Headaches Causes, Types, Symptoms, Diagnosis, Treatment and FAQs

What is a headache?

Headache is defined as a pain arising from the head or upper neck of the body. The pain originates from the tissues and structures that surround the skull or the brain because the brain itself has no nerves that give rise to the sensation of pain (pain fibers). The thin layer of tissue (periosteum) that surrounds bones, muscles that encase the skull, sinuses, eyes, and ears, as well as thin tissues that cover the surface of the brain and spinal cord (meninges), arteries, veins, and nerves, all can become inflamed or irritated and cause headache. The pain may be a dull ache, sharp, throbbing, constant, intermittent, mild, or intense.

Headaches can occur as a result of many conditions. There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society. Causes of headaches may include dehydration, fatigue, sleep deprivation, stress, the effects of medications, the effects of recreational drugs, viral infections, loud noises, common colds, head injury, rapid ingestion of a very cold food or beverage, and dental or sinus issues. Treatment of a headache depends on the underlying cause, but commonly involves pain medication. A headache is one of the most commonly experienced of all physical discomforts.

Symptoms

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. They include:

Chronic migraine
Chronic tension-type headache
New daily persistent headache
Hemicrania continua

Chronic migraine

This type typically occurs in people with a history of episodic migraines. Chronic migraines tend to:

Affect one side or both sides of your head
Have a pulsating, throbbing sensation
Cause moderate to severe pain

And they cause at least one of the following:

Nausea, vomiting or both
Sensitivity to light and sound

Chronic tension-type headache

These headaches tend to:

Affect both sides of your head
Cause mild to moderate pain
Cause pain that feels pressing or tightening, but not pulsating

New daily persistent headache

These headaches come on suddenly, usually in people without a headache history. They become constant within three days of your first headache. They:

Often affect both sides of your head
Cause pain that feels like pressing or tightening, but not pulsating
Cause mild to moderate pain
Might have features of chronic migraine or chronic tension-type headache

Hemicrania continua

These headaches:

Affect only one side of your head
Are daily and continuous with no pain-free periods
Cause moderate pain with spikes of severe pain
Respond to the prescription pain reliever indomethacin (Indocin)
Can become severe with development of migraine-like symptoms

In addition, hemicrania continua headaches are associated with at least one of the following:

Tearing or redness of the eye on the affected side
Nasal congestion or runny nose
Drooping eyelid or pupil narrowing
Sensation of restlessness

Types of headaches

Several different headache types exist. Examples of these headache types include:

Tension headaches

Tension headaches are the most common type of headache and occur most frequently in women over age 20. These headaches are often described as feeling like a tight band around the head. They are caused by a tightening of the muscles in the neck and scalp. Poor posture and stress are contributing factors.

Tension headaches usually last for several minutes, but in some cases, they can last for several days. They also tend to be recurrent.

Cluster headaches

Cluster headaches are non-throbbing headaches that cause excruciating, burning pain on one side of the head or behind the eye. They usually cause the eyes to tear up and produce nasal congestion or rhinorrhea (runny nose). These headaches can last for extended periods of time, known as the cluster period. The cluster period can be as long as six weeks.

Cluster headaches may occur every day and more than once a day. The cause is unknown; however, this type headache is rare and generally affects men age 20 to 40.

Migraine headaches

Migraine headaches are severe headaches that can cause throbbing, pounding pain, usually on one side of the head. Several different types of migraine headache exist. This includes chronic migraines, which are migraines that occur 15 or more days a month.

Hemiplegic migraines are those with symptoms resembling that of a stroke. A person can even experience migraines without head pain, which means they have migraine symptoms such as nausea, visual disturbances, and dizziness, but without head pain.

Rebound headaches

Rebound headaches are those that occur after a person stops taking medications they used regularly to treat headaches. A person is more likely to experience rebound headaches if they take medications such as acetaminophen, triptans (Zomig, Imitrex), ergotamine (Ergomar), and painkillers (like Tylenol with codeine).

Thunderclap headaches

Thunderclap headaches are abrupt, severe headaches that often come on very quickly. They will usually appear without warning and last up to five minutes. These headache types can signal an underlying problem with blood vessels in the brain and often require prompt medical attention. A significant number of headache types exist. Learn more about 10 of the most common headache types.

Headache vs. migraine

Migraines are the most severe and complex type of headache. Researchers believe they may be caused by changes in the activity of nerve pathways and brain chemicals. Genetic factors and environmental factors are also thought to affect a person’s susceptibility to developing migraines.

