pain, which can be a frequent cause (companion) of headache.

There are primary and secondary types of headaches:

1. Primary headaches are independent nosological forms, which include migraine, cluster headaches, chronic paroxysmal hemicrania and muscle tension headaches.
2. Secondary or symptomatic headaches caused by any disease (traumatic brain injury, vascular pathology of the brain, tumors, etc.).

Other classifications are also of great interest. L.O. Badalyan et al. (1991) propose to distinguish four groups of headaches:

1. acute;
2. acute recurrent;
3. chronic progressive;
4. chronic non-progressive.

This division allows us to characterize headaches according to a time criterion (over a period of life).

In practical terms, the pathogenetic classification of headaches is very relevant, linking the type of headache with the leading pathophysiological mechanism. According to this classification, the following types of headaches are distinguished:

1. vascular headache;
2. muscle tension headache;
3. cerebrospinal fluid dynamic headache;
4. neuralgic headache;
5. mixed headache;
6. psychogenic headache.

Some of these headache types are divided into a number of subtypes based on the underlying pathophysiological mechanism.

These classifications are given for the following reasons. If we are talking about diagnosis, it is necessary to use the generally accepted international classification. To select the method and tactics of treatment, it is advisable to distinguish types of headaches by pathophysiological mechanism and nature of the course (time criterion).

Classification of headaches

No.	Category	Characteristic	Frequency of occurrence in primary care
1	Migraine	With aura, without aura	Widespread (may not be noticed during diagnosis)
2	Tension headache (tension headache)	Acute, chronic	The most widespread (the diagnosis can be made even in its absence)
3	"Histamine" - cluster headache and chronic paroxysmal hemicrania	Occurs episodically, chronic	Very rarely
4	Miscellaneous headaches not associated with structural lesions	Cough, physical exertion, sexual intercourse (orgasmic), external pressure, cold	Rarely
5	Associated with head trauma	Acute, chronic	Frequency of occurrence is variable
6	Associated with dysfunction of the vascular system	IHD or stroke, subdural hematoma, epidural hematoma, subarachnoid hemorrhage, arteriovenous malformation, hypertension	This condition is not usually characterized by headache alone.
7	Associated with intracranial disorders that do not affect the functioning of the vascular system	High or low cerebrospinal fluid pressure, infection, tumor	Rarely
8	Associated with the abuse of drugs, narcotic substances or their sudden absence (abuse)	Iatrogenic disease, carbon monoxide, alcohol and drug withdrawal syndrome	Frequency of occurrence is variable, infrequent (may not be noticed during diagnosis)
9	Headaches caused by extracerebral infections	Viral, bacterial and other infections. Systematically, centrally	Frequency of occurrence is variable, widespread
10	Associated with metabolic disorders	Hypoxia, hypercapnia, hypoglycemia	It is not common
11	Associated with diseases and structural abnormalities in the structure of the head and neck	Diseases of the skull, neck, eyes, ears, nose, sinuses, teeth, oral cavity or other facial or cranial structures	Very widespread
12	Neuralgia and related health conditions	Neuropathy, shingles, cranial neuralgia	It is not common enough to be considered a "headache"
13	Cases that defy classification	Cases of "mixed" and non-traditional type	Widespread distribution

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