When a bad headache strikes, you just want it to end. The aching, throbbing pain can be debilitating and result in missed appointments, work, or time with family and friends.
Your headache symptoms can help your doctor determine its cause and the appropriate treatment. Most headaches aren’t the result of a serious illness, but some may result from a life-threatening condition requiring emergency care.
Headaches are generally classified by cause:
A primary headache is caused by overactivity of or problems with pain-sensitive structures in your head. A primary headache isn’t a symptom of an underlying disease.
Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can play a role in primary headaches. Some people may also carry genes that make them more likely to develop such headaches.
The most common primary headaches are:
- Cluster headache
- Migraine with aura
- Tension headache
- Trigeminal autonomic cephalalgia (TAC), such as cluster headache and paroxysmal hemicrania
A few headache patterns also are generally considered types of primary headache, but are less common. These headaches have distinct features, such as an unusual duration or pain associated with a certain activity.
Although generally considered primary, each could be a symptom of an underlying disease. They include:
- Chronic daily headaches (for example, chronic migraine, chronic tension-type headache, or hemicranias continua)
- Cough headaches
- Exercise headaches
- Sex headaches
Some primary headaches can be triggered by lifestyle factors, including:
- 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 secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions — varying greatly in severity — may cause secondary headaches.
Possible causes of secondary headaches include:
- Acute sinusitis (nasal and sinus infection)
- Arterial tears (carotid or vertebral dissections)
- Blood clot (venous thrombosis) within the brain — separate from stroke
- Brain aneurysm (a bulge in an artery in your brain)
- Brain AVM (arteriovenous malformation) (arteriovenous malformation) — an abnormal formation of brain blood vessels
- Brain tumor
- Carbon monoxide poisoning
- Chiari malformation (structural problem at the base of your skull)
- Coronavirus disease 2019 (COVID-19)
- Dental problems
- Ear infection (middle ear)
- Encephalitis (brain inflammation)
- Giant cell arteritis (inflammation of the lining of the arteries)
- Glaucoma (acute angle closure glaucoma)
- High blood pressure (hypertension)
- Influenza (flu) and other febrile (fever) illnesses
- Intracranial hematoma
- Medications to treat other disorders
- Monosodium glutamate (MSG)
- Overuse of pain medication
- Panic attacks and panic disorder
- Persistent post-concussive symptoms (Post-concussion syndrome)
- Pressure from tight headgear, such as a helmet or goggles
- Pseudotumor cerebri
- Trigeminal neuralgia (as well as other neuralgias, all involving irritation of certain nerves connecting the face and brain)
Some types of secondary headaches include:
- External compression headaches (a result of pressure-causing headgear)
- Ice cream headaches (commonly called brain freeze)
- Medication overuse headaches (caused by overuse of pain medication)
- Sinus headaches (caused by inflammation and congestion in sinus cavities)
- Spinal headaches (caused by low pressure or volume of cerebrospinal fluid, possibly the result of spontaneous cerebrospinal fluid leak, spinal tap or spinal anesthesia)
- Thunderclap headaches (a group of disorders that involves sudden, severe headaches with multiple causes)
Regardless of whether you are prone to migraines, tension headaches, or cluster headaches (see “Is this your headache?”), you may be able to reduce their frequency by identifying what brings them on. Here’s a look at the most common triggers for each of these kinds of headaches.
1. Stress. Stress can cause tight muscles in the shoulders and neck, which often leads to tension headaches. “It’s believed to start in the muscles. When tension headaches become frequent, the pain in shoulder and neck muscles is felt by the brain as pain in the head,” says Dr. Sait Ashina, a neurologist who specializes in headache treatment at Harvard-affiliated Beth Israel Deaconess Medical Center. Stress is also a common trigger for migraines.
2. Diet. Hunger itself can trigger a migraine or tension headache. But eating certain foods may trigger migraines. It could be just one type of food — like beans or nuts — or many foods, such as avocados, bananas, cheese, chocolate, citrus, herring, dairy products, and onions. “Processed foods with nitrites, nitrates, yellow food dyes, or monosodium glutamate can be especially problematic,” Dr. Ashina notes.
3. Alcohol intake. Alcohol is a common cause of migraine and cluster headaches. For some people, a few ounces of red wine are all it takes to provoke a headache, although any kind of alcohol can be a trigger. It’s not clear if the alcohol itself is to blame or if another component in the drink causes the problem.