Migraines are very intense, throbbing headaches that affect one side of the head. They can also increase sensitivity to light and noise. They may last anywhere from several hours to several days.

Incidence and types of migraines

According to the Migraine Research Foundation, nearly 1 out of every 4 households in the United States includes someone with a migraine. Migraines are one of the top 20 most disabling illnesses in the world.

Among adolescents, migraines are more common in boys than in girls. Among adults, however, migraines occur more frequently in women than in men. They are also more likely to affect those who have family members that often experience migraines.

There are two basic types of migraine headaches: migraine with aura and migraine without aura. Auras are visual disturbances that consist of bright spots, flashing lights, or moving lines. In some cases, auras cause a temporary loss of vision. These visual disturbances occur about 30 minutes before the migraine begins and can last for 15 minutes.

Migraine with aura tends to be less severe and disabling than migraine without aura. However, most people experience migraine without aura.

Hemiplegic migraines are another type of migraine. These migraines are accompanied by stroke-like symptoms, such as slurred speech and numbness or weakness on one side of the body.

Migraine phases

Migraines have three phases: prodrome, peak headache, and postdrome.

Prodrome is the period leading up to the migraine. This is the time when auras can occur. The prodrome phase may affect concentration, mood, and appetite. This phase may also cause frequent yawning.

Peak headache is the period when migraine symptoms become the most severe. This phase may last for several minutes.

Postdrome is the 24-hour period after the migraine. During this time, drowsiness can occur and mood can fluctuate between feelings of sadness and feelings of joy.

Migraine triggers

The exact cause of migraines isn’t known. However, there are numerous factors that are known to trigger the onset of migraine episodes. These include:

fluctuating hormone levels, especially among boys going through puberty, and women
stress or anxiety
fermented and pickled foods
cured meats and aged cheeses
certain fruits, including bananas, avocados, and citrus
skipped meals
too little or too much sleep
bright or strong lights
fluctuations in atmospheric pressure due to changing weather
alcohol consumption
caffeine withdrawal

How are headaches classified?

There are three major categories of headache based upon the source of the pain.

Primary headaches
Secondary headaches
Cranial neuralgias, facial pain, and other headaches

What are primary headaches?

Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headaches.

Tension headaches are the most common type of primary headache. Tension headaches occur more commonly among women than men. According to the World Health Organization, 1 in 20 people in the developed world suffer with a daily tension headache.
Migraine headaches are the second most common type of primary headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected.
Cluster headaches are a rare type of primary headache. It more commonly affects men in their late 20s, though women and children can also suffer from this type of headache.

Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitating. While these headaches are not life threatening, they may be associated with symptoms that can mimic strokes.

Many patients equate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. Read our Migraine Headache article for more information about the symptoms, causes, and treatment of migraines.

A headache can sometimes be a symptom of a disease or other medical condition. A doctor may be able to determine the underlying cause of a headache by taking a medical history and performing a physical examination. This exam should include a complete neurological evaluation.

Taking a comprehensive history is also important, as the sudden absence of medication and certain foods can cause recurrent headaches. For example, heavy coffee drinkers who suddenly stop drinking coffee can experience headaches.

A doctor may also order diagnostic tests if they suspect that a certain medical condition is causing the headaches. These tests might include:

complete blood count (CBC), a blood test that can show signs of an infection
skull X-rays, an imaging test that provides detailed pictures of the bones of the skull
sinus X-rays, an imaging test that may be performed if sinusitis is suspected
head CT or MRI scan, which might be done in cases where stroke, trauma, or blood clots on the brain are suspected

When to see a doctor

Most headaches aren’t symptoms of a life-threatening illness. However, you should contact your doctor if a headache occurs after head trauma. You should also call your doctor immediately if a headache is accompanied by the following symptoms:

drowsiness
fever
vomiting
facial numbness
slurred speech
weakness in an arm or a leg
convulsions
confusion

Pressure around the eyes with a yellowish-green nasal discharge and sore throat also should be evaluated by your doctor.

Headache treatment

Treatment for headaches varies according to the cause. If headaches are being caused by an illness, then it’s likely that the headaches will go away once the underlying condition is treated. However, most headaches aren’t symptoms of serious medical conditions and can be successfully treated with over-the-counter medications, such as aspirin, acetaminophen (Tylenol), or ibuprofen (Advil).

