Headache

What is a headache?

A headache is a pain or throbbing in the head or face. Almost everyone will experience headaches at some time. The most common types of headache are tension headaches and migraines.

People understandably worry if their headache symptoms seem different - either particularly severe, more frequent or unusual in any other way. The most common worry is that the headache is a symptom of a brain tumour.

Headaches may be associated with other symptoms. The pattern of symptoms can help to make the diagnosis - the history (what you tell the doctor) is usually much more important than any examination that they might make. Other symptoms include:

• Nausea or vomiting.

• Dislike of light or loud music.

• Pain on the face.

• Dizziness.

• Focal neurological signs - these are when a part of your nervous system seems not to work, for example, slurred speech, blurred vision, a dark curtain coming down in front of your eye or falling to one side when you walk.

• Runny nose.

• Droopy eyelids.

• Red or watery eye.

Headaches can be primary, or they can be secondary. Secondary headaches are a side effect of a separate illness or injury.

Primary headaches

Types of primary headaches include:

Tension headaches

• These are the most common type of headache and are usually felt as a band or pressure across the forehead.

• They can last for several days.

• They can be uncomfortable and tiring but they do not usually disturb sleep.

• Most people can carry on working with a tension headache.

• They tend to worsen as the day progresses and are not usually made worse by physical activity, although it's not unusual to be a bit sensitive to bright light or noise.

Migraines

• These are also very common.

• A typical migraine is one-sided and throbbing, usually above or behind one eye.

• Headaches that are one-sided, headaches that cause throbbing pain and headaches that cause nausea are more likely to be migraines than anything else.

• Migraines usually ask for at least four hours - a headache that goes away much more quickly than that is unlikely to be a migraine.

• Migraines are often severe enough to be disabling. Some patients need to go to bed to sleep off their headache. They very often cause extreme sensitivity to light and sound.

Cluster headaches

• Cluster headaches are very severe and have been known to cause suicidal thoughts because the pain is so bad.

• They occur in clusters, often every day for a number of days or even weeks. They then disappear for months on end. They are uncommon and tend to occur particularly in adult male smokers.

• They are one-sided headaches which are very disabling (they prevent regular activity). People often describe them as the worst pain they have ever felt.

• Patients often have a red watery eye on the affected side, a stuffy runny nose and a droopy eyelid.

Chronic tension headaches

• Chronic tension headache (or chronic daily headache) is usually caused by muscle tension in the back of the neck and affects women more often than men.

• The word chronic means that the condition is persistent and ongoing; many people use it to mean 'very severe', but this isn't actually its medical meaning.

• These headaches can be started by neck strain (for example, sitting awkwardly at a computer for hours per day) or tiredness and may be made worse by medication overuse (see below).

• When headaches occur almost every day for three months or more, this is called a chronic daily headache.

Exertional headaches/sexual headaches

• Exertional headaches are headaches associated with physical activity.

• They can become severe very quickly after a strenuous activity such as running, coughing, having sex (intercourse), or straining with bowel movements.

• They are more commonly experienced by patients who also have migraines or who have relatives with migraine.

• Headaches related to sex particularly worry patients. They can occur as sex begins, at orgasm, or after sex is over. Headaches at orgasm are the most common type. They tend to be severe, at the back of the head, behind the eyes, or all over.

• Exertional and sexual intercourse-related headaches are not usually a sign of serious underlying problems. Very occasionally they can be a sign that there is a leaky blood vessel on the surface of the brain and so a bad first exertional or sex related headache should prompt you to seek urgent medical attention. Once a leaky blood vessel has been ruled out, other episodes shouldn't cause worry.

Primary stabbing headaches

• Primary stabbing headaches are sometimes called 'ice-pick headaches' or 'idiopathic stabbing headache'. The term 'idiopathic' is used by doctors for something that does not have a clear cause.

• These are short, stabbing headaches which are very sudden and severe. They usually last between 5 and 30 seconds, at any time of the day or night. They feel as if a sharp object (like an ice pick) is being stuck into the head.

• They often occur in or just behind the ear and they can be quite frightening.

• Although they are not migraines they are more common in people who have migraines - almost half of people who experience migraines have primary stabbing headaches. They are often felt in the place on the head where the migraines tend to occur.

• Primary stabbing headaches are too short to treat although migraine prevention medications may reduce their frequency.

Hemicrania continua

• Hemicrania continua is a primary chronic daily headache.

• It typically causes a continuous but fluctuating head pain on one side. The pain is usually continuous with episodes of more severe pain, which can last between 20 minutes and several days.

• During these episodes of severe pain there may be other symptoms such as watering or redness of the eye, runny or blocked nose, and drooping of the eyelid, all on the same side as the headache. Similar to migraine, there may also be sensitivity to light, feeling sick (nausea) and being sick (vomiting).

• The headaches do not go away on their own but there may be periods without the headache. However, hemicrania continua headaches respond well to a medicine called indometacin.

