Headaches
Head pain ranging from mild tension to severe migraine
Quick Facts
- Type: Neurological / pain condition
- Most common types: Tension headache, migraine, cluster headache
- Common triggers: Stress, dehydration, poor sleep, certain foods
- Seek emergency care: Sudden worst-ever headache, weakness, confusion
Overview
A headache is pain or discomfort felt anywhere in the head, scalp, or upper neck. Headaches are among the most common health complaints, and almost everyone experiences them at some point. Most are primary headaches, meaning the headache itself is the main problem rather than a symptom of another illness. The three main primary types are tension headaches, migraines, and cluster headaches.
A smaller number are secondary headaches caused by an underlying condition such as a sinus infection, head injury, high blood pressure, medication overuse, or, rarely, a serious problem like bleeding in the brain or meningitis. The vast majority of headaches are not dangerous, but certain warning features should prompt urgent medical attention.
Symptoms
Headache features differ by type and help guide diagnosis.
- Tension headache: a dull, tight, band-like pressure around the head, usually mild to moderate and affecting both sides
- Migraine: throbbing pain often on one side, with nausea, sensitivity to light and sound, and sometimes visual disturbances called an aura
- Cluster headache: severe, piercing pain around one eye occurring in clusters, often with a watering eye and stuffy nose on that side
- Sinus headache: pressure and pain over the cheeks and forehead, often with nasal congestion
Headaches may be accompanied by neck stiffness, fatigue, irritability, or trouble concentrating depending on the cause.
Causes
Headaches arise from activation of pain-sensitive structures in and around the head, such as blood vessels, nerves, and muscles. Causes vary widely.
- Lifestyle and triggers: stress, dehydration, skipped meals, poor sleep, caffeine, and alcohol.
- Muscle tension: tight muscles of the neck and scalp, often from posture or stress.
- Migraine mechanisms: changes in brain chemicals and nerve pathways, often with inherited tendencies.
- Infections and illness: colds, sinus infections, fevers, and viral illnesses.
- Medication overuse: taking pain relievers too often can paradoxically cause ongoing headaches.
- Serious causes (uncommon): high blood pressure crisis, head injury, bleeding in the brain, brain tumor, or meningitis.
Risk Factors
- A family history of migraines or headache disorders
- High stress levels and poor sleep habits
- Skipping meals or inadequate fluid intake
- Frequent use of over-the-counter pain medication
- Hormonal changes, particularly in women around menstruation
- Caffeine, alcohol, and certain dietary triggers
- Eye strain, poor posture, and prolonged screen time
Diagnosis
Most headaches are diagnosed from the history and a physical and neurological examination, without the need for scans.
- Headache history: the pattern, location, triggers, timing, and associated symptoms help identify the type.
- Headache diary: recording attacks, triggers, and treatments can reveal patterns.
- Neurological examination: checks for any signs pointing to a serious underlying cause.
- Imaging (CT or MRI): reserved for warning features such as a sudden severe headache, new headaches in older adults, or abnormal examination findings.
Treatment
Treatment depends on the type and frequency of headaches and combines relieving attacks with preventing them.
- Pain relievers: acetaminophen, ibuprofen, or aspirin for occasional tension headaches and mild migraines, used sparingly to avoid medication-overuse headache.
- Migraine-specific medicines: triptans and other prescription drugs to stop migraine attacks, and newer preventive treatments for frequent migraines.
- Preventive medication: daily medicines for people with frequent or disabling headaches.
- Lifestyle measures: regular sleep, meals, hydration, exercise, and stress management.
- Treating the cause: addressing sinus infection, high blood pressure, or other underlying problems for secondary headaches.
Prevention
- Keep a regular sleep schedule and aim for enough rest
- Stay hydrated and avoid skipping meals
- Identify and avoid personal triggers using a headache diary
- Manage stress with relaxation, exercise, or counseling
- Limit caffeine and alcohol, and avoid overusing pain relievers
- Take regular breaks from screens and maintain good posture
When to See a Doctor
See a doctor for headaches that are frequent, severe, getting worse, or interfering with daily life, or that do not respond to usual treatment. Call emergency services or go to the emergency department immediately for:
- A sudden, severe "worst headache of my life"
- A headache with fever, stiff neck, rash, confusion, or seizures
- A headache with weakness, numbness, vision loss, slurred speech, or difficulty walking
- A headache after a head injury, or one that wakes you from sleep and steadily worsens
Frequently Asked Questions
What are the most common types of headache?
The most common are tension headaches, which feel like a tight band around the head; migraines, which are often throbbing and one-sided with nausea and light sensitivity; and cluster headaches, which cause severe pain around one eye in bursts. Most headaches are not dangerous.
When is a headache a sign of something serious?
Warning signs include a sudden "worst-ever" headache, headache with fever and a stiff neck, or headache with weakness, confusion, vision loss, or slurred speech. These need emergency care, as they can signal bleeding in the brain, meningitis, or a stroke.
Can taking too many painkillers cause headaches?
Yes. Using over-the-counter or prescription pain relievers too often, generally more than a couple of days a week, can lead to medication-overuse or rebound headaches. Cutting back, with medical guidance, usually helps over time.
What can I do to prevent headaches?
Regular sleep, staying hydrated, eating on time, managing stress, limiting caffeine and alcohol, and avoiding overuse of pain relievers all help. Keeping a headache diary can reveal personal triggers to avoid.
When should I see a doctor for headaches?
See a doctor if headaches are frequent, severe, worsening, or interfere with daily life, or if they are new in someone over 50. Seek emergency care for a sudden severe headache or one with neurological symptoms, fever, or a stiff neck.
References
- National Institute of Neurological Disorders and Stroke (NINDS). Headache.
- MedlinePlus, U.S. National Library of Medicine. Headache.
- Mayo Clinic. Headache — Symptoms and causes.
- World Health Organization (WHO). Headache disorders.