If medications aren’t working, there are several other remedies that can help treat headaches:

Biofeedback is a relaxation technique that helps with pain management.
Stress management classes can teach you how to cope with stress and how to relieve tension.
Cognitive behavioral therapy is a type of talk therapy that shows you how to recognize situations that make you feel stressed and anxious.
Acupuncture is an alternative therapy that may reduce stress and tension by applying fine needles to specific areas of your body.
Mild to moderate exercise can help increase the production of certain brain chemicals that make you feel happier and more relaxed.
Cold or hot therapy involves applying a heating pad or ice pack to your head for 5 to 10 minutes multiple times a day.
Taking a hot bath or shower can help relax tense muscles.

Preventive treatment is used when headaches occur three or more times per month. Sumatriptan is a drug that’s commonly prescribed for the control of migraine headaches. Other medications that can be used to treat or prevent chronic migraine or cluster headaches are:

beta blockers (propranolol, atenolol)
verapamil (calcium channel blocker)
methysergide maleate (helps to reduce blood vessel constriction)
amitriptyline (antidepressant)
valproic acid (anti-seizure medication)
dihydroergotamine
lithium
topiramate

The U.S. Food and Drug Administration (FDA) also recently approved the use of the drug Aimovig, which belongs to a class of medications called calcitonin gene-related peptide (CGRP) monoclonal antibodies. These medications specifically target the causes of migraines.

Other medications used to treat migraines usually treat another condition, yet may offer some relief from migraines. Several other similar medications are also in the research stages at this time.

You and your doctor can discuss which specific treatment would be best for relieving your headaches.

Headache natural remedies

Some people may choose to manage or attempt to treat and prevent their headaches through taking vitamins and herbs. You should always talk to your doctor before starting any new medications to make sure they don’t negatively interact with something you’re already taking. Some natural remedies a person may take to reduce headaches include:

Butterbur. Extracts from this shrub have been shown to reduce the frequency at which migraines occur, according to the National Institutes of HealthTrusted Source. While people generally tolerate the herb well, there have been some reports of allergic reactions in those allergic to ragweed, marigolds, daisies, and chrysanthemums.
Coenzyme Q10. Taking 100 milligrams (mg) of this enzyme three times a day (or taking a single 150-mg dose per day) may reduce the frequency of migraine headaches, according to the University of Minnesota.
Feverfew. Feverfew is an herb that can potentially decrease the incidence of migraines. However, there aren’t a lot of scientific studies to back this up.
Magnesium. Some patients with severe migraines receive magnesium infusions as a means to reduce their headache. However, those with other headache types may also take this supplement as well.
Vitamin B-12. Also known as riboflavin, this vitamin may have headache-reducing properties. According to the University of Minnesota, taking 200 mg twice daily can help.

In addition to herbs and supplements, some people reduce their headaches through alternative medicine practices. Examples include Chinese medicine, such as massage and acupuncture. However, a person may have to participate in multiple acupuncture sessions across the course of several weeks to experience the best benefits. Read more about natural remedies for headaches.

Risk factors

Factors associated with developing frequent headaches include:

Female sex
Anxiety
Depression
Sleep disturbances
Obesity
Snoring
Overuse of caffeine
Overuse of headache medication
Other chronic pain conditions

Complications

If you have chronic daily headaches, you’re also more likely to have depression, anxiety, sleep disturbances, and other psychological and physical problems.

Prevention

Taking care of yourself might help ease chronic daily headaches.

Avoid headache triggers. Keeping a headache diary can help you determine what triggers your headaches so that you can avoid the triggers. Include details about every headache, such as when it started, what you were doing at the time and how long it lasted.
Avoid medication overuse. Taking headache medications, including over-the-counter medications, more than twice a week can increase the severity and frequency of your headaches. Consult your doctor about how to wean yourself off the medication because there can be serious side effects if done improperly.
Get enough sleep. The average adult needs seven to eight hours of sleep a night. It’s best to go to bed and wake up at the same time every day. Talk to your doctor if you have sleep disturbances, such as snoring.
Don’t skip meals. Eat healthy meals at about the same times daily. Avoid food or drinks, such as those containing caffeine, that seem to trigger headaches. Lose weight if you’re obese.
Exercise regularly. Regular aerobic physical activity can improve your physical and mental well-being and reduce stress. With your doctor’s OK, choose activities you enjoy — such as walking, swimming or cycling. To avoid injury, start slowly.
Reduce stress. Stress is a common trigger of chronic headaches. Get organized. Simplify your schedule. Plan ahead. Stay positive. Try stress-reduction techniques, such as yoga, tai chi or meditation.
Reduce caffeine. While some headache medications include caffeine because it can be beneficial in reducing headache pain, it can also aggravate headaches. Try to minimize or eliminate caffeine from your diet.

