Headache

Headaches can affect anyone of any age and are very common. Over 10 million people in the UK regularly have headaches and almost everyone will have headaches at some point in their life. 

In most cases, a headache will go away on its own or with simple home remedies, such as over-the-counter painkillers, drinking more water, having a rest or simply waiting for it to pass.

Most concerns about headaches arise if the headaches become more frequent, more severe or feel unusual. This can lead to worries about brain tumours. However, in most cases, headaches are nothing serious. 

There are two main types of headaches: primary headaches and headaches that are a side effect of another condition ie secondary headaches.

Primary headaches are the most common type of headaches and include tension headaches, cluster headaches and migraines. They are not caused by a separate medical condition but by an underlying process in your brain. 

Secondary headaches are less common and are caused by overuse of mediation or an underlying medical condition, such as

• Blocked sinuses
• Brain tumour or brain aneurysm
• Meningitis
• Neck problems — this can cause cervicogenic headaches
• Spinal problems
• Trauma

Tension headaches

Tension headaches feel like a tight band across your forehead and can last for several days. Although they are uncomfortable, in most cases, you can continue working and they won't disturb your sleep. Tension headaches usually worsen through the day and can make you slightly more sensitive to bright light and noise. Physical activity doesn't worsen tension headaches.

Symptoms include: 

• A stiff neck
• A tender scalp
• Dull, aching pain
• Stiff shoulders
• Tightness or pressure across your forehead, which may spread to the back or sides of your head

A tension headache can sometimes feel like a migraine. However, tension headaches do not cause visual disturbances, as migraines can. 

Migraines

Migraines often cause throbbing on one side of your head. If you have a headache that is one-sided, throbbing or makes you feel nauseous, you likely have a migraine. Severe migraines can prevent you from working or getting on with your daily activities — you may need to go to sleep to clear your migraine.

Symptoms include: 

• A throbbing feeling in your head
• Blurred vision
• Nausea
• Pain on one side of your head
• Sensitivity to light and sound 
• Vomiting

Cluster headaches

Cluster headaches cause sudden, intense pain around one of your eyes or one side of your temple. They are rare but very severe and are sometimes called suicide headaches due to the intensity of the pain. They prevent you from working or getting on with your daily activities. 

They happen in bouts or clusters, usually every day for several days or weeks, lasting as long as 12 weeks in some cases, before disappearing for months. They don’t respond to over-the-counter painkillers.

Symptoms include: 

• A droopy eyelid on the affected side of your head
• A red watery eye on the affected side of your head
• A runny nose 
• Very severe pain on the side of your head

Chronic tension headaches

Chronic tension headaches, also called chronic daily headaches, are caused by tense muscles in the back of your neck. They are more common in women than in men. Chronic means long-term; chronic tension headaches are therefore persistent and ongoing, which means you have a headache every day for three months or more. 

Chronic tension headaches can be triggered by tiredness or neck injuries. Medication overuse can make them worse. 

Medication-overuse headaches

Also known as medication-induced headaches, these headaches are the most common type of secondary headaches. They are long-lasting and caused by taking painkillers, often in response to having a headache. 

Regularly taking painkillers for headaches can cause your body to produce more pain sensors in your head, which can eventually make your head super-sensitive — this is what causes your headache to persist even longer. You may then take even more painkillers but by this point, the painkillers have stopped working. 

Exertional headaches

Exertional headaches occur after strenuous physical activity and come on quickly and strongly. Activities include coughing, having sex, running and straining to pass stools. They are more common if you already suffer from migraines or have close relatives who have migraines. 

Exertional headaches linked to sex can occur when sex begins or after sex but most commonly at orgasm. These headaches are severe with pain at the back of your head, behind your eyes or all over. 

Exertional headaches normally last around 20 minutes and are not usually a sign of a serious underlying condition. In very rare cases, they could be a sign of a leaky blood vessel on the surface of your brain. If you have repeated exertional headaches, see your GP. 

Primary stabbing headaches

Also known as ice-pick headaches or idiopathic stabbing headaches, these headaches come on suddenly and strongly at any time of day or night. They are short and stabbing, usually lasting five to 30 seconds. They are often described as feeling as if someone is striking your head with an ice pick or other sharp object.

They are more common if you already suffer from migraines — half of all people with migraines also have primary stabbing headaches, usually affecting the same area where the migraines occur.

Given how short these headaches are, they can't be treated. However, migraine prevention medications may help reduce how often they occur. 

Hemicrania continua

Hemicrania continua is a type of primary headache that is chronic (long-term) and occurs every day, although there may be periods of time where you don't have any headaches. It causes continuous pain on one side of your head that fluctuates in intensity. Periods of intense pain can last anywhere from 20 minutes to several days. 

During a period of intense pain, you may experience the following symptoms: 

• A droopy eyelid on the affected side of your head
• A runny or blocked nose
• Nausea
• Sensitivity to light
• Vomiting
• Watery and/or red eyes 

It can be treated with a medication called indometacin.

