Headaches are a common and painful occurrence. Almost everyone has had a headache at some point in his or her life. We’ve already talked in depth about common headaches like tension and migraine headaches. But there are less common headaches including:

• Cluster headaches
• Cervicogenic headaches
• Giant cell arteritis
• Subarachnoid hemorrhage
• Idiopathic intracranial hypertension

These headaches are much more rare and usually diagnosed only by specialists. In this article we will explore the causes of each headache and discuss possible treatment options.

Cervicogenic Headaches

Cervicogenic headaches are a type of tension headache generated from muscle spasms in the neck.  These occur most often after neck injury, commonly a whiplash in a motor vehicle accident or similar type of trauma.  Cervicogenic headaches often improve greatly as trauma heals within one to two months.  Massage, heat, and ice, over the counter medications, chiropractic adjustments, and physical therapy may all be useful.  About 5% of these require more aggressive treatment by a pain specialist including cervical injections.  If the headaches are not resolving, a physical medicine pain specialist can be extremely helpful in coordinating more aggressive management to stabilize or cure symptoms.

Subarachnoid Hemorrhages (SAH)

Subarachnoid hemorrhages (SAH) are very distinct, severe headaches.  Known as thunderclap headaches, they are described as the worst pain you’ve ever experienced in the head.  They occur suddenly, lasting minutes to hours, and almost always send the person to the hospital for treatment due to the severe pain and symptoms.  A CT scan of the head usually shows the bleed, but sometimes lumbar punctures and MRI scans are also needed.  Depending on the severity and cause of the bleed, treatment may require neurosurgical intervention versus supportive care.

Cluster Headaches

Cluster headaches are a rare type of chronic headache.  They are most common in men.  Typically, they consist of one-sided pain, with tearing of the eyes and runny/stuffy nose.  They occur daily for a period of time and then stop, before starting again some time later.  At this time they are thought to be associated with serotonin release and the hypothalamus.  Treatments include avoiding triggers, breathing oxygen, pain and migraine medications.  A neurologist specializing in headaches usually coordinates management.

Giant Cell Arteritis

Giant cell arteritis is an inflammatory condition of the blood vessels in the head.  It affects mainly the elderly, those over 60 years of age.  It is characterized by pain over a blood vessel, often in the temporal region.  Blood tests show signs of inflammation, especially the ESR being very elevated.  Biopsy of the vessel is often done to help make the diagnosis.  Treatment is with steroids, and often it may be necessary to take them a long time.  Not treating the condition can lead to complications like strokes.

Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension, previous known as pseudotumor cerebri, is where there is increased intracranial pressure.  The headache is a dull deep pressure with nausea, vomiting, and visual changes.  It is most commonly seen in young, obese woman.  MRI brain scans looking for other causes of symptoms and lumbar punctures are necessary in the evaluation.  By its name – idiopathic, the cause is unknown.  Treatment may include medications and sometimes requires neurosurgical management.

The above headaches are rare.  Most of them have unusual presentations and send one to see a physician immediately.  A neurologist is most commonly involved in both the diagnosis and management depending on the problem.  When symptoms do not improve despite optimum management, occasionally secondary specialty headache clinics become involved.  Generally, once one of these rare headaches is diagnosed, the treatment is effective.

Have you ever experienced any of these rare headaches? We’d love to hear your story in the comments!