Understanding what causes headaches and finding treatments to relieve the pain
Nearly everyone has had headache pain, and most of us have had it many times. A minor headache is little more than a nuisance that's relieved by an over-the-counter pain reliever, some food or coffee, or a short rest. But if your headache is severe or unusual, you might worry about stroke, a tumor, or a blood clot. Fortunately, such problems are rare. Still, you should knowwhen a headache needs urgent careand how to control the vast majority of headaches that are not threatening to your health.
What causes headaches?
Doctors don't fully understand whatcauses most headaches. They do know that the brain tissue and the skull are never responsible since they don't have nerves that register pain. But the blood vessels in the head and neck can signal pain, as can the tissues that surround the brain and some major nerves that originate in the brain. The scalp, sinuses, teeth, and muscles and joints of the neck can also cause head pain.
When to worry about a headache
You can take care of many types of headaches by yourself, and your doctor can give you medication to control most of the tougher headaches. But some headaches call for prompt medical care. Here are some warning signs for when you should worry about headaches:
- Headaches that first develop after age 50
- A major change in the pattern of your headaches
- An unusually severe headache
- Head pain that increases with coughing or movement
- Headaches that get steadily worse
- Changes in personality or mental function
- Headaches that are accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures
- Headaches that are accompanied by a painful red eye
- Headaches that are accompanied by pain and tenderness near the temples
- Headaches after a blow to the head
- Headaches that prevent normal daily activities
- Headaches that come on abruptly, especially if they wake you up
- Headaches in patients with cancer or impaired immune systems
Types of headaches
There are more than 300types of headaches, but only about 10% of headaches have a known cause. The others are called primary headaches. Here is a rundown on some major primary headaches.
Occurring in about three of every four adults, tension headaches are the most common of all headaches. In most cases, they are mild to moderate in severity and occur infrequently. But a few people get severe tension headaches, and some are troubled by them for three or four times a week.
The typical tension headache produces a dull, squeezing pain on both sides of the head. People with strong tension headaches may feel like their head is in a vise. The shoulders and neck can also ache. Some tension headaches are triggered by fatigue, emotional stress, or problems involving the muscles or joints of the neck or jaw. Most last for 20 minutes to two hours.
If you get occasional tension-type headaches, you can take care of them yourself. Over-the-counter pain relievers such as acetaminophen (Tylenol, other brands) and nonsteroidal anti-inflammatories (NSAIDs) such as aspirin, naproxen (Aleve, other brands), or ibuprofen (Motrin, Advil, other brands) often do the trick, but follow the directions on the label, and never take more than you should. A heating pad or warm shower may help; some people feel better with a short nap or light snack.
If you get frequent tension-type headaches, try to identify triggers so you can avoid them. Don't get overtired or skip meals. Learn relaxation techniques; yoga is particularly helpful because it can relax both your mind and your neck muscles. If you clench your jaw or grind your teeth at night, a bite plate may help.
If you need more help, your doctor may prescribe a stronger pain medication or a muscle relaxant to control headache pain. Many people with recurrent tension-type headaches can prevent attacks by taking a tricyclic antidepressant such as amitriptyline (Elavil, generic). Fortunately, most people with tension-type headaches will do very well with simpler programs.
Migrainesoccur less often than tension headaches, but they are usually much more severe. They are two to three times more common in women than men, but that's small consolation if you are among the 6% to 8% of all men who have migraines. And since a Harvard study of 20,084 men age 40 to 84 reported that having migraines boosts the risk of heart attacks by 42%,men with migrainesshould take their headaches to heart.
Neurologists believe that migraines are caused by changes in the brain's blood flow and nerve cell activity. Genetics play a role since 70% of migraine victims have at least one close relative with the problem.
Migraine triggers.Although a migraine can come on without warning, it is often set off by a trigger. The things that set off a migraine vary from person to person, but a migraine sufferer usually remains sensitive to the same triggers. The table lists some of the most common ones.
