Migraine and headache classifications

combat headaches

Do you suffer from headaches, migraines or both?

Curious about the different types of headaches and migraines? Wondering what type you may have?

Excerpt from Dr. Karin Drummond's book:  
"Combat Headaches" 


Tension headaches are often described as the pain you would feel if you had a band wrapped around and squeezing your head.

Roughly 90 percent of all headaches that I see are caused by tension. When muscles in the neck become tense, they pinch the nerves that send signals to the head. The most common tension headache is caused by pressure from tight suboccipital muscles on the greater occipital nerve (Figure below).

greater occipital nerve causing headaches migraine chiropractor

To explain this phenomenon, I like to use a more commonly known medical condition, sciatica, as an example of how a pinched nerve causes pain in the part of the body that the nerve supplies.   

The sciatic nerve sends signals down the back side of the thigh and through most of the lower leg and foot. Sciatica occurs when the nerve is irritated or inflamed. Such irritation can result when a muscle in the buttock pinches the sciatic nerve. Because the sciatic nerve only knows how to communicate input from the leg, when the nerve is pinched, it screams, “Severe leg pain!” to the brain. This is why when the sciatic nerve is pinched, a person feels severe pain that radiates down the leg.

Similarly, the greater occipital nerve only knows to communicate sensations from the head. So when it’s pinched, it screams, “Severe head pain!” This is why I say that a tension headache is like having sciatica of the head.

When the muscles at the base of the skull and top of the neck contract too strongly or sustain their contraction for a prolonged period of time (for example, slouching in front of a computer screen for hours), they squish the nerves supplying the head, causing a band of pain across the front of the head (where the nerves end).

People can also suffer from one-sided tension headaches. Leaning to one side while sitting for a long period, like when you rest your left arm on an armrest and use a mouse with your right hand, can lead to one-sided spasms of the neck’s posterior muscles (the muscles in the back of the neck). A one-sided tension headache can mimic migraine headaches and lead to the misdiagnosis of tension headaches as migraines. This misdiagnosis may explain why migraine medication is not working for you.

Another cause of tension headaches can be muscle tension in the front of the neck. This occurs when super-sensitive trigger points on the muscles cause people to feel pain into the head. Figure 1-3 shows the sternocleidomastoid and trapezius muscles, which have trigger points at the dots. When those trigger points experience too much pressure, they send pain signals to the sprayed area of the head.

Headache from trigger point migraine chiropractor

People often come to me thinking that they are having migraines because their headaches are so bad. They believe their migraine medication is not helping because it’s not strong enough. So they take higher doses, but to no avail.

These patients don’t think they are having tension headaches because they have been led to believe that tension headaches are moderate headaches. Migraine headaches, on the other hand, are labeled as severe headaches. Because the pain these patients feel from tension headaches is so crippling that it incapacitates them and affects their quality of life, they believe they must be having a migraine headache.

Tension headaches can be just as bad as, if not worse than, a migraine headache. The good news is that tension headaches are easier to treat with muscle therapy than migraines because they respond quickly to chiropractic care and massage therapy.

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People suffering from migraine headaches often describe their head pain as nauseating and usually report disturbances in their vision.

A migraine is characterized by severe pain in the head (usually on one side) that may trigger nausea. Migraines affect more than 10 percent of the population, and people who suffer from migraine headaches can also suffer from tension headaches. 

A migraine is caused by a change in brain chemistry that alters blood flow. Stress, a change in hormones, certain foods, alcohol, barometric pressure, and many other factors may affect brain chemistry. The chemical reaction causes the arteries to swell, resulting in the throbbing pain reported by migraine suffers; classic migraines are caused by inflammation of the temporal artery.

The pain of a migraine headache is usually one-sided, although a third of suffers have pain bilaterally. Attacks are extremely debilitating and cause neurological symptoms like dizziness, extreme sensitivity of the senses (sound, light, touch, taste, and smell), tingling or numbness in the face or extremities, visual disturbances, and nausea (sometimes to the point of vomiting). Migraine attacks can last as long as seventy-two hours or as short as four hours.

A classic migraine produces an aura twenty to sixty minutes before it strikes. During this time, a person may see flashes of light, dots, or wavy lines before the head pain sets in. 

Migraines can follow hormonal cycles and may occur right before a woman’s period when her estrogen levels drop. The hormones injected into our supply of meat also affect the body’s levels of various hormones. For this reason, among many others, I advise everyone to eat hormone-free meat. 

Food sensitivities and stress are other triggers of migraines because they too can change your biochemistry and increase inflammation in your system. Diet and lifestyle changes are required to treat migraine headaches and are discussed later in this book.