Frequently Asked Questions About Headaches

What is migraine? What causes it, and how can I treat it?

Generally, migraine begins as a dull ache and then develops into a constant throbbing and pulsating pain that you may feel at the temples, as well as the front or back of one or both sides of the head. The pain is usually accompanied by a combination of nausea, vomiting, and sensitivity to light and noise. Some people (about 15% of migraine sufferers) experience an aura before an attack. The cause of migraine is believed to be chemical reactions in the brain. Treatment for migraine may include over-the-counter or prescription medications, as well as self-help techniques such as relaxation training and biofeedback.

What is an aura?

About 15-20% of people with migraine get an “aura,” which is a manifestation of neurological symptoms that occurs before a migraine headache. You may see wavy or jagged lines, dots, or flashing lights; or you might experience tunnel vision or blind spots in one or both eyes. The aura can include visual or auditory hallucinations and disruptions in smell (such as strange odors), taste, or touch. Other symptoms include numbness, a “pins and needles” sensation, or difficulty in recalling or speaking the correct word. These neurological events may last as long as sixty minutes and will fade as the headache begins.

What is a trigger?

Certain physical or environmental factors, such as foods, hormonal changes, weather, and stress, can lead to or “trigger” a migraine. However, it’s important to remember that triggers are different for everyone. That’s why, to help prevent migraine attacks, you need to figure out which triggers affect you and which ones don’t. Keeping a headache diary is an effective way to track triggers, and it will help you talk to your healthcare professional about your condition.

Does weather affect migraines?

Bright sunshine, hot, humid conditions, and drastic changes in barometric pressure may lead to, or “trigger,” a migraine attack in some migraineurs. However, studies have shown that weather does not act as a trigger for everyone who has migraine.

What is the link between migraine and hormones?

Hormones initiate and regulate many of your body’s functions, keeping your body in balance within a constantly changing environment. When the levels of hormones in your body are unbalanced – during menstruation, pregnancy, or menopause – it can lead to a migraine attack. In fact, about three quarters of all women with migraine report that their attacks are related to the menstrual cycle.

Is there an increased risk of stroke for migraine sufferers?

While the severity of a migraine attack often causes patients to fear they are having a stroke, the likelihood of a migraine attack causing a stroke is very remote. That is not to say that migraine sufferers cannot have a stroke associated with their migraines. In persons under age 40, the most common associated factor for stroke is migraine headache. However, over the course of a person’s normal life span, the occurrence of migraine headache may actually be associated with a reduced risk of dying from cerebrovascular disease due to stroke.

What are acute medications for migraine?

Acute medications – sometimes referred to as acute abortive medications – are used to treat the pain of the headache after it has started. Examples of acute abortive medications include over-the-counter medications, NSAIDs, ergots, and triptans.

What are the triptans?

Triptans are the newest class of abortive medications specifically targeted to treat migraine. In addition to being vasoconstrictors, they moderate some chemical reactions in the brain. The triptans work on receptors in your brain, helping to restore the balance of a neurotransmitter called serotonin. Changing levels of serotonin are thought to be a main cause of migraine.

Are over-the-counter medications for migraine effective?

Over-the-counter, or “OTC,” medications may be effective in relieving mild to moderate pain and associated symptoms of migraine. However, you should see your doctor before beginning any treatment regimen for migraine.

What are preventive medications for migraine?

Preventive medications for migraine – sometimes referred to as “prophylactic” treatments – are used to reduce the frequency, severity, and length of migraine attacks. Most preventive migraine medications were initially developed to treat other diseases, such as seizures, depression, or hypertension. Examples of preventive medications include antiepileptic medications, antidepressants, beta-blockers, calcium channel blockers, and NSAIDs (nonsteroidal anti-inflammatory drugs).

Why are anticonvulsants used to treat migraine?

Most preventive migraine medications were initially developed to treat other diseases, such as seizures, depression, or hypertension. During the past few years, there has been an increased interest in antiepileptic drugs (sometimes referred to as “anticonvulsants”) for the prevention of migraine, as both epilepsy and migraine may be caused by similar reactions in the brain.

Why are antidepressants used to treat migraine?