Major migraine triggers
- Changing weather: rising humidity, heat
- Lack of sleep or oversleeping
- Emotional stress
- Sensory triggers: bright or flickering lights, loud noises, strong smells
- Dietary triggers:
- missing a meal
- alcohol, especially red wine
- nitrates in cured meats and fish
- aged cheese
- an increase or decrease in caffeine
- MSG (often present in Asian and prepared foods)
Migraine symptoms.Migraines often begin in the evening or during sleep. In some people, the attacks are preceded by several hours of fatigue, depression, and sluggishness or by irritability and restlessness. Because migraine symptoms vary widely, at least half of all migraine sufferers think they have sinus or tension headaches, not migraines.
About 20% of migraines begin with one or more neurological symptoms called an aura. Visual complaints are most common. They may include halos, sparkles or flashing lights, wavy lines, and even temporary loss of vision. The aura may also produce numbness or tingling on one side of the body, especially the face or hand. Some patients develop aura symptoms without getting headaches; they often think they are having a stroke, not a migraine.
The majority of migraines develop without an aura. In typical cases, the pain is on one side of the head, often beginning around the eye and temple before spreading to the back of the head. The pain is frequently severe and is described as throbbing or pulsating. Nausea is common, and many migraine patients have a watering eye, a running nose, or congestion. If these symptoms are prominent, they may lead to a misdiagnosis of sinus headaches. One way to remember the features of migraine is to use the word POUND
P is for pulsating pain
O for one-day duration of severe untreated attacks
U for unilateral (one-sided) pain
N for nausea and vomiting
D for disabling intensity.
Without effective treatment, migraine attacks usually last for four to 24 hours. When you're suffering a migraine, even four hours is far too long — and that's why early treatment for a migraine is so important.
Migraine treatment.If you spot a migraine in its very earliest stages, you may be able to control it with nonprescription pain relievers. Acetaminophen, aspirin, ibuprofen, naproxen, and a combination of pain medications and caffeine are all effective — if you take a full dose very early in the attack.
When prescription drugs are needed, most doctors turn to the triptans, which are available as tablets, nasal sprays, or as injections that patients can learn to give to themselves. Examples include sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt). Triptans provide complete relief within two hours for up to 70% of patients; the response is best if treatment is started early. Some patients require a second dose within 12 to 24 hours. Patients with cardiovascular disease and those who take a high dose of certain antidepressants need to discuss the risks of using them with their doctor.
Work with your doctor to find the migraine treatment that works best for you. Remember, though, that overuse can lead to rebound headaches and a vicious cycle of drugs and headaches. So, if you need treatment more than two or three times a week, consider preventive medications.
Migraine prevention.Some people can prevent migraines simply by avoiding triggers. Others do well with prompt therapy for occasional attacks. But patients who suffer frequent migraine attacks often benefit from preventive medications. Effective prescription drugs include beta blockers (such as propranolol, nadolol and atenolol), certain antidepressants (such as amitriptyline), and certain antiseizure medications (such topiramate and valproate). Difficult cases may benefit from referral to a headache specialist.
Cluster headaches are uncommon but very severe headaches, and they occur five times more often in men than women. Although anyone can get cluster headaches, the typical patient is a middle-aged man with a history of smoking.
The problem gets its name because the headaches tend to come in clusters, with one to eight headaches a day during a one- to three-month period every year or two, often at the same time of year. The pain always strikes one side of the head and is very severe. The eye on the painful side is red and watery, the eyelid may droop, and the nose runs or is blocked. The attack starts abruptly and lasts for 30 to 60 minutes. Most sufferers become restless and agitated during the attack; unable to sit still, they pace, jog in place, or beat their head against a wall. Nausea and sensitivity to light and sound may accompany the pain.
Inhaling high flow oxygen soon after the onset of the headache can often stop the attack. Sumatriptan is often effective for cluster headaches, particularly when given by injection. Other triptans may also help. Some patients favor lidocaine nose drops, dihydroergotamine injections, or other treatments. The most effective medication for preventing cluster headache attacks is verapamil, a calcium-channel blocker. Other drugs that may help include divalproex, topiramate, and lithium.
