When Should I Worry About a One-Sided Headache?

The short answer from a headache specialist

Q: When should I worry about a one-sided headache?

A: One-sided headaches can mean different things. I ask my patients: Are the headaches continuous or do they come and go ? How long do the headaches last?

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When we talk about unilateral or one-sided headaches, there’s a distinct family of headache disorders called TACs, or the trigeminal autonomic cephalgias, and they have four distinct headaches:

  1. Cluster headache. This type more often affects men. These headache attacks can occur around certain seasons. They last 15 to 180 minutes. They are so severe and sharp that patients sometimes call them suicide headaches.
  2. Hemicrania continua headache. This headache causes continuous pain on one side of the head for 24 hours, while also causing sharp attacks of pain. A person will get a runny nose and may also have teary eyes.
  3. Paroxysmal hemicrania headache. This one is similar to hemicrania continua, but people will get shorter attacks that last less than 24 hours, and they will be pain-free in between.
  4. SUNCT (Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing) and SUNA (Short-lasting Unilateral Neuralgiform headache with cranial Autonomic symptoms). These are short-lasting headaches that rarely affect people. They cause a few seconds of severe head pain on one side of the head with teary eyes and runny nose.

If you have one-sided headaches, it’s important to seek an evaluation by a neurologist or a headache specialist. A workup is crucial and brain imaging is often necessary to rule out any secondary causes.

— Headache specialist Emad Estemalik, MD

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