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Health condition · Clinically reviewed

Headache syndromes, classified properly - and treated with the right tool.

Migraine, cluster, tension-type, TACs and secondary headaches each have specific treatments. A structured diagnosis, a red flag screen and the right specialist route change outcomes.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, the British Association for the Study of Headache and ICHD-3 sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK neurology practice including CGRP monoclonals, gammaCore and specialist commissioned headache centres.

Key facts

Headache syndromes at a glance.

The ICHD-3 groupings, the syndromes inside each, and the alarm features that change everything.

  • What it is

    A family of headache disorders classified by ICHD-3 into primary, secondary and painful cranial neuropathies. Precise diagnosis drives precise treatment.

  • Primary group

    Migraine, tension-type headache, the trigeminal autonomic cephalalgias and other primary headaches such as hypnic, exercise and stabbing headache.

  • Secondary group

    Headache caused by trauma, vascular disease, raised or low intracranial pressure, infection, neuralgia or medication overuse.

  • Red flags

    Thunderclap, new headache over 50, fever, focal neurology, papilloedema or pregnancy postpartum need urgent imaging and specialist review.

  • Common trap

    Medication overuse headache turns episodic migraine into chronic daily headache and is reversible with careful detoxification.

  • Specialist care

    Complex, refractory or unusual headache belongs in a commissioned headache clinic (Queen Square, King’s and other national centres).

Why this guide matters

Same symptom, different diseases.

Head pain is one presentation but dozens of syndromes. Three principles frame the rest of this page.

  • Classify before you treat

    ICHD-3 is the map. Migraine, tension-type, cluster and TACs each have their own first-line treatments - the label matters.

  • Screen every headache for SNOOP10

    Red flags identify the small but critical minority with a secondary cause needing urgent imaging and specialist care.

  • Escalate to specialists early

    Refractory migraine, chronic daily headache and cluster deserve a neurologist, a headache clinic and the newer treatments.

How the diagnosis is made

From first consultation to a precise diagnosis.

The steps a UK GP or neurologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Structured history and headache diary

    Onset, pattern, triggers, medication tally and impact - the diary is the single most useful diagnostic tool in headache medicine.

  2. 02

    Assessing

    SNOOP10 red flag screen

    Systemic, Neurologic, Onset, Older, Pattern change and 10 further alarm features - drives the urgency of imaging.

  3. 03

    Assessing

    ICHD-3 classification

    Map the pattern to a primary syndrome, a secondary cause or a neuralgia - the classification directs the treatment.

  4. 04

    Confirming

    Neurological examination

    Fundoscopy for papilloedema, cranial nerves, gait and blood pressure - a careful bedside exam narrows the differential quickly.

  5. 05

    Confirming

    MRI and MR venography

    Reserved for red flags, unusual features or treatment failure - looks for tumour, hydrocephalus, dissection, RCVS, IIH and CSF leak.

  6. 06

    Confirming

    Lumbar puncture where indicated

    For suspected subarachnoid haemorrhage after negative CT, meningitis, encephalitis or to measure opening pressure in IIH.

  7. 07

    Preparing

    Specialist headache clinic

    Complex, refractory, cluster and TAC patients belong with neurology or a commissioned headache service for advanced options.

Typical timeline: a first consultation to a specialist plan in weeks, not months.

The syndromes

What each headache syndrome actually looks like.

The classic clinical portraits - and the features that mean it is time to escalate.

  • Migraine

    Unilateral, throbbing, moderate to severe pain with nausea, photophobia and phonophobia - see /conditions/migraine-headaches/ for the deep dive.

  • Tension-type headache

    Bilateral, pressing, mild to moderate band-like pain without nausea - the commonest primary headache.

  • Cluster headache

    Severe unilateral orbital pain with autonomic features - see /conditions/cluster-headaches/. Attacks cluster in bouts.

  • Paroxysmal hemicrania and hemicrania continua

    Shorter or continuous unilateral pain with autonomic features - absolutely responsive to indomethacin, a diagnostic hallmark.

  • SUNCT and SUNA

    Very short, very frequent stabs of unilateral pain with tearing or conjunctival injection - a rare TAC that needs specialist care.

  • Cough, exercise and sexual headache

    Brief primary headaches triggered by Valsalva, exertion or orgasm - see /conditions/exercise-headaches/ for the red flag rules.

  • Hypnic and new daily persistent

    Hypnic headache wakes older adults from sleep. NDPH begins on a memorable day and does not remit - both need imaging first.

  • Red flag - thunderclap or focal deficit

    Sudden severe headache, focal neurology, fever, seizures or reduced consciousness - call 999 and expect urgent imaging.

Treatment

How each syndrome is treated in the UK.

Migraine, cluster, tension-type, TACs and medication overuse each have their own first-line pathway. Specialist commissioning matters.

  • Migraine - triptans and NSAIDs

    A stratified acute plan with a triptan (sumatriptan, rizatriptan) plus an NSAID for moderate to severe attacks. Antiemetics help nausea.

  • Migraine - CGRP monoclonals

    Erenumab, fremanezumab, galcanezumab and eptinezumab - transformative preventives for chronic or refractory migraine. See /treatments/migraine-cgrp-mabs/.

  • Chronic migraine - botulinum

    PREEMPT-protocol botulinum toxin every 12 weeks - NICE-approved for chronic migraine after two failed oral preventives. See /treatments/botox-medical-neurological/.

  • Tension-type headache

    Simple analgesia used sparingly, amitriptyline as the mainstay preventive, physiotherapy and cognitive behavioural therapy for chronic patterns.

  • Cluster - oxygen and sumatriptan

    High-flow 100% oxygen at 12 to 15 L/min via a non-rebreather and subcutaneous sumatriptan abort most attacks quickly.