Trigeminal neuralgia

Trigeminal neuralgia causes headaches as well as facial pain that feels like bursts of electric shock. This pain can be felt around the eyes, in your forehead, jaws, nose, lips and scalp. Pain usually occurs on one side and can be triggered by touch or a breeze on your face. It is more common if you are aged over 50. 

Rebound headaches

Rebound headaches occur after you stop taking regular medication to treat your headaches. They usually occur every day and are worse in the morning. They are more common if you are taking medications including acetaminophen, ergotamine and triptans, as well as over-the-counter painkillers. The type of pain usually depends on the type of medication being taken. 

Symptoms include:

• Forgetfulness
• Irritability
• Nausea
• Restlessness

Taking medication will usually improve your symptoms but the headaches will return after the medication wears off. 

Thunderclap headaches

Thunderclap headaches come on suddenly and strongly, lasting up to five minutes. They may be a sign of an underlying problem with the blood vessels in your brain. You should seek urgent medical attention for these headaches. 

Tension headaches

If your head is aching and you feel as though there’s a tight band around your skull or across your forehead, you may have a tension headache. It is the most common type of headache and can be triggered by:

• Bad posture
• Common illnesses, such as a cold or flu
• Dehydration, skipping meals or drinking too much alcohol
• Deteriorating eyesight
• Hormones — some women often have headaches during their period or while going through the menopause
• Tiredness or stress

They can also be caused by taking too many painkillers regularly. 

Migraines

It isn’t known exactly what causes migraines, although it is widely thought to be due to abnormal brain activity. This may affect the blood vessels, chemicals or nerves in your brain. Abnormal brain activity may be triggered by a variety of factors, including bright lights, dehydration, hormonal changes, (in women), loud noises, poor sleep or stress. 

Cluster headaches

It isn’t known exactly what causes cluster headaches, although it is linked to abnormal brain activity in a specific part of the brain called the hypothalamus. This can be triggered by alcohol or strong smells (eg paint, perfume or petrol). Smoking and having family members who have cluster headaches, increases your risk of having them.

Headaches caused by referred pain (eg sinusitis)

Headaches can be caused by pain elsewhere in your head and neck, including your ears, eyes, jaws and mouth. 

If you have pain at the front of your head accompanied by a painful face, ears and teeth, it is likely that you have a sinus headache. 

Your sinuses are holes in your skull that have linings that produce mucus in response to infections or allergies. Normally, the mucus drains out of your nose. However, if the linings swell up, this can prevent mucus from draining out, which causes a headache. Symptoms of a headache caused by sinusitis include: 

• A stuffy nose
• Facial tenderness, particularly around your nose and just below your eyes
• Pain at the front of your head, face and teeth 
• Pain that gets worse when you bend forward

Acute sinusitis occurs when you get a cold or sudden allergy and is often accompanied by a fever. Chronic sinusitis is a long-term condition caused by allergies, overusing decongestants or acute sinusitis that doesn't resolve. In chronic sinusitis, the sinus linings are always swollen but may not be infected. 

Another condition that can cause referred pain in your head is acute glaucoma where the pressure in your eye suddenly rises. This can cause a severe headache, with pain felt behind your affected eye. Other symptoms include: 

• Eyeball that feels very hard
• Blurred vision
• Cloudy cornea (front part of your eye)
• Red eye

In most cases, a headache is nothing to worry about. However, if it is caused by medication overuse, it needs appropriate treatment to avoid it becoming a long-term condition. 

Occasionally, a headache is a symptom of an underlying condition. In very rare cases, it can be life-threatening; these headaches tend to come on suddenly and become worse over time. They are more common in older people. 

In the minority of cases where headaches are a sign of something more serious, there is a range of potential causes. These include: 

Brain infections 

Meningitis is an infection of the protective coverings (meninges) of the brain, while encephalitis is an infection of the brain. Brain infections are rare and can be caused by bacteria, viruses or fungi. They cause severe headaches that make it impossible to function normally. Symptoms include: 

• A fever
• A stiff neck — you can't bend your head down so your chin touches your chest 
• Light sensitivity
• Sweating
• Vomiting 

Brain tumour

Very rarely, a brain tumour is the cause of headaches. The headache will usually be there as soon as you wake up in the morning and worsens when sitting up. The headache will be continuous and get worse every day. Coughing and sneezing may make it worse — this also occurs if you have a headache caused by sinusitis or a migraine. 

Giant cell arteritis

Also known as temporal arteritis, this condition usually only occurs in those aged over 50. It is caused by the arteries in your temples and behind your eyes becoming inflamed and swollen. This can cause a headache behind your forehead (frontal headache). Symptoms include: 

• Pain that gets worse when chewing
• Scalp pain when combing your hair
• Tender arteries in your forehead

If left untreated, giant cell arteritis can cause blindness. It can be treated with steroids, usually prescribed for several months — during this time your GP will closely monitor your condition through regular blood tests. 

Subarachnoid haemorrhage

A subarachnoid haemorrhage refers to bleeding around the brain. This is life-threatening and needs urgent medical treatment. It occurs when a small blood vessel on the surface of your brain bursts. This can cause a sudden, severe headache, stiff neck and unconsciousness. It is a rare cause of a severe headache. 

