Headaches are an incredibly common experience, impacting almost everyone at some point in their lives. They are a leading cause of pain, often disrupting work, school, and daily routines, and are a frequent reason for doctor visits. If headaches are significantly affecting your quality of life, it’s important to consult with a healthcare professional.
Headaches are diverse, varying in frequency, intensity, and associated symptoms. They can be episodic, occurring periodically, or chronic, persisting for days or even weeks. The pain can range from a mild annoyance to debilitating, and may be accompanied by symptoms like nausea or heightened sensitivity to light and sound.
Broadly, headaches are categorized into three main groups: primary headaches, which arise independently and aren’t caused by an underlying condition; secondary headaches, which are symptoms of another medical issue; and a third category encompassing neuropathies, facial pains, and other headaches resulting from nerve damage or exhibiting pain characteristics distinct from primary and secondary headaches.
Primary Headaches: When the Headache is the Main Problem
Primary headaches are not symptoms of another disease, but rather conditions in themselves. They are typically categorized into four main types:
- Tension-type headaches
- Migraines
- Trigeminal autonomic cephalalgias (TACs)
- Other primary headache disorders
Tension-Type Headaches: The Most Common Headache
Tension-type headaches are the most prevalent form of headache. Individuals can experience them infrequently, frequently, or chronically. While the precise mechanisms behind tension-type headaches are still being investigated, current research suggests a combination of genetic predisposition, brain signaling variations, and muscle tenderness play significant roles.
Alt: Man experiencing tension headache, holding hands to head, illustrating common headache pain location and intensity.
The term “tension” highlights the role of emotional stress as a major trigger. Stress can lead to the contraction of muscles in the neck, face, scalp, and jaw, initiating a tension headache. Other common triggers include:
- Mental Stress: Periods of intense concentration or worry.
- Sleep Disturbances: Insufficient sleep or poor sleep quality.
- Postural Strain: Maintaining awkward head or neck positions, such as while reading, working at a computer, or using a smartphone.
- Alcohol Consumption: Alcohol can trigger headaches in many individuals.
- Dehydration: Not drinking enough water.
- Sunlight Exposure: Prolonged exposure to bright sunlight.
The pain associated with tension-type headaches is usually mild to moderate, often described as a constant pressure or tightness across the head, face, or neck. Many describe it as feeling like a band tightening around their head. Pain is typically felt on both sides of the head.
People with tension-type headaches may also experience sensitivity to light or sound, but usually not both simultaneously. Unlike migraines, tension-type headaches do not involve a pre-headache aura, nausea, or vomiting, and they are not worsened by routine physical activity.
Tension-type headaches can last anywhere from 30 minutes to several days. Chronic tension-type headaches are more frequent and can persist for hours, days, or even be continuous. These headaches often begin around puberty and are most common in a person’s 30s.
Factors that increase the likelihood of experiencing tension-type headaches include:
- Female Gender: Women are more prone to tension-type headaches.
- Younger Age: Younger individuals are more frequently affected.
- Fatigue and Sleep Issues: People who experience frequent tiredness and sleep difficulties.
- Migraine History: A personal history of migraines.
- Depression History: A history of depression.
Migraines: Intense, Throbbing Head Pain
Migraine is a neurological condition characterized by recurrent episodes of moderate to severe throbbing or pulsating pain, typically affecting one side of the head. Migraines affect both children and adults, and are more prevalent in women than men.
For more in-depth information about migraines, you can explore resources like the National Institute of Neurological Disorders and Stroke (NINDS) website.
Trigeminal Autonomic Cephalalgias (TACs): Rare but Severe Headaches
TACs are a group of rare headache disorders characterized by intense, one-sided head pain accompanied by autonomic symptoms such as eyelid swelling, nasal congestion, and sweating. There are five subtypes within the TAC category:
- Cluster headaches
- Paroxysmal hemicrania
- Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)
- Hemicrania continua
- Probable TACs
Cluster headaches are the most common and often the most severe type of TAC and primary headache overall. They involve sudden, excruciatingly painful attacks that typically occur at the same time of day or night over several weeks. These attacks occur in series, known as “cluster periods.” Attacks can range from occurring every other day to up to eight times per day during a cluster period.