Other types of headaches
Doctors have diagnosed hundreds of conditions associated with headaches. Here are just a few:
Medication headaches.Many drugs number headaches among their side effects. And although it seems paradoxical, many medications used to treat headaches can also cause medication overuse headaches or rebound headaches. Migraine sufferers are particularly vulnerable to a vicious cycle of pain leading to more medication, which triggers more pain. If you have frequent headaches and use medication, OTC or prescription, or both, for more than 10 to 15 days a month, you may have medication overuse headaches. The way to find out is to discontinue or taper your medication — but always consult your doctor first. A corticosteroid such as prednisone may help control pain during the withdrawal period.
Sinus headaches.Acute sinusitiscauses pain over the forehead, around the nose and eyes, over the cheeks, or in the upper teeth. Stooping forward increases the pain. Thick nasal discharge, congestion, and fever pinpoint the problem to the sinuses. When the acute infection resolves, the pain disappears. Sinusitis is not a common cause of chronic or recurrent headaches.
Ice cream headaches.Some people develop sharp, sudden headache pain when they eat anything cold. The pain is over in less than a minute, even if you keep eating. If you are bothered by ice cream headaches, try eating slowly and warming the cold food at the front of your mouth before you swallow it.
Headache from high blood pressure.Except in cases of very high blood pressure, hypertension does not cause headaches. In fact, most people withhigh blood pressuredon'thave any symptoms at all, and a study of 51,234 people reported that hypertension was associated with areducedincidence of headaches. But that's no reason to neglect your blood pressure. Hypertension leads to strokes, heart attacks, heart failure, and kidney disease, so all men should have their pressure checked, and then take steps to correct abnormalities.
Headache from exercise and sex.Sudden, strenuous exercise can bring on a headache. Gradual warm-ups or treatment with an anti-inflammatory medication before exercise can help. Sexual intercourse may also trigger headaches; some men note only dull pain, but others suffer from severe attacks called orgasmic headaches. Some people can prevent orgasmic headaches by taking an NSAID 30 to 60 minutes before intercourse.
Modern medicine depends on tests to diagnose many problems. For most headaches, though, a good old-fashioned history and physical will do the job. In fact, CT scans, MRIs, and EEGs (brain wave tests) look normal in tension-type headaches, migraines, and cluster headaches. Still, these tests can be vital in patients with warning signs or other worrisome headaches.
Living with constant headaches
For most of us, an occasional headache is nothing more than a temporary speed bump in the course of a busy day. Even so, most men can ease the problem with simple lifestyle measures and nonprescription medications. Relaxation techniques, biofeedback, yoga, and acupuncture may also help. But for some of us, headaches are a big problem. Learn to recognize warning signs that call for prompt medical care. Work with your doctor to develop a program to prevent and treat migraines and other serious headaches. And don't fall into the trap of overusing medications; for some gents, rebound headaches are the biggest pain of all.
Image: wavebreakmedia LLC/Getty Images
When should I worry about a headache? ›
Your headache comes on suddenly and is explosive or violent. Your headache is "the 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 24 hours.Why does my head physically hurt when I have a headache? ›
A headache may feel like a pain inside your brain, but it's not. Most headaches begin in the many nerves of the muscles and blood vessels that surround your head, neck, and face. These pain-sensing nerves can be set off by stress, muscle tension, enlarged blood vessels, and other triggers.What is best pain relief for headache? ›
Simple pain relievers available without a prescription are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).What does a brain tumor headache feel like? ›
Every patient's pain experience is unique, but headaches associated with brain tumors tend to be constant and are worse at night or in the early morning. They are often described as dull, "pressure-type" headaches, though some patients also experience sharp or "stabbing" pain.What type of headache is worrisome? ›
Headaches that get steadily worse. Changes in personality or mental function. Headaches that are accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures.What are the red flags for headaches? ›
“Red flags” for secondary disorders include sudden onset of headache, onset of headache after 50 years of age, increased frequency or severity of headache, new onset of headache with an underlying medical condition, headache with concomitant systemic illness, focal neurologic signs or symptoms, papilledema and headache ...What could be the cause of constant headache? ›
Conditions that might cause nonprimary chronic daily headaches include: Inflammation or other problems with the blood vessels in and around the brain, including stroke. Infections, such as meningitis. Intracranial pressure that's either too high or too low.Why does my scalp hurt on top of my head? ›
Burning scalp pain can occur for a variety of reasons. The pain may be stemming from inflammatory skin conditions such as dandruff, fungal infection, psoriasis, or eczema. The pain may also be secondary to an underlying neurological dysfunction, most likely either temporal arteritis or trigeminal neuralgia.What happens to my brain when my head hurts? ›
Headache pain results from signals interacting among your brain, blood vessels and surrounding nerves. During a headache, multiple mechanisms activate specific nerves that affect muscles and blood vessels. These nerves send pain signals to your brain, causing a headache.What gets rid of a headache ASAP? ›
- Turn off the lights. Light and sound can make migraine pain worse. Relax in a dark, quiet room. ...