Secondary headaches

Types of secondary headaches include:

Thunderclap headaches

• Thunderclap headaches start very suddenly and are very painful, often described as being hit with a hammer.

• Pain reaches a maximum within about one minute; the headache lasts at least five minutes but sometimes much longer.

• It is important to seek medical attention immediately because thunderclap headaches may be caused by a serious underlying health condition, such as a subarachnoid haemorrhage.

Medication-overuse headaches

• Medication-overuse headache (medication-induced headache or 'rebound headache') is an unpleasant and long-lasting headache. It is caused by taking painkilling medication - usually for headache.

• The reason for this is that when pain is chronic (long-lasting), the nerves in the body respond differently to when pain is acute (short-lasting). This means that usual painkillers don't work, even if taken at high dose.

• Medication-overuse headaches are the most common cause of secondary headache. These headaches can be treated but require stopping of the painkillers which can be difficult in the short-term.

Post-traumatic headache (PTH)

• This is a headache which occurs after trauma, such as an accident, or within one week of surgery which involves cutting into the skull (craniotomy).

• It can be acute (short-lasting) or chronic (long-lasting).

• Chronic PTH is associated with past trauma, insomnia and a history of loss of consciousness.

Stroke

• Some people will have a persistent headache after they have a stroke.

• This is more common in women than in men, and in those who have had a headache disorder before their stroke.

• A stroke itself is a painless event; acute strokes do not produce headaches.

Cerebral venous sinus thrombosis

• This is a rare type of stroke, caused by a blood clot in an area of the brain, which stops blood from draining out of the brain.

• It can present with a non-specific headache that has no obvious features which would suggest a stroke.

• It is more common in women (particularly during or soon after pregnancy) and is associated with medications that increase blood clot risk (for example, combined hormonal contraception).

• It is also a rare complication of some vaccines.

Giant cell arteritis (GCA)

• This is a headache caused by inflammation in an artery.

• It presents with a very typical headache which is felt in the temples (the side of the head) and usually only seen in those who are aged over 50.

• It is associated with pain in the jaw when chewing and a problem with the vision, where it feels as if a dark curtain is coming down over the eye.

• GCA is a medical emergency - urgent high dose steroids are needed or there is a risk of permanent blindness.

Malignant hypertension

• In most cases, it is an urban myth that hypertension (raised blood pressure) causes headaches. It is usually the other way round - raised blood pressure is a normal reaction to pain, so someone has a headache for another reason, checks their blood pressure and finds it to be high.

• Those with malignant hypertension, where the blood pressures is dangerously high, may have a headache (but not always). Malignant hypertension needs treatment in hospital.

Headaches due to respiratory infection

• Infections such as colds and flu can cause a headache and stuffed-up feeling in the face and head. They are usually treated with over-the-counter medication such as paracetamol; you don't need to see a doctor unless you are very dehydrated or have other symptoms.

• Sinusitis is also an infection of the respiratory tract - it causes pain particularly in the face, which may be worse when bending over. It also often resolves on its own.

Acute glaucoma

• Acute glaucoma is caused by a sudden increase in the pressure in the eye.

• The headache of acute glaucoma usually comes on suddenly and is associated with blurred vision and seeing halos around lights.

• It may cause nausea and vomiting.

• It is a medical emergency.

Headaches can be caused by a variety of lifestyle triggers, environmental triggers, and certain medical conditions.

Lifestyle triggers

Common lifestyle triggers include:

• Dehydration (lack of fluid in the body).

• Drinking alcohol (especially during a hangover).

• Caffeine.

• Poor sleep.

Medical conditions

Some medical conditions can cause headaches - these are listed under 'secondary headaches' above. A headache can also be a side-effect of some medication.

There are a number of ways to try to prevent headaches or to help get rid of a headache. These include:

• Drinking enough fluids but avoiding or limiting alcohol.

• Getting enough sleep and avoiding screen time (TV, computers, etc) before going to bed.

• Drinking a small amount of caffeine.

• Applying a cold pack to the eyes or head.

• Having a warm bath or shower.

• Staying in a darkened, quiet room.

• Trying methods to help relaxation, such as mindfulness, breathing exercises, lavender oil, meditation, or yoga.

• Trying acupressure, acupuncture, massage, or osteopathic or chiropractic treatments.

• Taking simple pain relief, such as paracetamol, ibuprofen, or aspirin. (Aspirin cannot be taken by children under the age of 16.)

No one method works for everyone or every headache so it is sensible to experiment with different options.

How do you stop a headache fast?

To get rid of a headache fast, try resting, staying hydrated, and taking over-the-counter painkillers such as paracetamol or ibuprofen. Using a cool compress or gentle neck stretches can also help, but see a doctor if headaches are severe, sudden, or do not improve.

Most headaches aren't serious, however, a few are and need urgent medical attention. These include:

Bleeding around the brain (subarachnoid haemorrhage)

• Subarachnoid haemorrhage is a very serious condition which occurs when a small blood vessel bursts on the surface of the brain.

