Headaches: The Difference Between Primary and Secondary

Difference between Primary and Secondary Headache

Headaches are defined as pain in any part of the head and may be felt on one or both sides of the head. In addition, it may be isolated in one location, can radiate from one area, or feel like a vise is gripping your head. Also, it may feel like a sharp pain, a throbbing sensation, or a dull ache. Head pains may come about slowly or all of a sudden and can last anywhere from under an hour to several days.

What are Primary and Secondary Headaches?

Headaches have two categories: primary and secondary. Let’s take a closer look at these types and see exactly what they mean.


These head pains are caused by actual pain-sensitive structures in the head. These structures may be overactive or malfunctioning for some reason. Primary headaches are not due to an underlying condition.

Primary headaches are brought about by the chemical activity going on in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your neck and head. There can be a hereditary factor as some people carry genes that make them more predisposed to primary headaches.

Most common primary headaches are:

  • Migraine headaches -- with and without aura
  • Tension headaches
  • Exertion headaches
  • Cluster headaches
  • Chronic daily headaches
  • Cough headaches

Triggers known to bring on primary headaches are:

  • Low blood sugar due to skipping meals
  • Stress
  • Improper posture
  • Alcohol -- red wine in particular
  • Certain food and food additives (nitrates, aspartame)
  • Changes in sleep patterns or losing sleep


These head pains occur because of another underlying cause or disease that is activating the pain-sensitive nerves in your head. Many conditions can cause secondary headaches. Here are some possible causes:

  • Brain aneurysm
  • Acute sinusitis
  • Chiari malformation -- a structural problem at the base of your skull
  • Arterial tears -- carotid or vertebral dissections
  • Blood clot in the brain (venous thrombosis) -- different from stroke
  • Brain arteriovenous malformation (AVM) -- an abnormal formation of blood vessels
  • Hangovers
  • High blood pressure
  • Influenza
  • Concussion
  • Dental issues
  • Giant cell arteritis -- inflammation of the lining of the arteries
  • Dehydration
  • Meningitis
  • Medications that treat other disorders
  • Middle ear infections
  • Encephalitis -- inflammation of the brain
  • Panic attacks and other panic disorders
  • Glaucoma
  • Intracranial hematoma -- blood vessel ruptures causing bleeding in or around the brain
  • MSG -- monosodium glutamate
  • Trigeminal neuralgia and other neuralgias that involve the irritation of nerves in the face and brain
  • Toxoplasmosis
  • Overuse of pain medication (rebound headaches)
  • Post-concussion syndrome
  • Pressure from headgear -- goggles or a helmet
  • Pseudotumor cerebri -- increased pressure inside your skull

Types of secondary headaches can include:

  • Rebound headaches -- caused by overuse of pain medication
  • External compression headaches -- pressure caused by headgear
  • Brain freeze or ice cream headaches
  • Sinus headaches -- due to inflammation and congestion in the sinus cavities
  • Thunderclap headaches -- a collection of disorders that involve sudden, severe headaches with multiple causes
  • Spinal headaches -- caused by low volume of pressure of cerebrospinal fluid, possibly due to a leak, a spinal tap, or spinal anesthesia
  • A cervicogenic headache -- this is related to an underlying condition of the neck, such as degenerative disc disease
  • A post-traumatic headache -- due to a traumatic event, such as being involved in an accident
  • Brain tumor or an aneurysm headache

How to Tell If You Have Primary or Secondary Headache

One way doctors determine if your head pain is primary or secondary is to use the “SNOOP” method listed below:

  1. Systematic symptoms: Fever, weight loss, a history of cancer, abnormal blood test results should be observed. This may mean a headache is due to meningitis, cancer or other illness.
  2. Neurological exam: If the neurological exam is normal, then secondary headaches can be ruled out. If you have abnormal speech, abnormal walking, dizziness, or confusion, it may be a secondary reason.
  3. Onset: A sudden onset can indicate a secondary headache due to an aneurysm or a bleed. Onset less than two weeks ago can indicate meningitis. The onset of a headache over 6 months ago can probably be considered a primary headache disorder.
  4. Onset of age: If it comes on before the age of 5 or after the age of 50, secondary headaches can be ruled out. If you are over 50, an MRI may be suggested. People over 50 do not usually develop migraines for the first time.
  5. Progressive: Headaches of this sort worsen over time. Migraine patients can develop secondary headaches due to a tumor or an aneurysm, so it is important to mention this to your doctor if it is the case. This may require that they take a deeper look into your pain.

Finding Help for Headaches

As you can see from the above information, relying on medication to care for headaches can bring on further problems long-term. Many headaches can be linked back to a problem going on with the bones of the upper cervical spine. Issues here can cause both primary and secondary headaches to occur. How so?

The bones of the upper cervical spine, especially the top bones of the neck (the C1 and C2 vertebrae), were created to protect the brainstem from damage. The brainstem is the communication highway of the entire body, sending messages to and from the brain. If the C1 or C2 become misaligned due to an accident or minor blow to the head or neck, they can actually put pressure on the brainstem and cause communication to be disrupted. A misalignment here can also hinder the flow of blood and cerebrospinal fluid from leaving or getting to the brain. All of these scenarios can lead to headaches.

Upper cervical chiropractors are specially trained to find the tiniest of misalignments and then work to correct them through a gentle, effective method. We are not required to force or crack the spine to get positive results. Many patients report seeing improvement in their headache conditions in only a few visits.

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The content and materials provided in this web site are for informational and educational purposes only and are not intended to supplement or comprise a medical diagnosis or other professional opinion, or to be used in lieu of a consultation with a physician or competent health care professional for medical diagnosis and/or treatment. All content and materials including research papers, case studies and testimonials summarizing patients' responses to care are intended for educational purposes only and do not imply a guarantee of benefit. Individual results may vary, depending upon several factors including age of the patient, severity of the condition, severity of the spinal injury, and duration of time the condition has been present.