A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are very rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and sometimes by taking medications.
Pain - head; Rebound headaches; Medication overuse headaches
The most common headaches are likely caused by tight muscles in your shoulders, neck, scalp, and jaw. These are called tension headaches. They are often related to stress, depression, or anxiety.
Overworking, not getting enough sleep, missing meals, and using alcohol or street drugs can make you more likely to get them. Headaches can be triggered by:
- Monosodium glutamate (MSG)
People who drink caffeine can have headaches when they don't get their usual daily amount.
Other common causes include:
- Clenching or grinding your teeth
- Exerting yourself too much
- Holding your head in one position for a long time, like at a computer, microscope, or typewriter
- Poor sleep position
Tension headaches tend to be on both sides of your head. They often start at the back of your head and spread forward. The pain may feel dull or squeezing, like a tight band or vice. Your shoulders, neck, or jaw may feel tight and sore. The pain is usually persistent, but it does not get worse with activity.
Migraine headaches are severe headaches that usually occur with other symptoms such as vision disturbances or nausea. The pain may be described as throbbing, pounding, or pulsating. It tends to begin on one side of your head, although it may spread to both sides.
You may have an "aura" (a group of warning symptoms that start before your headache). The pain usually gets worse as you try to move around. For more information on this type of headache, see: Migraine.
Other types of headaches:
- Cluster headaches are sharp, very painful headaches that tend to occur several times per day for months and then go away for a similar period of time. They are far less common than other types of headaches.
- Sinus headaches cause pain in the front of your head and face. They are due to inflammation in the sinus passages behind the cheeks, nose, and eyes. The pain tends to be worse when you bend forward and when you first wake up in the morning. Postnasal drip, sore throat, and nasal discharge usually occur with these headaches.
Headaches may occur if you have a cold, the flu, fever, or premenstrual syndrome.
If you are over age 50 and are getting headaches for the first time, a condition called temporal arteritis may be the cause. Symptoms of this condition include vision problems and pain that gets worse when you chew. There is a risk of becoming blind with this condition, so you should get treatment right away.
Rare causes of headache include:
Keep a headache diary to help find the source or trigger of your symptoms. Then change your environment or habits to avoid future headaches.
When a headache occurs, write down:
- The date and time the headache began
- What you ate for the past 24 hours
- How long you slept the night before
- What you were doing and thinking about just before the headache started
- Any stress in your life
- How long the headache lasted
- What you did to make it stop
After a period of time, you may begin to see a pattern.
You may relieve a headache by resting with your eyes closed and head supported. Relaxation techniques can help. A massage or heat applied to the back of the upper neck can help relieve tension headaches.
TAKING HEADACHE MEDICATIONS AT HOME
Try acetaminophen, aspirin, or ibuprofen for tension headaches. Do NOT give aspirin to children because of the risk of Reye syndrome.
Migraine headaches may respond to nonsteroidal anti-inflammatory drugs (NSAIDs), or migraine medications that contain a combination of drugs.
If over-the-counter remedies do not control your pain, talk to your doctor about possible prescription medications.
People who take pain medications regularly for 3 or more days a week may develop medication overuse, or rebound headaches. All types of pain pills (including over-the-counter drugs) can cause rebound headaches. If you think this may be a problem for you, talk to your health care provider.
Prescription medications used for migraine headaches include:
- Ergotamine with caffeine (Cafergot)
- Isometheptene (Midrin)
- Triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), eletriptan (Relpax), almotriptan (Axert), and zolmitriptan (Zomig)
Sometimes medications to relieve nausea and vomiting are helpful for other migraine symptoms.
If you get headaches often, your doctor may prescribe medication to prevent headaches before they occur. It is important to take these medicines every day as prescribed, even when you are not having a headache.
When to Contact a Medical Professional
Take the following symptoms seriously. If you cannot see your health care provider right away, go to the emergency room or call 911 if:
- This is the first headache you have ever had in your life and it interferes with your daily activities
- Your headache comes on suddenly and is explosive or violent
- You would describe your headache as "your worst ever," even if you regularly get headaches
- You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache
- Your headache gets worse over a 24-hour period
- You also have fever, stiff neck, nausea, and vomiting with your headache
- Your headache occurs with a head injury
- Your headache is severe and just in one eye, with redness in that eye
- You are over age 50 and your headaches just began, especially if you also have vision problems and pain while chewing
- You have cancer and develop a new headache
See your health care provider soon if:
- Your headaches wake you up from sleep
- A headache lasts more than a few days
- Headaches are worse in the morning
- You have a history of headaches but they have changed in pattern or intensity
- You have headaches often, and there is no known cause
What to Expect at Your Office Visit
Your health care provider will take a medical history and will perform an examination of your head, eyes, ears, nose, throat, neck, and nervous system.
The diagnosis is usually based on your history of symptoms. A "headache diary" may be helpful for recording information about headaches over a period of time. Your doctor may ask questions such as:
- Is the headache located in your forehead, around your eyes, in the back of your head, near your temples, behind your eyeball, or all over?
- Is the headache on one side only?
- Is this a new type of headache for you?
- Would you describe the headache as throbbing?
- Is there a pressure or band-like sensation?
- When does the headache occur?
- How long have you had headaches?
- How long does each headache last?
- Does the headache wake you up from sleep? Are the headaches worse during the day and better at night?
- Did other symptoms begin shortly after the headaches began? Do headaches occur repeatedly?
- Does the headache reach maximum intensity over 1 to 2 hours?
- Are the headaches worse when you are lying down? Standing up?
- Are the headaches worse when you cough or strain?
- Do they occur at a specific time related to your menstrual period?
- What home treatment have you tried? How effective was it?
Diagnostic tests that may be performed include the following:
If a migraine is diagnosed, you may be prescribed medications that contain ergot. Temporal arteritis must be treated with steroids to help prevent blindness. Other disorders are treated as appropriate.
The following healthy habits can lessen stress and reduce your chance of getting headaches:
- Getting enough sleep
- Eating a healthy diet
- Exercising regularly
- Learning proper posture
- Learning to relax using meditation, deep breathing, yoga, or other techniques
- Quitting smoking
- Stretching your neck and upper body, especially if your work involves typing or using a computer
- Wearing proper eyeglasses, if needed
Boes CJ, Capobianco DJ, Cutrer FM, et al. Headache and other craniofacial pain. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 73.
Kwiatkowski T, Alagappan K. Headache. In: Marx JA, Hockberger Rs, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 101.
Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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