Headaches can result from stress, lack of sleep or migraine. Sometimes, however, they are also a warning sign of a serious condition. Knowing the different types of headache helps in assessing complaints and finding appropriate treatment.
1. Why do we get headaches?
Headaches are among the most common complaints of the nervous system. Almost everyone experiences them at some point in life. The pain can vary considerably: it may be pressing, throbbing or stabbing, affect one side or the entire head, and last from a few minutes to several days.
Brain tissue itself does not possess pain receptors in the way many other body tissues do. Headaches arise instead through the activation of pain-sensitive structures such as the meninges, certain blood vessels, cranial nerves or muscles in the head and neck area. The processing of pain signals within the nervous system also plays an important role.
The precise mechanisms depend on the type of headache. In migraine, the activity of the nervous system and the trigeminovascular system are among the factors involved. In tension-type headache, both pain perception and the central processing of pain signals can be altered.
Various factors can trigger or worsen headaches:
- Sleep problems: Too little sleep, irregular sleep patterns or poor sleep quality.
- Stress and psychological strain: Persistent tension, worries and insufficient recovery periods.
- Physical strain: Prolonged sitting, sustained poor posture or pain in the neck and shoulder area.
- Everyday habits: Insufficient fluid intake, skipped meals or alcohol consumption.
- Medications: Certain drugs can cause headaches. Frequent use of pain relievers can also trigger additional headaches.
Importantly, not every headache is stress-related or caused by tense muscles. With recurring complaints, it is worth first clarifying which type of headache is present.
2. What types of headaches are there?
Medically, headaches are fundamentally divided into primary and secondary headaches. In primary headaches, the headache itself is the condition. Secondary headaches are, by contrast, the consequence of another illness or triggering factor.
Tension-type headache: A feeling like a tight band around the head
Tension-type headache is one of the most common types. Typical features include:
- A bilateral, pressing or drawing pain
- A feeling as though the head is being gripped by a tight band
- Usually mild to moderate pain
- Routine physical activity does not typically worsen the pain significantly
- Usually no pronounced nausea or vomiting
- Some affected individuals also report discomfort in the neck, shoulders or scalp
Tension-type headaches can occur occasionally or develop into a chronic problem. If they occur on at least 15 days per month for more than three months, chronic tension-type headache may be the diagnosis. The name does not mean that the complaints are caused exclusively by psychological stress or tense muscles. Rather, different physical and neurobiological mechanisms may be involved.
Migraine: More than ordinary headaches
Migraine is a neurological condition and not simply a more severe form of ordinary headache. Typical features include:
- Moderate to severe pain, often with a pulsating character
- Pain on one or both sides of the head
- Worsening with routine activities such as walking or climbing stairs
- Frequently nausea or vomiting and heightened sensitivity to light and sound
- In some people, an aura occurs before or during a migraine attack
A migraine attack typically lasts four to 72 hours in adults. Because migraine and tension-type headaches require different treatment approaches, an accurate diagnosis is important.
Cluster headache: Very severe, recurring attacks
Cluster headaches are comparatively rare but can cause exceptionally severe pain. Typical features include:
- Very severe, usually one-sided pain around, above or at the temple
- A watering or reddened eye on the affected side
- A blocked or running nose
- Frequently marked restlessness during the attack
- A single attack usually lasts 15 to 180 minutes
Cluster headaches should be medically assessed, as targeted treatment may be necessary.
Secondary headaches: When another condition is the cause
Headaches can also arise as a consequence of other health problems, for example:
- Certain infections
- Head injuries
- Vascular diseases
- Conditions affecting the eyes or teeth
- Certain conditions in the neck area
- Side effects of medications or excessive use of pain relievers
- More rarely, other conditions within the skull
The cause cannot be reliably determined from the location of the pain alone. New or unusual headaches should therefore not be hastily categorised as tension or migraine.
3. What consequences can recurring headaches have?
The burden of headaches cannot be measured by pain intensity alone.
Impairment at work and study
Pain can affect concentration, attention and performance. During severe attacks, everyday tasks can sometimes barely be managed.
Sleep problems and psychological strain
Recurring complaints can disturb sleep and be accompanied by anxiety, low mood or fear of the next attack.
Restrictions in personal life
Some affected individuals give up sport, social activities or family outings. Over time this can noticeably reduce quality of life.
Medication overuse
People who frequently take pain relievers to control recurring complaints can develop medication-overuse headache, which complicates treatment.
The World Health Organization (WHO) notes that headache disorders represent a significant burden worldwide. The consequences include not only pain but also restrictions in everyday life, reduced quality of life and economic burdens.[1] Recurring headaches are therefore not a problem that should simply be accepted indefinitely.
4. When should you seek medical help for headaches?
Most headaches are not caused by an immediately life-threatening condition. However, certain warning signs must be taken seriously.