During a cluster headache, the pain is usually localized to one side of the head, often around or behind one eye. The pain intensity typically peaks within 5 to 10 minutes of onset and can persist at that level for up to three hours.
Accompanying symptoms often include redness, swelling, and tearing of the eye and nasal congestion on the affected side of the face. Some individuals may also experience restlessness, agitation, changes in heart rate and blood pressure, and sweating. Cluster headaches are notorious for waking people from sleep.
Cluster headaches typically begin between the ages of 20 and 40, but can start at any age. They are more common in men than women and are also more prevalent among smokers compared to non-smokers. Alcohol, especially red wine, and smoking can act as triggers for cluster headache attacks.
Compared to migraines, cluster attacks are usually shorter and occur less frequently. It is common to experience one to three cluster attacks daily, with one to two cluster periods per year, separated by symptom-free intervals lasting months. Cluster periods often exhibit seasonal patterns, typically occurring in the spring and fall, which can lead to misdiagnosis as allergies. Cluster attacks are more frequent at night, suggesting a potential link to the sleep-wake cycle.
A subset of individuals develops chronic cluster headaches, characterized by cluster periods that can persist for years with only brief pain-free periods.
Paroxysmal hemicrania is another TAC subtype characterized by severe, throbbing, or claw-like pain, typically on one side of the face near the eye and sometimes radiating to the back of the neck during attacks. Between attacks, individuals may experience dull pain, soreness, or tenderness. Paroxysmal hemicrania attacks are frequent, occurring multiple times a day and lasting up to 30 minutes. They can be chronic or episodic, with periods of remission.
SUNCT headaches are marked by short bursts of moderate to severe burning, piercing, or throbbing pain, usually on one side of the head and around the eye or temple. Systolic blood pressure may increase during attacks. These attacks are very brief, lasting from as short as one second to up to 10 minutes, and typically occur during the day. Individuals generally experience multiple attacks per hour and may also have a watery, red eye on the same side as the pain.
Hemicrania continua is a chronic headache type characterized by continuous pain on the same side of the face and head. Some individuals may experience pain on both sides. Within a 24-hour period, there are often attacks of increased pain intensity. A distinguishing feature of hemicrania continua is its responsiveness to indomethacin, a non-steroidal anti-inflammatory drug (NSAID). Pain typically resolves with indomethacin treatment.
Other Primary Headache Conditions
Beyond the main categories, there are other primary headache disorders that don’t neatly fit the criteria for tension-type headaches, migraines, or TACs. Diagnosing these less common headache types can be challenging, requiring a thorough evaluation by a doctor, including specific tests and consideration of all symptoms.
Secondary Headaches: Headaches as a Symptom
Secondary headaches are not primary conditions themselves, but rather symptoms of an underlying medical issue that is affecting pain-sensitive nerve endings in the head. These conditions often involve the brain and its surrounding structures. Causes of secondary headaches include:
- Cerebrovascular Disorders: Conditions affecting blood vessels in the brain, including stroke. Learn more about stroke.
- Brain Tumors: Abnormal growths within the brain. Learn more about brain tumors.
- Traumatic Brain Injury (TBI): Head injuries. Learn more about brain injury.
- Changes in Routine: Alterations in normal patterns, such as jet lag from airplane travel or fasting.
- Hypertension (High Blood Pressure): Elevated blood pressure.
- Seizures: Disruptions in brain electrical activity. Learn more about seizures.
- Substance Abuse or Withdrawal: Headaches can be associated with drug or alcohol use or withdrawal.
- Infections: Infections like meningitis or encephalitis can cause headaches.
Neuropathies, Facial Pain, and Other Headache Disorders
This category includes headaches stemming from neuropathy, which is nerve damage. Trigeminal neuralgia is an example, characterized by sudden, severe attacks of facial pain affecting the trigeminal nerve. Learn more about trigeminal neuralgia.
Occipital neuralgia is another neurological condition causing shooting, shocking, throbbing, burning, or aching pain in the head region. Pain typically originates in the neck and spreads upwards, affecting the occipital nerves.
The Mechanism of Headache Pain: Why Do Headaches Hurt?