- Try temperature therapy. Apply hot or cold compresses to your head or neck. ...
- Sip a caffeinated drink. In small amounts, caffeine alone can relieve migraine pain in the early stages.
What is stronger than Tylenol for headaches? ›
Aymen: Nonsteroidal anti-inflammatory medications (NSAIDs) are more powerful compared to acetaminophen because NSAIDs reduce inflammation. Examples of NSAIDs include Motrin, Aleve or Advil.What is better than Tylenol for headache? ›
Here's what experts say. While both are effective in treating tension-type headaches, a few studies show that ibuprofen may be more effective than acetaminophen for treating this condition, says Lauren Natbony, MD, FAHS, at the Icahn School of Medicine at Mount Sinai in New York City.What part of the head hurts with brain tumor? ›
Symptoms that accompany a brain tumor headache
double vision, blurred vision, or a loss of vision. increased pressure felt in the back of the head.
In general, the most common symptoms of a brain tumor may include: Headaches. Seizures or convulsions. Difficulty thinking, speaking or finding words.What are the first warning signs of a brain tumor? ›
- New onset or change in pattern of headaches.
- Headaches that gradually become more frequent and more severe.
- Unexplained nausea or vomiting.
- Vision problems, such as blurred vision, double vision or loss of peripheral vision.
- Gradual loss of sensation or movement in an arm or a leg.
- Difficulty with balance.
The easiest way to differentiate between the two is to pay attention to sensations. A migraine headache produces sensations like auras, flashing lights, or tingling skin, while a stroke-related headache causes sensations to be lost, such as a loss of vision or feeling.What are the 4 types of headache? ›
- Migraine headache.
- Tension headache.
- Hypnic headache.
- Cluster headache.
What are the symptoms? The most common symptom of migraine is the intense throbbing head pain. This pain can be so severe that it interferes with your day-to-day activities. It can also be accompanied by nausea and vomiting, as well as sensitivity to light and sound.What does a stress headache look like? ›
Signs and symptoms of a tension-type headache include: Dull, aching head pain. Sensation of tightness or pressure across the forehead or on the sides and back of the head. Tenderness in the scalp, neck and shoulder muscles.What your headache is trying to tell you? ›
If you're experiencing a headache located in the forehead, it may be another sign of a tension headache. If the pain is only affecting one side of the forehead it may be an indicator of a migraine or cluster headache. Forehead headaches are also commonly caused by infection of the Frontal sinus.
When should you get an MRI for a headache? ›
While many people with migraine don't need an MRI, your doctor might recommend it if you have any headache red flags. These are sudden changes in headache patterns or certain signs that there may be a more serious underlying problem, including: Increase in frequency or changes in the intensity of headache.Is it normal to constantly have headaches everyday? ›
No, it's NOT normal to get headaches everyday
Most people have headaches from time to time. But if you have a headache more days than not, you might have chronic daily headaches, which come in many forms – most of them pretty disabling.
- Alcohol, particularly red wine.
- Certain foods, such as processed meats that contain nitrates.
- Changes in sleep or lack of sleep.
- Poor posture.
- Skipped meals.
