What Is a Headache?
Headaches are among the most common health concerns people experience, and healthcare providers encounter. Though rarely life-threatening, headaches are debilitating and the second leading cause of years lived with disability globally.
Headaches can be acute (short-term) and resolve independently or chronic (long-term), in which pain and other symptoms recur regularly or persist. Chronic headaches, such as tension, cluster, or migraine, may imply a headache disorder.
This article provides an overview of headaches and their symptoms and discusses how to treat and manage them.
Types of Headaches
There are several types of headaches categorized by underlying causes and location. Broadly, they can be divided into primary headaches, considered neurological disorders, and secondary headaches, which occur due to a separate condition.
Primary Headache
Major primary headache disorders include:
Tension headaches are the most common primary headache disorder, affecting both sides of the head or heck, forming a ring around the head at the level of the temples. They arise with no other symptoms.
Migraine headaches are debilitating, throbbing headaches that typically affect one side of the head—migraine attacks last hours to days. People who experience migraines often experience other symptoms like nausea or visual disturbances (aura).
Trigeminal autonomic cephalgias are rare, severe headaches that go through periods of repeated daily attacks and remission. The pain from trigeminal autonomic cephalgias localizes behind one eye or temple, with flares lasting 15 minutes to three hours. Cluster headaches are a type of trigeminal autonomic cephalgia.
Hemicrania continua is a primary headache characterized by continuous pain on one side of the face and head. It also causes other symptoms, such as runny nose and nausea. Hemicrania continua can last anywhere from a few minutes to several days.
New daily persistent headache (NDPH) causes continuous mild to severe pain on both sides of the head, often along with nausea and other symptoms.
Ice pick headaches are a rare primary headache disorder causing a stabbing headache localized around the eye. Attacks are intense but brief, typically resolving within 10 seconds.
Hypnic headaches are mild to moderate headaches that affect both sides of the head. They arise at night and recur regularly. Attacks last 15 minutes to several hours and include other symptoms such as nausea and light or sound sensitivity.
Secondary Headache
Other conditions cause secondary headaches. The most common types of secondary headaches include:
Post-trauma headaches occur following impact to the head and typically arise within 48 hours of the event. Symptoms include dull or throbbing pain, vertigo, dizziness, and memory problems.
Allergy (sinus) headaches arise from inflammation in the sinuses and cause pressure and pain around the nose, temples, and face.
Thunderclap headaches can be primary or secondary headaches. They typically arise and become severe in five minutes and could indicate a serious issue, like brain hemorrhage (bleeding). If you experience a thunderclap headache, seek immediate medical attention.
Medication overuse headaches (MOH) occur when you take too much pain medication for too long. These headaches cause daily or frequent attacks, which go away when you stop taking the medication.
Dehydration headaches are the result of insufficient fluid intake. They may affect the whole head or localize in a specific area, such as the back or front of the head.
The triggers, pain, and duration of headaches and migraines are similar; however, important characteristics distinguish migraines from headaches. Migraines are neurological disorders, occurring independently of other conditions and include other symptoms, such as:
Nausea and vomiting
Sensitivity to light, sound, and smells
Aura
What Do Headaches Feel Like?
Headaches cause a variety of symptoms. Depending on the type of headache you have, you may experience the following:
Steady pain across the temples, back of the head, or across parts of the face
A feeling of pressure, as if a vice were squeezing the head or parts of the face
Throbbing or pulsating pain, sometimes worsening with head motion
Shooting pains in the neck
Nausea and vomiting (often accompanying cluster or migraine)
Light sensitivity (photosensitivity) and sensitivity to sound
Visual disturbances that cause the appearance of zigzags or flashing (auras)
Fatigue
Difficulty concentrating
Tingling, numbness, or weakness in a limb
Double vision
What Causes Headaches?
Headache pain is the result of the stimulation of the trigeminal nerve, which relays sensory signals from the scalp, blood vessels inside and outside of the skull, and the meninges (the membranes that surround and protect the brain), as well as the face, and mouth, neck, ears, eyes, and throat.
When exposed to headache triggers, receptors of the trigeminal nerve called nociceptors relay signals to the brain region responsible for processing pain sensations throughout the body (the thalamus). This physiological process can result from either other diseases, injury, or a primary headache disorder.
What Causes Headaches That Last Multiple Days?
Chronic headaches—those occurring 15 or more days a month—and those that persist multiple are debilitating. Causes of headaches that last multiple days include:
Primary headache disorders: Chronic or standing headaches can be a feature of migraine and hemicrania continua.
Medical overuse headaches: MOHs due to the overuse of pain medications frequently cause chronic headaches.
Stress or mood disorders: Stress is a common headache trigger, and mood disorders, such as depression and generalized anxiety disorder (GAD), can also lead to chronic headaches.
Inflammation: Inflammation or interrupted blood flow around the brain can also cause chronic headaches.
