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Ranking Every Type of Headache by How Painful They Are

From ‘suicide’ headaches to migraines, here’s where each sits on the agony scale

Last month, a 34-year-old man developed a series of skull-crushing “thunderclap” headaches after eating a Carolina Reaper — the world’s hottest pepper — while participating in a competitive eating event. The extremely hot pepper reportedly motivated blood vessels in his brain to constrict, which was diagnosed as the “unusual” cause of these intense headaches. Fortunately for him, the blood vessels returned to normal five weeks later. (We’re going to guess that his tolerance for spicy foods will never recover.)

Soon, though, a person won’t have to wait more than a month to get relief. That is, the FDA recently approved a new state-of-the-art drug (Aimovig) designed to reduce the number of migraines among people who suffer them frequently. Taking the form of a monthly shot, it regulates the levels of “calcitonin gene-related peptides” in the blood (the neurotransmitters whose levels rise during migraine attacks).

But let’s back up for a moment: What exactly is a “thunderclap” headache, and how painful is it compared to other types of headaches? To find out, I asked Elizabeth Loder, chief of the Division of Headache and Pain at Brigham and Women’s Hospital, past president of the American Headache Society and vice president of the Headache Cooperative of New England, to help me rank common types of headaches — from most painful to least painful.

I should note, however, that a “thunderclap” headache isn’t one type of headache; it’s a medical term used to describe any kind of headache that escalates suddenly and severely within a short period of time (usually as quickly as 60 seconds). “It’s really more a description of the onset of the headache,” Loder explains, meaning that “thunderclap” headaches won’t actually be on my list of headache types.

And no, your Sunday morning hangover headache didn’t make the cut, either. While the pounding in your head may seem horrible at the time, alcohol-induced headaches are nothing compared to the hardcore head hammers (which is officially my new band name) listed below.

Now, if you don’t have too much of a headache from reading all that, let’s press on…

1) Cluster Headache (aka, Suicide Headache): Cluster headaches tend to strike in groups, hence the name, and they only affect one side of the head. On the side being affected, the eyelid droops, the eye tears, the pupil becomes smaller and the nostril runs. Cluster headaches also affect men three to four times more often than women, according to Loder.

As per the pain, it’s really, really bad. “Cluster headaches are noticeably severe to the point where patients often can’t control themselves during a headache — they may bang their head, pace the room or become violent,” Loder explains. “A long time ago, I wrote an article about medical-legal consequences of cluster headaches, and there are some very interesting stories in the literature: One person held a SWAT team at bay [by holding a hostage], because he wanted medicine for his cluster headache.”

Making matters even worse, the exact cause of cluster headaches is unknown, meaning there’s no cure. Doctors can provide preventative treatments (including inflammation-suppressing medications) in an attempt to subdue attacks, or they can administer fast-acting pain relievers to help you press through the agony.

All of which leads Loder to believe that cluster headaches should sit atop the pain scale.

2) Hemorrhage Headache: Headaches associated with bleeding in the brain are “way up there” on the list, according to Loder. There’s just one problem: “Many of these people don’t live to tell us about them, so it’s hard to rank these kinds of things,” she says. Even still, any headache resulting from bleeding in the brain — Loder specifically points to gunshot wounds and aneurysms as potential causes of this — deserves a top spot on the list.

3) Migraine: Migraines are characterized by pounding headaches (often on one side of the head) that can last for days at a time. Worse yet, that pain is often accompanied by nausea, vomiting and extreme sensitivity to light and sound. Women are also three times more likely to experience migraines than men, because hormonal fluctuations — which occur more often in women — can trigger them.

Because migraines are a neurological disorder, if you suffer from migraines, you have a genetic predisposition for your brain cells to misfire (which is the real cause behind the pain associated with migraines). Every migraine sufferer has his or her own set of ‘triggers’ that ignite this hurricane in their brain, but here are a few common triggers: Alcohol, artificial sweeteners, cigarette smoke, hormonal changes, stress, sleep deprivation, dehydration, heat and excessive noise.

All in all, migraines are no fun. Your average over-the-counter pain relievers can be enough to help at least take the sharpest edge from the pain brought on by migraines, but doctors also recommend turning off the lights, applying a hot or cold compress to your head and consuming a small (note: small) amount of caffeine. In tiny amounts, caffeine can help enhance the pain-reducing effects of drugs like Tylenol and Aspirin.

4) Tension-Type Headache: Tension-type headaches are the most common type of headache, and they cause mild to moderate pain that may feel like either a tight band around your head or a weight on top of it. The pain typically lasts for 30 minutes to several days, and these headaches are often triggered by stress. Unlike migraines, tension-type headaches aren’t accompanied by nausea or vomiting, making them the most tolerable (but still painful) headache, according to Loder. Similar to migraines, tension-type headaches can be remedied with a combination of over-the-counter pain relievers and a hot or cold compress.

Now please excuse me while I down an entire bottle of Advil.