  • Cluster - verapamil and galcanezumab

    Verapamil is the first-line preventive with ECG monitoring. Galcanezumab is licensed for episodic cluster in the UK.

  • TACs - indomethacin and gammaCore

    Indomethacin is diagnostic and therapeutic for paroxysmal hemicrania and hemicrania continua. gammaCore vagus-nerve stimulation is NICE-approved for cluster.

  • Medication overuse headache

    The main driver of chronic daily headache - see /conditions/chronic-daily-headaches/. Treated by structured withdrawal and a new preventive plan.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or neurologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • International Headache Society. ICHD-3 - The International Classification of Headache Disorders, 3rd edition.

  • NICE. Headaches in over 12s: diagnosis and management (CG150).

  • NICE technology appraisals: erenumab, fremanezumab, galcanezumab, eptinezumab, botulinum toxin type A for chronic migraine.

  • British Association for the Study of Headache (BASH). National headache management system guidelines.

  • Royal College of Physicians and NHS England. Commissioning guidance for specialist headache services.

Red flags

When a headache needs urgent attention.

Most headaches are primary and manageable. These are the SNOOP10 features that need urgent imaging and specialist review.

  • Thunderclap headache

    Peak intensity within one minute - assume subarachnoid haemorrhage, RCVS or dissection until proven otherwise. See /conditions/subarachnoid-haemorrhage/. Call 999.

  • New headache over 50

    First-ever headache in later life needs imaging. Consider giant cell arteritis with jaw claudication or scalp tenderness and start high-dose steroids urgently.

  • Focal neurology or seizures

    Weakness, speech disturbance, visual loss or seizures with headache - urgent stroke or space-occupying lesion pathway. See /conditions/hemorrhagic-stroke/.

  • Fever, neck stiffness or rash

    Suspect meningitis or encephalitis - see /conditions/encephalitis/. Empirical antibiotics and antivirals should not wait for imaging.

  • Papilloedema or visual obscurations

    Raised intracranial pressure - consider tumour, hydrocephalus or IIH. See /conditions/idiopathic-intracranial-hypertension/. Urgent imaging and ophthalmology.

  • Postural headache

    Worse standing, better lying flat - suggests spontaneous intracranial hypotension. See /conditions/csf-leak/. Consider an epidural blood patch.

  • Pregnancy or postpartum headache

    Consider pre-eclampsia, cerebral venous sinus thrombosis and pituitary apoplexy - low threshold for imaging including MR venography.

  • Progressive pattern change

    A stable headache that becomes daily, changes character or escalates in frequency deserves imaging and specialist review.

  • Immunocompromise or malignancy

    HIV, chemotherapy or known cancer with new headache needs imaging to exclude opportunistic infection, metastasis or venous thrombosis.

Living with it

Manageable conditions, with the right plan.

Four things that make the biggest difference day to day - keeping a diary, capping acute medications, protecting sleep and knowing when to escalate.

A quiet reminder

Prevention pays back over months, not days.

Preventive treatments in migraine and cluster need eight to twelve weeks to show their full effect. Judge them fairly.

  1. 01 Diary

    Track every attack

    A four-week headache diary with medication tally, triggers and menstrual cycle transforms the next consultation.

  2. 02 Limit

    Cap acute medications

    Simple analgesia on fewer than 15 days a month and triptans on fewer than 10 - the ceiling that prevents medication overuse headache.

  3. 03 Sleep

    Protect sleep and hydration

    Regular sleep, meals and hydration are unglamorous but the strongest lifestyle levers in migraine and tension-type headache.

  4. 04 Escalate

    Ask for specialist review

    Two failed preventives, chronic pattern, cluster or unusual features deserve a neurologist or a commissioned headache clinic.

Frequently asked

Everything we get asked about headache syndromes.

Quick answers on classification, TACs, medication overuse, red flags, CGRP mAbs and specialist care.

  • How are headache syndromes classified?

    The International Classification of Headache Disorders (ICHD-3) sorts them into primary (migraine, tension-type, trigeminal autonomic cephalalgias and other primary headaches), secondary (trauma, vascular, non-vascular intracranial, infection, homeostasis, facial and psychiatric) and painful cranial neuropathies. Getting the label right drives everything downstream.

  • What is a trigeminal autonomic cephalalgia?

    A group of primary headaches with severe unilateral pain and cranial autonomic features - tearing, redness, ptosis or nasal congestion. It includes cluster headache, paroxysmal hemicrania, hemicrania continua and SUNCT/SUNA. Each has a specific first-line treatment, so the sub-diagnosis matters.

  • What is medication overuse headache?

    A secondary chronic daily headache caused by regular use of acute painkillers or triptans - simple analgesia on 15 or more days a month, or triptans and combination analgesics on 10 or more days a month, for at least three months. It is a major cause of chronic daily headache and is reversible with careful withdrawal alongside a new preventive plan.

  • When is urgent imaging needed?

    When SNOOP10 red flags appear - Systemic symptoms, Neurologic signs, Onset thunderclap, Older age at onset, Pattern change and other alarm features such as papilloedema, postural pattern, precipitation by Valsalva, pregnancy, painful eye or post-traumatic onset. Urgent CT, MRI or MR venography and, sometimes, lumbar puncture, follow.

  • What are CGRP monoclonals?

    A class of preventive antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) targeting the calcitonin gene-related peptide pathway. NICE has approved them for chronic and episodic migraine after inadequate response to older preventives. Galcanezumab is also licensed for episodic cluster headache.

  • Where should complex headaches be managed?

    In a specialist headache clinic or with a consultant neurologist. UK commissioned headache services include Queen Square, King’s College Hospital and other regional centres, offering CGRP mAbs, botulinum toxin, occipital nerve blocks, gammaCore and inpatient detoxification for medication overuse headache.

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