Headaches are common and vary in the types of pain and associated symptoms experienced and as well as how long they last. Most headaches are a temporary annoyance and can be relieved with self-care, but some types of headache can indicate something more serious.
Headache pain can occur on one or both sides of the head and can be isolated to a certain location or radiate across the head from a focal point.
There are many different types of headache, including tension headache, migraine, and sinus headache. Stress, tiredness, hunger, eyestrain, noise, or bright light are common triggers for a headache to develop.Most headaches are mild and short-lived and not a reason for concern. However, a severe or unusual headache can be a symptom of an underlying illness or even a life-threatening condition requiring emergency care.
Different types of headache can be categorised by their cause: A primary headache is due to the headache condition itself, rather than another cause, while a secondary headache is a result or symptom of another health condition.
Primary headaches include tension headache, migraine, and cluster headache. They are caused by problems with pain-sensitive structures in the head, such as blood vessels in the head and neck, tissues that surround the brain, and nerves in the brain. In addition, the scalp, sinuses, teeth, and muscles and joints of the neck can also cause head pain.
Tension headache is the most common type of headache. It is often stress-related and usually due to tight muscles in your shoulders, neck, scalp, and jaw. A typical tension headache is described as a mild to moderate, dull, squeezing pain or tightness on both sides of the head, sometimes accompanied by muscle stiffness in the neck and shoulder.
Migraines are less common than tension headaches but are usually more severe. They are caused by changes in the brain’s blood flow and nerve cell activity and are set off by specific triggers. A typical migraine is described as throbbing pain on one side of the head and is often accompanied by visual disturbances including halos, sparkles or flashing lights, and wavy lines.
Cluster headaches are less common than both tension headache and migraine. They are sudden and severe pain attacks, often in or around one eye or on one side of the head, that occur in clusters, daily or several times a day over a period of weeks.
Other types of primary headache, but which could also be a symptom of an underlying disease (i.e. secondary headaches) are ice cream headaches (‘brain freeze’) in which some people develop sudden, short-term, intense headache pain when they eat something cold, and exercise and sex headaches in which sudden strenuous exercise or sexual intercourse can bring on headache pain.
Some primary headaches can be triggered by lifestyle factors, including:
- Drinking alcohol
- Eating certain foods, notably processed foods that contain nitrates and monosodium glutamate (MSG)
- Lack of sleep or changes in sleep patterns
- Poor posture
- Missing meals
Headaches caused by alcohol or substances in certain foods are also known as toxic headaches.
A secondary headache is a symptom of a disease or health condition that activates pain-sensitive nerves of the head. There are many possible causes of secondary headaches, some of which are:
- Abnormal formation of brain blood vessels (arteriovenous malformation)
- Encephalitis (inflammation of the brain)
- Brain cancer
- Dental issues
- Ear infection (middle ear)
- Influenza (flu)
- Intracranial haemorrhage (bleeding within the skull)
- Increased intracranial pressure (including as a result of fluid build-up around the brain (hydrocephalus)
- Certain medications used to treat other disorders
- Overuse of pain relievers, which can result in rebound headache
- Neuralgia (pain due to irritated or damaged nerves), post-herpetic neuralgia associated with shingles
- Panic attacks and panic disorder
- Acute sinusitis (sinus infection). Sinus headaches are a common type of headache, which are caused by inflammation and congestion of the sinus cavities
- Venous thrombosis (blood clot in the brain)
- Pressure from tight headgear, such as a helmet or goggles (known as external compression headaches)
Diagnosis and treatment
A doctor should be consulted if a headache comes on abruptly, gets steadily worse or doesn’t go away after self-care; or if headaches occur more often than usual, are more severe than usual, or prevent normal daily activities. A doctor should also be seen for headaches that develop after a blow to the head.
The doctor will review your medical history and may conduct physical and neurological tests to try to identify a headache’s cause.
Your description of the pain (constant/pulsating, sharp/dull), its intensity and location may help pin-point possible causes. MRI or CT scans might be recommended for unusual or complex headaches to rule out potentially serious causes of head pain such as tumours.
Emergency care: A headache may be a symptom of a health condition such as meningitis or a stroke that needs immediate medical attention. Emergency care should be sought for an extremely painful headache or a headache that is accompanied by any of the following symptoms:
- Drowsiness, confusion, or difficulty understanding speech
- Numbness or weakness in arms or legs
- Neck pain/stiffness or a rash
- Difficulty waking up
- A seizure or fit
- Nausea or vomiting
- Visual disturbances
- Slurred speech
- Difficulty walking.
Self-care recommendations to reduce the frequency, duration or severity of headaches include the following:
- Avoid things that you know can trigger your headaches (e.g., alcohol, chocolate, processed meats)
- Stay hydrated, e.g. by drink water regularly throughout the day
- Don’t miss or delay meals
- Try not to smoke
- Don’t drink alcohol
- Avoid straining your eyes, e.g. by looking at a screen for a long time
- Take over-the-counter pain relievers, such as paracetamol or ibuprofen
- Lie in a dark, quiet room
- Alternate warm and cool compresses on your forehead or back of your neck
- Have someone gently massage your neck, temples, scalp, back of head, and shoulders
- Have a warm bath to relax.
Education on recognising and managing headache triggers, stress management, relaxation techniques, deep-breathing exercises, biofeedback, yoga, acupuncture, and physical therapy may also help.
Taking non-steroidal anti-inflammatory drugs (NSAIDs) before exercise or sexual intercourse can help to prevent exercise headaches and sex headaches.
Further information and support
Freephone: 0800 611 116
Cleveland Clinic (2015). Headache treatment: Overview (Web Page). Cleveland, OH: Cleveland Clinic. https://my.clevelandclinic.org/health/articles/8262-headache-treatment-overview [Accessed: 09/10/18]
Harvard Health Publishing (2018). Headache: When to worry, what to do. Boston, MA: Harvard Medical School of Harvard University. https://www.health.harvard.edu/pain/headache-when-to-worry-what-to-do [Accessed 10/10/18]
Mayo Clinic (2018). Headache (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/symptoms/headache/basics/definition/sym-20050800 [Accessed: 09/10/18]
Ministry of Health (2012). Headache (Web Page). Wellington: New Zealand Government Ministry of Health. https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/headache [Accessed: 09/10/18]
NHS inform (2018). Headaches (Web Page). Glasgow: National Health Information Service, National Health Service (NHS) Scotland. https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/headaches [09/10/18]
Updated: December 2018