Most preventive migraine medications were initially developed to treat other diseases, such as seizures, depression, or hypertension. Antidepressants are typically used to treat people with depression, although they may reduce migraine frequency by regulating chemical levels in the brain.

What alternative therapies are used to treat migraine?

The term “alternative therapies” is often used to describe treatments considered outside the scope of conventional Western medicine. Examples of alternative therapy include acupuncture, acupressure, and yoga. Another common alternative treatment is herbal therapy, as some herbs are believed to relieve headache pain. Always discuss alternative therapies with your doctor before proceeding.

What is a tension-type headache? What causes it, and how can I treat it?

Tension-type headaches occur randomly and are often the result of temporary stress, anxiety, fatigue, or anger. Symptoms include soreness in your temples, a tightening band-like sensation around your head (a “vice-like” ache), a pulling feeling, pressure sensations, and contracting head and neck muscles. The headache begins in your forehead, temples, or the back of your head and neck. Treatment for tension-type headache may include over-the-counter or prescription medications, as well as self-help techniques such as relaxation training and biofeedback.

What is a cluster headache? What causes it, and how can I treat it?

Cluster headache gets its name because the attacks come in groups. The pain arrives with little, if any, warning and is usually on one side of the head. A tearing or bloodshot eye and a runny nose on the side of the headache may also accompany the pain. Cluster headache, believed to be caused by chemical reactions in the brain, has been described as the most severe and intense of any headache type. Treatment for cluster headache includes prescription medication and oxygen.

What is a sinus headache? What causes it, and how can I treat it?

When a sinus becomes inflamed, usually as the result of an allergic reaction, a tumor, or an infection, the inflammation will cause a localized pain. If your headache is truly caused by a sinus blockage, such as an infection, you will probably have a fever. An x-ray will confirm a sinus blockage. Your physician’s treatment might include antibiotics for the infection, as well as antihistamines or decongestants.

What is a rebound headache? What causes it, and how can I treat it?

A pattern of taking acute headache medications too often (more than two days per week) or in excessive amounts (more than the label or a doctor advises) can lead to a condition known as “rebound headache.” With rebound headache, your medications not only stop relieving pain, they actually begin to cause headaches. Doctors treat rebound headache by tapering the medication that is being overused, sometimes by gradually substituting a different type of treatment or medication. Stopping may be a challenge, but regularly overusing a medication increases the potential for serious side effects. Consult a physician if you regularly use headache medications more than two days per week or more than the label advises.

What is biofeedback?

Biofeedback is a self-help treatment that utilizes special equipment to monitor your body’s involuntary physical responses such as breathing, pulse, heart rate, temperature, muscle tension, and brain activity. Biofeedback helps you refine and perfect your relaxation exercises by learning to control the physical responses that are related to stress. An important benefit to learning biofeedback is that, once the technique has been mastered, you don’t need the equipment any more.

Are headaches hereditary?

According to estimates, approximately 29.5 million people in the United States suffer from migraine. Four out of five (80 percent) of them report a family history of migraine, but scientists are not sure if this is genetic or a family predisposition. Despite the uncertainty, a child has a 50% chance of having migraine if one parent suffers and a 75% chance if both parents suffer.

Can children get headaches?

By the time they reach high school, most young people have experienced some type of headache. However, once your child’s physician discovers the cause and type of the headache, many safe and effective approaches or medications can prevent a headache from occurring or stop it after it has attacked.

Why do I only have headaches on the weekend?

A change in your sleep pattern — too much or too little — may instigate a headache. It is best to get the same amount of sleep each night and get up the same time each day, even on the weekend.

How many types of headache are there?

According to the National Headache Foundation, headaches are divided into two basic categories: primary/benign (tension-type, migraine, cluster) and secondary (organically caused). All headaches fall into one of these two categories depending on their causes and symptoms.

Is it possible for one person to have several types of headaches?

It’s not uncommon for an individual to suffer from more than one type of headache. According to Dr. Seymour Diamond, Executive Chairman of the National Headache Foundation, people with mixed headache problems — such as migraine with tension-type headache — are not unusual.

What type of doctor should I see to diagnose and treat my headache?

When seeking treatment for your headache, start with your primary care physician. Discuss his or her experience and approach to headaches, including methods of classification, diagnosis, and treatment. Your doctor may decide to recommend you to a headache specialist, depending upon your symptoms or other physical conditions (diabetes, allergies, etc.) that require a more comprehensive and inclusive approach to your headache. To find headache specialist in your state, use our Physician Finder.

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