Brain tumor: About 50% of people with cancerous tumors in the brain experience headaches, which can become chronic and persistent headaches.
Traumatic brain injury (TBI): Chronic headaches can also result from TBI when an impact damages the brain.
Certain populations are more at risk for developing primary headache disorders. They are more common among people assigned female at birth, those between the ages of 25 and 50, and people who drink alcohol. People with the following conditions are also at increased risk:
Obesity
High blood pressure (hypertension)
Sleep disorders
Depression
Why Do I Wake Up With a Headache?
Your brain's activity pattern changes as you shift from sleeping to waking, making you more sensitive to pain. Waking up impacts the brain region responsible for sleep cycles and pain processing (the hypothalamus). Factors that lead to morning headaches include alcohol or drug use, sleep apnea (snoring), and insufficient or interrupted sleep.
Headache Triggers
Exposure to certain stimuli and health conditions can trigger headaches. Triggers vary from person to person and depend on your headache type. Here’s a breakdown of commonly reported headache triggers:
Emotional distress or stress
Bright lights
Changes in hormones (e.g., menstruation)
Skipping a meal
Sleep disturbances or sleeping too late
Strong odors (e.g., perfume, smoke)
Alcohol
Certain foods, including cured meats, dark chocolate, aged cheese, and fermented foods
Physical exertion
Neck pain
Pregnancy causes drastic changes in estrogen levels. As a result, primary headaches like migraine, tension headaches, and trigeminal autonomic cephalgia are more common when you’re expecting, especially in the first trimester and postpartum period.
When Does a Headache Indicate Something Serious?
Certain headache symptoms may indicate a severe or life-threatening condition requiring emergency medical attention. Call 911 if you or a loved one experiences the following:
Sudden onset of the “worst” headache you’ve ever had
Headache with loss of consciousness
Cognitive difficulties, such as confusion, memory problems, or changes in personality
Headache following an injury
Severe and sudden headache with stiffness in the neck
Severe pain alongside fever or nausea in the absence of known causes
Neurological signs, such as weakness or numbness in a limb, with headache
Worsening of headaches or spikes in headache frequency
Changes in your headache patterns
Recurring or persistent headaches in children
Convulsions or breathing difficulty alongside headache
A pattern of two or more headaches a week
Sudden onset of chronic headache in those 50 or older
New headaches in those with a history of cancer or human immunodeficiency virus (HIV/AIDS)
Diagnosing a Headache Disorder
There is no specific test for diagnosing headaches. A healthcare provider diagnoses the condition based on a physical assessment and evaluation of your symptoms. They may check vital signs, such as body temperature or blood pressure, to rule out an infection or another condition.
In addition, a healthcare provider, such as a neurologist, will ask about the following:
Your health history
Family history of headache problems
Medications you’re taking
The frequency, timing, intensity, duration, and location of your headaches
Any other symptoms you’re experiencing during attacks (e.g., nausea, light sensitivity, etc.)
Activities that worsen headaches or triggers
Age of the first onset of headaches
Imaging isn’t typically necessary to diagnose a headache disorder. However, a healthcare provider may use imaging or additional tests to rule out stroke, hemorrhage, aneurysm, infections, or blood vessel damage. These approaches include:
Blood or urine analysis
Cerebrospinal fluid (the fluid that surrounds the brain) analysis
Treating Headaches at Home
If you experience a headache, there are some things you can do at home to manage the condition. Steps that you can take include:
Taking a nap
Drinking water
Applying a cold compress to the forehead
Dimming the lights or blocking out light
How to Get Rid of a Headache That Won’t Go Away
Headaches can be difficult, especially if they aren’t going away. If you’re suffering from a persistent headache, such as a migraine or chronic daily headache, medication can help.
Healthcare providers frequently recommend non-steroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen), or other over-the-counter analgesics (painkillers), such as Tylenol (acetaminophen). However, you shouldn’t take these more than three times a week.
A healthcare provider may also prescribe medications to treat persistent headaches, including Ultram (tramadol) and triptans like Onzetra (sumatriptan), Axert (almotriptan), and others.
Tips for Managing Regular Headaches
Frequent or daily headaches can impact your quality of life. However, various strategies can help prevent or reduce the frequency of attacks, including:
Taking preventative medications, such as Lopressor (metoprolol) and Inderal (propranolol)
Keeping a headache journal to track the frequency of headaches, as well as symptoms, medications, and triggers
Sticking to a regular sleep routine and making sure you're getting enough sleep each night
Avoiding alcohol and tobacco
Exercising regularly
Eating a well-balanced diet and avoiding headache triggers
Practicing mindfulness and meditation to promote relaxation and ease stress
Using biofeedback therapy to help identify signs of tension
Participating in cognitive behavioral therapy to develop coping strategies for anxiety
Trying acupuncture, an alternative therapy to promote relaxation through various pressure points in your body