Nishimoto Clinic

HEADACHE CARE

Headache care at our clinic

Medically reviewed by Koshiro Nishimoto, MD, PhD (Director)

Updated October 15, 2026

Pichan gently holding one temple, looking slightly troubled

Types of headache

Headaches are broadly divided into primary headaches, in which the headache itself is the disorder, and secondary headaches, caused by another illness or injury.

Among 248 patients: primary headache 88.3%, secondary headache 11.7%. Of all 248 patients, migraine 51.6%, tension-type headache 30.6%, cluster headache 3.6%, and other primary headaches 2.4%.
The chart includes 248 of 281 patients who visited Tokyo Women's Medical University Medical Center East with headache in 2012; 33 patients with cranial neuralgia were excluded. Both rings use the same denominator of 248. This single-center study does not describe our clinic's patients or the general population. Shibata et al., 2014 (PDF)

View larger chart

In this study, primary headaches accounted for 88.3% and secondary headaches for 11.7%. Migraine accounted for 51.6% of the total, or approximately half.

Checking for secondary headache

Secondary headaches can result from infections, head injuries or bleeding in the brain. We first assess for an underlying cause through a clinical examination and CT or other tests when indicated.

Japanese Clinical Practice Guideline for Headache 2021, CQ I-23 and VIII-4 (Japanese PDF)

Main types of primary headache

Migraine

Migraine can cause throbbing pain on one or both sides of the head. Movement may make it worse, and it may be accompanied by nausea or sensitivity to light and sound.

Tension-type headache

This typically causes a heavy, pressing or tightening pain on both sides of the head. Treatment may include pain relievers such as acetaminophen, together with headache exercises and relaxation. Preventive medication may be considered for frequent headaches.

Headache Guideline 2021, CQ III-5–7 (Japanese PDF)

Cluster headache

Cluster headache causes extremely severe pain behind one eye, often with redness or tearing. Attacks recur over a period of time. Acute treatment includes high-concentration oxygen or subcutaneous sumatriptan; verapamil and other medicines may be used for prevention.

Headache Guideline 2021, CQ IV-6–8 (Japanese PDF)

Migraine self-check

When secondary headache is not suspected, we use a migraine screener to assess the possibility of migraine and make a diagnosis together with the symptoms and their course.

Think about your headaches over the past 3 months. Choose how often each statement applied to you.

1. Walking, climbing stairs, or other routine activity made your headache worse, or staying still felt better.
2. You felt nauseated or had an upset stomach during headaches.
3. Light that would not normally bother you felt too bright during headaches.
4. Smells felt unpleasant during headaches.

Migraine treatment with rimegepant

For patients diagnosed with migraine, we offer Nurtec OD (rimegepant) as a treatment option. Nurtec is an oral medicine that blocks the receptor for CGRP, a neuropeptide involved in migraine pain. It suppresses pain signalling mediated by CGRP and is used to treat and prevent migraine attacks.

Japanese Headache Society, new CGRP-related migraine treatments, CQ-10 (Japanese PDF)

Questions or appointments

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