A number of sleep or health disorders, as well as personal habits, can trigger a headache when you wake up. Sleep apnea, migraine, and lack of sleep are common culprits. However, teeth grinding, alcohol use, and certain medications can also cause you to wake up with a headache.How often should you wash your hair? ›
Rossi generally tells his patients they should wash their hair once or twice per week. But if you've had chemical treatments that can make your hair drier — such as bleach, perms or relaxers — you might want to wash it less than once weekly to avoid breaking or brittle hair or split ends, he said.Why does my head hurt to touch in one spot? ›
Migraine headaches cause intense, throbbing head pain. These headaches also can make your nerves so sensitive that even the slightest touch hurts. This is called allodynia, which means "other pain." Up to about 80% of people with this condition have allodynia during an attack.What autoimmune diseases cause scalp pain? ›
For this reason, giant cell arteritis is sometimes called temporal arteritis. Giant cell arteritis frequently causes headaches, scalp tenderness, jaw pain and vision problems. Untreated, it can lead to blindness.What neck pain causes headaches? ›
A cervicogenic headache is an example of referred pain. It's a pain in the neck that you feel in your head. People often develop cervicogenic headaches after an injury that causes whiplash or as a result of a pinched nerve in the neck. Arthritis, neck sprains or a neck fracture can also lead to cervicogenic headaches.What causes headache in forehead and eyes? ›
A sinus infection (sinusitis) can cause a headache around your eyes, nose, forehead, cheeks, and upper teeth. This is where your sinuses are. You'll often also have a fever, congestion, and a thick nasal discharge. The pain usually gets worse throughout the day.
Brain Cancer Facts
Some brain tumors do not cause headaches at all, since the brain itself isn't capable of sensing pain. Only when a tumor is large enough to press on nerves or vessels do they cause headache.
What to do when a headache won't go away? ›
See a doctor for a headache that never goes away, and for a constant headache that keeps occurring in the same area of the head. People should seek immediate medical attention if they experience the following: a sudden, severe headache. a headache accompanied by neck stiffness.What pain reliever is better than Tylenol? ›
NSAIDs such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Anaprox) may be more effective than acetaminophen for certain conditions because they reduce inflammation as well as relieve pain.What is better to take for a headache Tylenol or ibuprofen? ›
For most run-of-the-mill headaches, it's usually best to try acetaminophen (Tylenol and generic) first. It doesn't pose the risk of stomach bleeding and heart attack associated with the regular use of most nonsteroidal anti-inflammatory drugs (NSAIDs), a class of painkillers that includes ibuprofen (Advil and generic).How many 500mg Tylenol can I take for a headache? ›
How Many 500 mg Tylenol Can I Take?: The dose of Tylenol 500 mg (Tylenol Extra Strength) is 1 to 2 tablets every four to six hours. The safest maximum daily dose of Tylenol 500 mg for adults is 6 tablets (3000 mg). Never take more than 8 pills (4000 mg) in 24 hours.What is stronger than ibuprofen for headaches? ›
Advil Migraine and Excedrin Migraine are both effective for treating migraines. Research shows that the ingredients in Excedrin Migraine are more effective at reducing migraine pain than ibuprofen. The ingredients in Excedrin Migraine also kick in about 20 minutes faster.Is it okay to take Tylenol everyday for headache? ›
Is it harmful to take Tylenol every day? In short, no — most people can safely take Tylenol within recommended doses every day.How can you tell the difference between a brain tumor and a headache? ›
However, brain tumors cause a specific type of headache that is different than migraine or tension-type headaches. Headaches due to a brain tumor have the following characteristics: unusually severe or persistent, especially in people with no history of severe or chronic headaches. more painful or intense in the ...Where are most brain tumors located? ›
They may occur in many parts of the brain, but most commonly in the cerebrum. People of all ages can develop astrocytomas, but they are more prevalent in adults — particularly middle-aged men.How can you detect a brain tumor at home? ›
- Seizures. Regardless of your type of tumor, seizures are often one of the first signs of trouble. ...
- Clumsiness. ...
- Numbness. ...
- Changes in memory or thinking. ...
- Nausea. ...
- Vision changes. ...
- Not usually headaches. ...
- Everything else you need to know.