⚠️ Seek prompt medical assessment for the following signs
- Sudden, extremely severe headache that reaches maximum intensity within a short time.
- New-onset paralysis, speech disturbances, altered consciousness or other neurological abnormalities.
- Headache combined with fever, neck stiffness or a pronounced feeling of illness.
- New-onset headache following a head injury.
- Markedly worsening or substantially different headaches.
- Headaches triggered by physical exertion, coughing or straining.
- New-onset headache with visual disturbances, especially sudden vision loss.
In the event of sudden, extremely severe headache, altered consciousness or new neurological deficits, emergency medical assistance should be sought immediately. In Switzerland the emergency number is 144.
Even without acute warning signs, medical assessment is advisable if headaches occur regularly or impair quality of life. A headache diary can be helpful: record as precisely as possible when the pain occurs, how long it lasts, how severe it is, what accompanying symptoms are present and which medications you take.
5. Acupuncture and Traditional Chinese Medicine: What does research show?
In Traditional Chinese Medicine (TCM), headaches are considered in the context of the individual symptom picture and general state of health. Depending on the findings, acupuncture and other therapeutic measures may be employed.
From a modern medical perspective, there is evidence that acupuncture can influence pain-related processes in the nervous system. However, the precise mechanisms have not yet been fully elucidated.
What do studies from Hannover Medical School show?
At Hannover Medical School (MHH), a randomised controlled pilot study examined the effects of acupuncture and medical training therapy (MTT) on frequent episodic and chronic tension-type headache. A total of 96 adults were allocated to four groups: usual care, acupuncture, medical training therapy, and a combination of both. Treatment lasted six weeks and comprised twelve interventions each.[4]
Key findings
- The combination of acupuncture and MTT significantly reduced average pain intensity compared with usual care — a reduction of approximately 38 per cent.
- With acupuncture alone or MTT alone, no statistically significant advantage over usual care was found for this primary outcome measure.
- No significant between-group differences were found for headache frequency, duration of individual episodes or pain-reliever use.
A further study by the same research team examined depressive symptoms, anxiety and quality of life. The acupuncture group and the combination group showed improvements on several of these secondary endpoints.[5] The results provide indications of possible additional benefits, but must be interpreted in the context of the study design and limited sample size.
Author's note: The scientific foundation for this clinical investigation was published as early as 2019 in a study protocol in the journal Trials. Dr. Lei Jiang was also involved in that publication as a co-author. Dr. Lei Jiang is the same person as Dr. Changgeng Wei — the latter being a pseudonym of the former, as is also visible on Google Scholar. The results of this study appeared in 2021 and 2023 in Cephalalgia.
How can TCM be integrated into treatment?
For tension-type headaches that have been medically assessed, acupuncture can be considered as part of a comprehensive treatment concept. Further useful measures include:
- Regular sleep times and sufficient recovery.
- Physical activity and avoiding prolonged unfavourable postures.
- Targeted exercise or physiotherapy where appropriate to the condition.
- Monitoring possible triggers with a headache diary.
- Responsible use of pain relievers in consultation with a medical professional.
NICE guideline recommendation
The British NICE guideline recommends considering treatment with up to ten acupuncture sessions over five to eight weeks for chronic tension-type headache.[3] This is a recommendation for the preventive treatment of chronic tension-type headache, not a blanket recommendation for all types of headache.
At Anfang TCM Praxis, we place great value on carefully understanding the complaints and individual situation of our patients. The first step is always to clarify whether a medical examination or another form of treatment is needed. It can then be assessed whether acupuncture is appropriate as a complementary or stand-alone therapeutic measure.
Those who regularly suffer from headaches do not simply have to accept the complaints. An accurate diagnosis, a better understanding of possible triggers and evidence-oriented treatment can help to alleviate symptoms and improve quality of life.
Related conditions
View all conditions →Scientific References
- World Health Organization (WHO). Migraine and other headache disorders. 24 October 2025. WHO Fact Sheet
- International Headache Society. International Classification of Headache Disorders, 3rd edition (ICHD-3). ICHD-3
- National Institute for Health and Care Excellence (NICE). Headaches in over 12s: diagnosis and management. Guideline CG150. NICE CG150
- Schiller J, Kellner T, Briest J, et al. The best from East and West? Acupuncture and medical training therapy as monotherapies or in combination for adult patients with episodic and chronic tension-type headache: study protocol for a randomized controlled trial. Trials. 2019;20:623. DOI:10.1186/s13063-019-3700-1
- Schiller J, Niederer D, Kellner T, et al. Effects of acupuncture and medical training therapy on depression, anxiety, and quality of life in patients with frequent tension-type headache: A randomized controlled study. Cephalalgia. 2023;43(1). DOI:10.1177/03331024221132800 · PubMed:36622877