• People develop a severe headache and stiff neck and may become unconscious. This is a rare cause of severe headache.

Meningitis and brain infections

• Meningitis is infection of the tissues around and on the surface of the brain and encephalitis is infection of the brain itself.

• Brain infections can be caused by germs called bacteria, viruses or fungi and they are thankfully rare.

• They can cause a severe, disabling headache.

• Usually people are sick (vomit) and cannot bear bright light (this is called photophobia). Often they have a stiff neck, too stiff for the doctor to be able to bend the head down so that the chin touches the chest (even if trying to relax). People with meningitis or encephalitis are usually also unwell - hot, sweaty and ill.

Giant cell arteritis (temporal arteritis)

• Giant cell arteritis (temporal arteritis) is usually only seen in people over the age of 50.

• It causes a headache on the sides of the head (the temples) which sometimes also goes to the scalp and the jaw. It can cause pain on chewing or on brushing or combing the hair.

• It is caused by swelling (inflammation) of the arteries in the temples and behind the eye.

• Temporal arteritis is serious because if it is not treated it can cause sudden loss of vision.

• Diagnosis of temporal arteritis is made by a specialist. Treatment is with a course of steroids and they are typically needed for many months.

Brain tumours

• Brain tumour is a very uncommon cause of headaches - although most patients with long-lasting, severe or persistent headaches start to worry that this may be the cause.

• In reality, if someone with long-term headaches is then diagnosed with a brain tumour, this is more likely to be a coincidence than to be related to the long-term headaches.

• Usually the headache of brain tumours is present on waking in the morning, is worse on sitting up, and gets steadily worse from day to day, never easing and never disappearing. It can sometimes be worse on coughing and sneezing (as can sinus headaches and migraines).

Most headaches don't have a serious underlying cause.

The things which would suggest to a clinician that a headache might need further investigation include the following. They do not mean that the headache is serious or sinister but they mean that the clinician might wish to do some further checks to be sure:

• There has been a significant head injury in the previous three months.

• The headaches are worsening and accompanied by high temperature (fever).

• The headache started very suddenly.

• Problems with speech and balance have developed along with the headache.

• There are problems with memory or changes in behaviour or personality as well as headache.

• The headaches are accompanied by confusion or feeling muddled.

• The headache started on coughing, sneezing or straining.

• The headache is worse when you sit or stand.

• The headache is associated with red or painful eyes.

• The headaches are not like anything experienced before.

• There is unexplained vomiting with the headache.

• There is reduced immunity - for example, if in someone with HIV, or who is on oral steroid medication or immune suppressing drugs.

• The person has or has had a cancer that can spread through the body.

To help prevent a headache, you should:

• Manage stress levels well.

• Eat a balanced, regular diet.

• Take balanced regular exercise.

• Pay attention to posture and core muscles.

• Sleep on two pillows or fewer.

• Drink plenty of water.

• Have plenty of sleep.

Any of these should improve health and well-being and reduce the number of headaches.

Most headaches, whilst unpleasant, are harmless and respond to simple measures. Migraine, tension headache, and medication-overuse headache are all very common. Most of the population will experience one or more of these. Working out the underlying cause of any headaches is often the best way to solve them.

Most headaches go away by themselves. It is very rare for them to be a sign of a serious or sinister underlying condition.

Medical advice should be sought for a headache that is unusual or headaches which are particularly severe or stop regular activities, those which are associated with other symptoms like weakness or tingling, and those which cause a sore scalp (especially over 50 years of age).

Finally, seek medical attention for a morning headache which is present for several days, which does not go away or is getting gradually worse.

Why do I wake up with a headache?

You may wake up with a headache due to poor sleep, dehydration, alcohol, or teeth grinding at night. Most morning headaches are not serious, but if they are severe, frequent, or come with other symptoms, you should speak to a doctor.

Why am I getting headaches everyday all of a sudden?

Sudden daily headaches can be caused by stress, dehydration, poor sleep, eye strain, or medication overuse. They can also be a sign of an underlying condition. You should see a doctor if your headaches are sudden, severe, or persistent.

What's the difference between a headache and a migraine?

A headache is pain or pressure in the head, that is often mild to moderate. A migraine is a stronger type of headache that can cause throbbing pain, nausea, sensitivity to light or sound, and may last for hours or days.

Can toothache cause a headache?

Yes. Toothache can sometimes cause a headache because the nerves in your teeth and jaw are closely connected to the nerves in your head and face. Problems such as tooth decay, gum infection, or grinding your teeth can lead to pain that spreads to the temple, forehead, or behind the eyes.

Can high blood pressure cause a headache?

Usually, high blood pressure does not cause headaches. Most people with high blood pressure have no symptoms at all. Headaches from high blood pressure are rare and typically only occur if blood pressure becomes extremely high, such as in a hypertensive crisis, which is a medical emergency.