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People who suffer from cluster headaches report their pain as in and around one eye.

Cluster headaches are not as common as other types of headaches. Fewer than 0.2 percent of people suffer from this type of head pain. Cluster headaches are severe, intense headaches that are short in duration, but they happen one to three times a day for a period of time—normally a couple of months. Cluster headaches also usually occur around the same time of year. 

Cluster headaches are linked to the body’s circadian rhythm (internal biological clock). The link between cluster headaches and the internal clock isn’t fully understood. One theory is that the trigeminal nerve, the main sensory nerve of the face, has a relationship with the “clock” in the hypothalamus in your brain.

The trigeminal nerve exits the brain and sends signals to the face. It also performs automatic responses, like eyes when your eyes tear up. There is one for each side of your face.

The internal clock and the trigeminal nerve communicate with one another. So if the trigeminal nerve is vulnerable and receives a signal from the internal clock, that signal can be the last straw that causes the trigeminal nerve to escalate into an inflamed state, which then elicits the classic eye pain.

Usually just one side is triggered, causing pain that radiates into the eye on that side. It is worse than sciatica because the trigeminal nerve is a cranial nerve, closely linked to the brain. So when it screams, “Face pain,” it is heard all too well by the brain. Unfortunately, the pain is usually worse at night, which affects sleep.  Remember, sleep deprivation can lead to other types of headaches. 

Cluster headaches may stop occurring for months or years, only to return without warning. Like migraines, these severe headaches can respond to the lifestyle changes mentioned later in this book. 


Chronic daily headaches can be a sign you’re suffering from multiple types of headaches, each with a different cause. Eliminating these types of headaches takes major lifestyle changes and multiple types of treatments.

First, you need to identify the types of headaches from which you suffer; second, you need to determine the correct treatments to reduce the frequency, intensity, and duration of your headaches. Ideally, these lifestyle changes and treatments result in minimal to no headaches.

Any type of chronic pain, such as chronic headaches, can lead to depression and cause sleep disturbances. Make sure you put together a trusted team of healers (for both your physical and mental health) if you suffer from chronic daily headaches. 

Often after a trauma, the healing process continues indefinitely. I have had patients who suffered from daily headaches after experiencing a head trauma, concussion, or whiplash.

I have also had patients who suffered from chronic daily headaches after having an epidural. Spinal headaches occur with a decrease in cerebrospinal fluid (CSF). A drop in CSF can occur with trauma, such as a puncture wound from a spinal tap or an epidural. If the CSF continues to leak from the puncture wound, it leads to chronic head pain for an indefinite period.[1] I discourage pregnant women from getting epidurals because one of the risk factors is having headaches for the rest of their lives. 

Imaging and lab tests often fail to identify a cause for the pain of headache sufferers because they don’t show how the cranium is functioning. This is why you must pay attention to what your body tells you, such as where the pain is localized and whether it is dull or sharp. By doing so, you can work with your preferred healer to develop a treatment plan for your head pain. 

I have had multiple patients who have suffered for years with daily headaches, despite seeing several specialists and spending thousands of dollars. After making the changes mentioned in this book, they not only are freed from their suffering, but they feel better overall. 

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Secondary Headaches

 A secondary headache is a symptom of a disease that is irritating the nerves and/or blood vessels of the head.


Sinus headaches are often described as having pain behind the frontal bones (the bones in your forehead) or cheekbones.

Inflammation of the sinuses can cause headaches, as in acute sinusitis. Allergies can also cause head pain. Generally, sinus pain is caused by pressure on the mucous membranes (the lining of the sinuses) because they are unable to drain well.

Mobilization of the skull (cranial) bones helps improve drainage of the sinuses. The skull is made of multiple flat bones that articulate with each other.  There are no muscles that move these “joints,” so they are considered “immovable.”  However, the flat bones of the skull are not fused together.  A healthy skull has the ability to expand and contract to keep the pressure off the brain during changes of barometric pressure or sinus pressure.  If the sinuses are filling up with fluid from sickness or allergies, the skull should expand with this pressure, allowing the sinuses to drain with this extra space. If restricted, the sinuses can’t drain, pressure builds, and pain results in the form of a sinus headache. 

Mobilizing the cranial bones allows for the expansion of the skull, allowing the drainage of the sinuses.  This relieves the pressure on the mucous membranes, and the headache resolves.

Using a nasal irrigation system, like a Neti PotTM, may help as well. By cleaning out the nasal passageway, you rid the sinuses of the irritants that may be causing the swelling and remove the excess mucous that may be obstructing the drainage.


As illustrated in Figure 1-4, jaw tension can cause both tooth and head pain.

