TypeFeaturesTreatment
Short duration
Brief headache syndromes
HypnicDevelops during sleep; lack of autonomic symptoms; must have 2 of 3 criteria: (1) occurs more than 15 times per month, (2) lasts more than 15 minutes after awakening, and (3) starts after 50 years of ageLithium, caffeine
Primary coughOnset from cough or Valsalva maneuver; generalized pain; lasts from 1 second to 30 minutes; must rule out secondary causesIndomethacin (Indocin)
Primary exertionalPulsating pain; lasts 5 minutes to 48 hours; brought on by physical exertion; must rule out secondary causesIndomethacin
Primary stabbingTransient and localized stabs of pain; felt over orbit, temple, or parietal area; no accompanying symptomsIndomethacin
Trigeminal autonomic cephalalgias*
Chronic cluster headacheDeep stabbing pain behind the eye; abrupt onset; lasts 15 to 180 minutes; accompanied by at least 1 of the following ipsilateral symptoms: (1) conjunctival injection or lacrimation, (2) nasal congestion or rhinorrhea, (3) eyelid edema, (4) forehead or facial sweating, (5) miosis and/or ptosis, or (6) sense of agitation or restlessness; frequency of once every other day to 8 episodes per day; recurs for longer than 1 year without remission of more than 1 month's timeAbortive: 100% oxygen, sumatriptan (Imitrex)
Prophylactic: verapamil, lithium
Paroxysmal hemicraniaSevere unilateral orbital, supraorbital, or temporal pain; lasts 2 to 30 minutes; accompanied by 1 of the ipsilateral symptoms consistent with cluster headache; more than 5 attacks per day more than half the time; by definition, headache is prevented by indomethacin (unlike cluster headaches, which are longer and are not prevented by indomethacin)Indomethacin
SUNA/SUNCTUnilateral orbital, supraorbital, or temporal stabbing or pulsating pain; lasts 5 to 240 seconds; accompanied by ipsilateral conjunctival injection and lacrimation; 3 to 200 attacks per dayUncertain
Long duration
Hemicrania continuaUnilateral, continuous pain of moderate severity; has at least 1 of the following: (1) conjunctival injection and/or lacrimation, (2) nasal congestion and/or rhinorrhea, and (3) ptosis and/or miosis; defined by a complete response to indomethacinIndomethacin
MigraineLasts 4 to 72 hours; usually unilateral; often with nausea/vomiting and photophobia or phonophobia; aggravated by activityAbortive: analgesics, antiemetics, triptans
Prophylactic: amitriptyline, propranolol, topiramate (Topamax), valproate (Depacon)
New daily persistentPresent daily for more than 3 months; unremitting within 3 days of onset; usually bilateral with a pressing/tightening quality; not aggravated by activity; usually not with autonomic symptomsMigraine prophylactic agents; new daily persistent headaches generally refractory to treatment
Tension typeGradual increase in frequency from episodic to chronic headache; usually bilateral with a pressing/tightening quality; not aggravated by activity; usually not with autonomic symptomsAmitriptyline