Two Common Types of Headaches

The two commonest type of headaches seen in clinical practice are migraine and tension headache. There are other causes of headache that may be caused by underlying structural issues in the brain or by other physiological issues affecting the structures of the brain.

Understanding Different Types of Headaches

Headaches are broadly classified into two categories.

Primary Headaches

Primary headaches are not caused by another underlying medical condition and include:

• Migraine
• Tension-type headache
• Cluster headache

These are common neurological disorders that are often managed with medication, lifestyle modifications, and preventive strategies.

Secondary Headaches

Secondary headaches occur because of an underlying condition. Although less common, they require careful evaluation to identify and treat the underlying cause.

Potential causes include:

• Brain aneurysm
• Brain arteriovenous malformation (AVM)
• Stroke and other cerebrovascular conditions
• Dural arteriovenous fistula (DAVF)
• Raised intracranial pressure
• Infection or inflammation
• Other neurological disorders

Migraine or Something More Serious?

Migraines are one of the most common causes of recurrent headaches and are usually not related to structural abnormalities of the brain. However, some symptoms can overlap with those seen in certain neurovascular conditions, leading many patients to wonder whether their headaches could be related to a brain aneurysm or another underlying vascular abnormality.

Although migraines do not cause brain aneurysms, a sudden change in headache pattern, a “worst-ever” headache, or headaches accompanied by neurological symptoms should be medically assessed to exclude more serious conditions.

A detailed assessment considers:

• Your headache pattern and duration
• Associated neurological symptoms
• Medical history and risk factors
• Whether brain imaging is appropriate

Headache Assessment

Assessment of headache involves a detailed clinical assessment including history and physical examination. This is followed by imaging scan such as MRI/MRA which in most cases is done to exclude any structural cause of headache. MRI scan does not involve any radiation or contrast injection with no side effects and high degree of accuracy. In some cases, a cerebral angiography may be required to diagnose blood vessel conditions such as brain aneurysms and vascular abnormalities under the specialist care of Dr Manish Taneja.

Medical Management of Headaches

Understanding the Cause of Your Headache

Effective headache management begins with understanding the possible cause. Where appropriate, assessment and imaging may be used to identify or exclude an underlying structural or neurovascular cause, such as a brain tumour, brain aneurysm or other abnormalities affecting the brain or blood vessels.

Many headaches, however, are not caused by an underlying structural problem. These may include migraine, tension-type headaches and other primary headache disorders. Once the underlying cause has been assessed, treatment can be tailored according to the type, frequency and severity of the headache.

Medical treatment generally involves two approaches: acute treatment to relieve symptoms when a headache occurs and preventive treatment to reduce the frequency or severity of recurrent headaches.

Acute Headache Treatment

Acute medications are used to help relieve pain and associated symptoms during a headache episode. Depending on the type and severity of the headache, these may include Panadol (paracetamol), anti-inflammatory medications such as Arcoxia® (etoricoxib) and other prescribed medications where appropriate. Medication may also be used to manage associated symptoms such as nausea.

Preventive Headache Treatment

For patients with frequent, recurrent or severe headaches, preventive treatment may be considered to help reduce the frequency, severity or duration of future episodes. The most appropriate medication and management plan will depend on the type of headache, symptom pattern and individual clinical circumstances.

Personalised Headache Management

The management of headaches should be based on an accurate diagnosis. At the Supreme Vascular and Interventional Clinic, the assessment may begin by identifying whether symptoms could be associated with an underlying structural or neurovascular condition. Where a structural cause is not identified, patients with primary headache disorders such as migraine or tension-type headaches may require medical management, preventive strategies or referral to the appropriate specialist. This approach helps ensure that treatment is directed towards the underlying cause and type of headache, rather than simply focusing on temporary symptom relief.

Treatment Options

Most patients presenting with headache are managed medically with excellent response to treatment. There are various over the counter and prescription based medication available both for treating acute episodes of headache as well as to prevent episodes of severe headache. Newer injection based treatments given to prevent headache on a monthly or 3-4 monthly basis have added another dimension to treat patients effectively. Treatment depends entirely on the underlying diagnosis.

Management may include:

• Medical therapy for primary headache disorders
• Lifestyle modifications
• Preventive medications
• Observation and monitoring
• Endovascular treatment
• Other neurovascular interventions where clinically indicated

Our approach focuses on treating the underlying cause rather than simply managing symptoms.

Explore Our Headache Resources

Our Headache Resource Centre provides comprehensive information covering common headache disorders, warning signs, neurovascular conditions, diagnosis, treatment options, and long-term care.

Explore topics including:

Understanding Headaches

• Types of headaches
• Secondary headaches
• New medical treatments for headaches

Warning Signs

• Thunderclap headaches
• Sentinel headaches
• When is it time to worry about a headache?
• Is my headache a brain aneurysm?

Migraine & Brain Aneurysm

• Migraine vs brain aneurysm
• Tracking headache patterns
• Can you have a brain aneurysm without headaches?
• Brain aneurysm headaches explained

Recovery & Long-Term Follow-Up

• Headaches after brain aneurysm treatment
• Long-term monitoring following neurovascular procedures

Choosing the Right Headache Specialist in Singapore

Not every headache requires a neurointerventional specialist. However, referral may be appropriate when:

• Imaging identifies a vascular abnormality
• A brain aneurysm or AVM is suspected
• Symptoms remain unexplained
• A second opinion is required
• Neurovascular treatment options are being considered

A specialist consultation focuses on identifying the underlying cause of the headache and determining whether observation, further evaluation, or treatment is appropriate.

Frequently Asked Questions