Jaw causing headache migraine chiropractor

Temporomandibular joint (jaw) dysfunction (TMD) can radiate pain into the head. Muscle tension in the jaw, face, neck, and upper back can cause pain in the head as well. I have many patients who come to me when they have tooth pain because it is often a result of their tight jaw muscles. 

To learn more about TMD (jaw dysfunction), CLICK HERE.

If their tooth pain does not improve with their jaw treatment, then they see their dentist. If their tooth pain improves with their jaw treatment, they have saved themselves a trip to the dentist. 

A bad tooth can also radiate pain into the head, making it feel like a headache rather than a bad tooth. Often such pain causes jaw tension, which can be misleading for health practitioners. They may diagnose a patient’s head pain as jaw tension headaches, but the pain was actually coming from a diseased tooth.

With this misdiagnosis, the patient is prescribed an inappropriate treatment, so the condition worsens. Some patients suffer for months before finally going in for their dental checkup. When they find the root cause of their pain and their tooth condition is fixed, their headache resolves.


Infection or inflammation of the brain or its arteries can cause head pain. Bleeding in the neck causes nerve pain in the head because the nerves that exit the upper neck supply the head. Arterial tears (carotid or vertebral dissections) can cause headaches, too.

Bleeding in the brain, as with a brain aneurysm or stroke, can cause head pain.

The brain itself does not have nerves for pain reception, but its lining and its blood vessels are very sensitive, so any increased pressure in the brain causes head pain. 

Pseudotumor cerebri (an increase in pressure in the skull for no obvious reason) causes headaches as a result of the pressure increase.

A blood clot in a vein (unlike a stroke, which is a blood clot of in artery) can cause head pain because it causes the vein to swell, putting pressure on the brain. 

A Chiari malformation can cause head pain, too. In such a malformation, the lower part of the brain falls into the spinal canal. As it falls, it puts pressure on the base of the brain. 

This is another reason why, if your headaches are not resolving with treatments, or are worsening in anyway, an MRI may be indicated.  An MRI can help determine the cause of your headache (or at least, rule out conditions like this).  Such imaging can help the health care provider determine how your treatment should change, or if you need to be referred out to a different specialist.


Extreme cold on the roof of the mouth (ice cream headache) causes vasoconstriction (the blood vessels tighten and get smaller). When the vessels re-dilate, you feel head pain.

 Some medications can cause headaches, either directly or when their effect wears off. A headache that occurs when the medication wears off is called a “rebound headache.” Sometimes the rebound headache is worse than the pain for which the medication was taken in the first place. This is why I discourage people from taking pain pills.

Dehydration is yet another cause of head pain. Liquids such as alcohol and coffee can cause dehydration and trigger headaches.

 Liquids containing sulfates, as in red wine, can trigger headaches.

Coffee can trigger a headache when the effects of the caffeine wear off—these are called “caffeine withdrawal headaches.” For these reasons, it’s generally not a good idea to drink alcohol or caffeine if you suffer from headaches.

External pressure on the head (tight headgear or changes in barometric pressure) can cause head pain.

Other Headaches

Cough headaches 

Cough headaches suggest to me that there is a lack of movement of the cranial bones to offset the increase in pressure during a cough (Valsalva pressure).

When coughing, more blood is pushed into the head. If the skull bones do not expand with this increase of fluid, it puts pressure on the nerves and blood vessels that line the skull. Because nerves and blood vessels are sensitive to pressure, you feel pain at the slightest increase in pressure, especially if you are already on the verge of having a tension or migraine headache. The added pressure sends you over the edge.

Mobilization of the cranial bones often helps with headaches because it loosens the bones of the skull, allowing them to expand with the increase in blood flow. This expansion relieves pressure on the nerves and blood vessels that line the skull.

Exercise headaches and sex headaches 

Exercise and sex headaches suggest to me that blood pressure may be an issue. Again, mobilization of the cranial bones should help with this.

It takes a skilled practitioner to detect the subtle restrictions of the suture lines (the places where the flat bones of the skull meet).  A restriction of the flat bones of the skull can cause an increased vulnerability to headaches. These types of headaches respond well to mobilization and chiropractic manipulation of the cranial bones, even years after sustaining the original injury.

There is a plethora of other causes of head pain. To name a few:

·      Food and chemical sensitivities

·      Vitamin and mineral deficiencies

·      Exposure to certain mold in the home or workplace

·      Carbon monoxide poisoning or other air quality issues

This is why you must have a good healthcare provider who can help you diagnose the actual cause of your headache.

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Drummond Chiropractic, LLC
Migraine Specialists
Headache Specialists
565 N Walnut St,
Bloomington, IN 47404
(812) 336-2423

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