Difficulty thinking, speaking, or finding words. Changes in personality or behavior. Weakness, numbness, or loss of movement in one part or one side of the body. Difficulty with balance or dizziness.
What are the two most common presenting symptoms of brain tumor in adults? ›
- headache episodes.
- changes in personality.
- vision problems.
- memory loss.
- mood changes.
- loss of balance.
Brain tumour misdiagnosis can commonly be diagnosed as the following diseases, given the similarity across symptoms a patient suffers with: Alzheimer's disease. Encephalitis. Headaches or migraines.What do brain tumor headaches feel like? ›
Every patient's pain experience is unique, but headaches associated with brain tumors tend to be constant and are worse at night or in the early morning. They are often described as dull, "pressure-type" headaches, though some patients also experience sharp or "stabbing" pain.What are the symptoms of brain tumor in female? ›
- Headaches, which may be severe and worsen with activity or in the early morning.
- Seizures. People may experience different types of seizures. Certain drugs can help prevent or control them. ...
- Personality or memory changes.
- Nausea or vomiting.
- Sleep problems.
- Memory problems.
- new, persistent headaches.
- seizures (epileptic fits)
- feeling sick all the time, being sick, and drowsiness.
- mental or behavioural changes, such as changes in personality.
- weakness or paralysis, vision problems, or speech problems.
Seek immediate medical attention if you're experiencing the worst headache you've ever had, lose vision or consciousness, have uncontrollable vomiting, or if your headache lasts more than 72 hours with less than 4 hours pain-free.How long is it OK to have a headache? ›
Normally, tension headaches are not severe enough to prevent you doing everyday activities. They usually last for 30 minutes to several hours, but can last for several days.How many days is too long for a headache? ›
By definition, chronic daily headaches occur 15 days or more a month, for longer than three months. True (primary) chronic daily headaches aren't caused by another condition. There are short-lasting and long-lasting chronic daily headaches. Long-lasting headaches last more than four hours.Why is my headache not going away? ›
There are numerous potential causes, including migraine, a head injury, or a viral illness, such as COVID-19. Anyone who has a headache for days that does not respond to over-the-counter (OTC) pain relief medication should seek guidance from a doctor.Why am I having headache for 3 days? ›
Common headache triggers include the obvious — like stress and too much alcohol — but they can also be caused by dehydration, bad posture, a lack of sleep, or even strong smells or odors.
What tests does a neurologist do for headaches? ›
An electroencephalogram (EEG) measures your brain waves. Your neurologist will put electrodes, which are small metal discs, on your scalp. This will help your doctor look at your brain activity to see if your pain is from a brain disorder, brain damage, brain dysfunction, or sleep issues.Is 4 days too long for a headache? ›
See your doctor if your headaches are frequent, you've had a headache for more than a few days, or your headaches are causing you stress or worry. Rarely, a headache might be a sign of a serious medical condition.Why won't my headache go away after taking medicine? ›
Taking OTC pain relievers too often, or at a higher dose than advised, could cause more problems. Once the drug wears off, withdrawal symptoms start. This leads to more head pain and the need for more medicine. Doctors call this a rebound headache.What if headache lasts longer than a week? ›
You should seek a professional opinion if you experience a headache that lasts longer than a week. If you are having trouble functioning in daily life or have to frequently take medications to manage the pain, talk with your doctor.Why does my head hurt everyday? ›
Conditions that may cause it include: Inflammation or other problems with the blood vessels in and around the brain. Strokes, in which blood vessels in the brain a blocked, reducing blood flow to the brain. Infections, including meningitis.Is it normal to have a headache every day? ›
Your doctor may need to run tests to make sure these headaches aren't secondary — that is, a symptom of a serious underlying condition. Although daily headaches might not be the result of a dangerous problem, they can affect your quality of life and shouldn't be considered “normal.”Where is stroke headache located? ›
Strokes that start in the carotid artery (a major artery in the neck that brings blood to the brain) can cause a headache in the forehead. 5. Strokes in the vertebrobasilar system (which supplies blood to the back of the brain) may cause a headache at the back of the head.