4. Environment. “Cluster headaches seem to be seasonal and often happen in the spring or fall,” Dr. Ashina says. “It’s something in the environment, but we can’t tell exactly what it is yet.” Environmental factors such as bright light, smoke, humidity, intense scents, or cold weather are associated with migraine headaches.
5. Hormones. Changes in estrogen levels are associated with migraines in women, and women suffer from migraines more often than men. Menstrual cycles may be tied to migraine in younger women. Varying estrogen levels during perimenopause can sometimes start migraines in women who never experienced them before. Estrogen therapy may also be a migraine trigger. Menopause does seem to end migraines in most women.
6. Caffeine withdrawal. If you normally consume caffeine in coffee or tea, stopping intake abruptly may trigger a migraine. This may be because caffeine causes blood vessels to constrict; without caffeine, the blood vessels widen and bulge out with each heartbeat — a chief reason for the pounding pain of migraines.
7. Lack of sleep. A lack of sleep is associated with migraines and tension headaches. “We don’t know why, but we do know there’s a correlation and that sleep can lead to pain relief. Sometimes people feel better after taking a nap,” Dr. Ashina says.
How to Treat Headaches ?
Your head hurts. Again. The first step in foiling your frequent headaches is determining what type of headache you have. Sometimes headaches are a symptom of another disease or condition; sometimes there’s no clear cause.
Take a close look at your headache signs and symptoms. Keeping a headache diary might help determine your headache type. Note when your headaches occur, your symptoms, and potential triggers, such as food, stress or changes in sleep.
There are many types and sub-types of headaches. Chronic daily headaches, which occur 15 days or more a month, are one sub-type. Tension-type headaches and migraines are also common sub-types of headaches. They can both be chronic, though they aren’t always. Other types of chronic daily headaches include:
- Hemicrania continua, a one-sided headache that can feel like a migraine
- Primary stabbing headaches, which last for a few seconds and can occur several times throughout the day
- Primary exertional headaches, caused by exercise
- Chronic paroxysmal hemicranias, sharp, one-sided headaches that can cause tearing or a congested nose
- Medication overuse headaches, which occur from overusing pain medications for headaches for at least three months. These headaches occur at least 15 days out of the month.
Other headache types include:
- Cluster headaches, which cause severe pain on one side of the head and occur off and on for weeks over the course of a few months. Cluster headaches are associated with one or more signs and symptoms, such as tearing, nasal congestion and nasal discharge. These occur on the same side as the pain.
Tension-type headaches, the most common variety of headaches:
- Might be felt as a tight band of pain around your head, a dull ache or pressure
- Might cause mild to moderate pain on both sides of the head
- Vary widely in frequency
- Can be occasional
- May occur more than 15 days a month (chronic)
- Last from 30 minutes to a week
Most occasional tension-type headaches are easily treated with over-the-counter medications, including:
- Ibuprofen (Advil, Motrin IB, others)
- Acetaminophen (Tylenol, others)
Daily prescription medications, including tricyclic antidepressants, might manage chronic tension-type headaches. Alternative therapies aimed at stress reduction might help. They include:
- Cognitive behavioral therapy
- Massage therapy
Migraines are another common type of headache. They affect three times more women than men. Migraines typically:
- Cause pain that is moderate to severe
- Cause nausea, vomiting, or increased sensitivity to light or sound
- Affect only one side of your head, but can affect both sides
- Worsen with activity such as climbing steps
- Last from four to 72 hours without treatment
Migraine treatment is aimed at relieving symptoms and preventing additional attacks. If you know what triggers your migraines, avoiding those triggers and learning how to manage them can help prevent migraines or lessen the pain. Treatment might include:
- Rest in a quiet, dark room
- Hot or cold compresses to your head or neck
- Massage and small amounts of caffeine
- Over-the-counter medications such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) and aspirin
- Prescription medications including triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig)
- Preventive medications such as metoprolol (Lopressor), propranolol (Innopran, Inderal, others), amitriptyline, divalproex (Depakote), topiramate (Qudexy XR, Trokendi XR ,Topamax) or erenumab-aooe (Aimovig)
Recognize emergency symptoms
Seek emergency care if you have:
- A very severe, sudden headache
- Headache after a head injury or fall
- Fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
- Pain that worsens despite treatment
These symptoms suggest a more serious condition, so it’s important to get a prompt diagnosis and treatment.
Almost everyone gets headaches, and many are nothing to worry about. But if headaches are disrupting your activities, work or personal life, it’s time to see your doctor. Headaches can’t always be prevented, but your doctor can help you manage the symptoms.