Other causes

• Carbon monoxide poisoning
• Circulatory or brain problems, such as a stroke, blood clot or aneurysm
• Dental problems
• Trigeminal neuralgia — a rare condition causing extreme facial pain

Seek medical attention urgently if you suddenly have an extremely painful headache, are seriously concerned about a headache or have a headache alongside any of the following symptoms: 

• A fever with chills, a stiff neck or a rash
• Confusion, drowsiness or sudden difficulty remembering things
• Convulsions
• Facial numbness, slurred speech, vision loss or a red eye
• Weakness in an arm or a leg
• Vomiting

You should also seek urgent medical attention if you have had a serious head injury.

You should see your GP if: 

• Painkillers do not ease your headaches and your headache gets worse
• You become sensitive to light or noise
• You feel nauseous or vomit 
• You have a throbbing pain at the front or side of your head — you may have a migraine or in rare cases, a cluster headache
• You regularly have headaches which affect your daily life
• Your arms or legs feel numb or weak

Your GP will discuss your headaches and any other symptoms with you. They will also perform a physical examination, including a neurological examination. They will ask you about your general health and medical history — a sudden change in your diet (eg quitting drinking caffeine if you are a regular coffee drinker) can cause headaches.

Your GP will explain what causes headaches and may advise you about lifestyle changes to ease your headaches and prescribe some medication.

They will also ask questions to help determine if there is an underlying medical cause for your headaches. This doesn’t mean that there is a serious problem but it may mean you need further investigations. They may ask you whether you’ve had a head injury in the last three months or if you have a fever alongside worsening headaches. 

Other situations that may need further investigation if they occur alongside your headache include if you have: 

• Become confused 
• Been vomiting
• Cancer
• Developed speech and balance problems 
• Developed memory problems or changes in your behaviour or personality 
• Impaired immunity eg if you have HIV or are taking steroid or immunosuppressant medications

You may also need further investigations if your headaches:

• Feel unusual ie unlike any other headache you've ever had before
• Get worse when you sit or stand
• Occur alongside red or painful eyes
• Started suddenly or when you coughed, sneezed or strained

If your GP thinks an underlying medical condition could be causing your headaches, they may refer you for further investigations, such as:  

• A blood test to check your complete blood count (CBC) — this can show signs of an infection
• An X-ray of your skull or sinuses if they suspect sinusitis
• CT scan or MRI scan of your head if they suspect blood clots, a stroke or brain trauma

You can help prevent headaches, including a tension headache or migraine, by:

• Being active, ideally outdoors
• Getting enough sleep
• Not drinking alcohol and not skipping meals — instead drink lots of water and eat regular, balanced meals
• Resting your eyes — do not spend too much time straining your eyes eg looking at digital screens
• Taking time to relax
• Walking, standing and sitting correctly

To ease the pain of a headache, including a tension headache or migraine, try:

• Drinking lots of water
• Resting
• Taking over-the-counter painkillers such as ibuprofen and paracetamol

If over-the-counter painkillers do not work, you can try: 

• Biofeedback — a relaxation technique to help manage pain 
• Cognitive behavioural therapy — a type of talk therapy to help you recognise and better cope with stressful or anxiety-inducing situations 
• Cold or hot therapy — placing a heat pad or ice pack against your head for 5-10 minutes several times a day
• Exercise — not intense exercise but mild to moderate activities that increase the production of endorphins by your body to help you feel relaxed
• Hot baths or showers to relax tense muscles
• Stress management classes to teach you how to better cope with stress and relieve tension

You may also want to try acupuncture — an alternative therapy that places fine needles in specific parts of your body. This may help reduce stress and tension although there isn't clear evidence that it works.

If your headaches are caused by an underlying medical condition, they will usually go away once that condition is treated. 

If you’re having regular, severe headaches, your GP may prescribe pain relief or other medication.

Getting enough sleep every night and leading a healthy lifestyle, which includes exercising at least three times a week for 30 minutes, can help prevent headaches. 

It is also important to avoid drinking too much caffeine — six or more cups of coffee every day can cause chronic headaches when you go into withdrawal as caffeine levels in your body fluctuate. If you can, stop drinking coffee or at least limit it to two to three cups a day. 

Similarly, try to avoid or limit certain foods that you know trigger your headaches. This is different for every individual but it is generally a good idea to avoid highly processed foods (eg processed meats) and foods that contain a lot of additives (eg ready meals). Some people find dark beers as well as the below foods also trigger headaches:

• Cashew nuts
• Chocolate
• Dairy products or specifically aged cheeses
• Onions
• Wheat

If you have tension headaches, you can try mind-body techniques eg guided imagery and progressive muscle relaxation. These techniques involve deep breathing and imagining your tense muscles relaxing ie they focus your mind on your body. 

Massage and chiropractic techniques may also help with certain types of headaches. However, you should always speak to your doctor before trying these manual therapies.