Interestingly, the brain tissue itself does not contain pain receptors and therefore cannot feel pain. Headaches arise when pain-sensitive nerve endings (neurons) in other structures of the head respond to various triggers or signals within the body. These triggers can include stress, certain foods or smells, or medications. These stimulated nerve endings then transmit pain signals to the brain. Even though the source of the problem may be elsewhere, the brain interprets this as pain originating from within the head.
To understand more about the workings of the brain, explore resources on brain function.
Who is Susceptible to Headaches?
Headaches can affect anyone, regardless of age, gender, or background. A predisposition to certain types of headaches, particularly primary headaches, can be hereditary. However, certain factors and triggers can make some individuals more susceptible to experiencing headaches.
Dietary factors can play a role in triggering headaches in some people. Keeping a food journal can help identify potential dietary triggers by tracking food intake and subsequent headache occurrences. Foods and ingredients that have been linked to headache attacks, especially migraines, in susceptible individuals include:
- Aged Cheeses: Cheeses that have undergone aging processes.
- Aspartame: An artificial sugar substitute.
- Caffeine: Both caffeine consumption and withdrawal can trigger headaches.
- Chocolate: A common migraine trigger for some.
- Cured or Processed Meats: Deli meats and similar products.
- Monosodium Glutamate (MSG): A flavor enhancer.
- Nuts (Especially Salted): Certain types of nuts, particularly salted varieties.
- Alcohol (Especially Wine): Alcoholic beverages, with wine being a common trigger.
Other non-dietary triggers for headache attacks include:
- Emotional Stress: Stress from school, work, family, or life events.
- Weather Changes: Fluctuations in weather patterns.
- Changes in Eating and Sleep Patterns: Irregular meal times or sleep schedules.
- Dehydration: Inadequate fluid intake.
Headaches in Children
Headaches are also common in children and adolescents. Headache disorders that begin in childhood can sometimes evolve into migraines as children grow older.
Treatment strategies for headaches in children and teenagers typically include:
- Hydration: Increasing fluid intake, especially water.
- Dietary Improvements: Establishing a healthy and balanced diet.
- Regular Exercise: Promoting physical activity.
- Addressing Sleep Problems: Establishing healthy sleep habits.
- Over-the-Counter Pain Relief Medications: Medications like acetaminophen or ibuprofen.
It is crucial to consult with a doctor before administering any headache medication to a child. Seek immediate medical attention for headaches that occur after a head injury or if a child presents with additional symptoms like rash, fever, or excessive sleepiness.
Diagnosing the specific type of headache in children can be challenging as they may struggle to describe the pain location, frequency, and duration. Asking a child to draw a picture of their headache pain can be a helpful tool for doctors to better understand their symptoms and determine appropriate treatment.
Pay attention to a child’s ability to eat during a headache attack. Young children may exhibit crankiness, irritability, or complain of stomach pain in association with headaches.
Diagnosis and Treatment of Headaches
Not all headaches require medical intervention. However, headaches can sometimes be a warning sign of a more serious underlying medical condition that necessitates prompt medical attention.
Seek immediate medical attention if you or someone you are with experiences any of the following symptoms:
- Sudden, Severe Headache: Especially if accompanied by a stiff neck.
- Severe Headache with Systemic Symptoms: Headache with fever, nausea, or vomiting not attributable to another illness.
- “First” or “Worst” Headache: Experiencing what feels like the first or most severe headache ever, particularly if accompanied by confusion, weakness, double vision, or loss of consciousness.
- Worsening Headache: Headache that progressively worsens over days or weeks or changes in its typical pattern or behavior.
- Recurrent Headaches in Children: Headaches that keep returning in children.
- Headache After Head Injury: Headache following a head injury.
- Headache with Neurological Symptoms: Headache accompanied by loss of sensation or weakness in any part of the body, which could indicate stroke.
- Headache with Seizures or Respiratory Distress: Headache associated with convulsions (shaking) or difficulty breathing.
- Frequent Headaches: Two or more headaches per week.
- New Onset of Headaches in Older Adults: New headaches in individuals over 50 years of age, especially in those without prior headache history.
- Headaches in Individuals with Underlying Conditions: New headaches in someone with a history of cancer or HIV/AIDS.
Diagnosing Headaches
To determine the underlying cause of headaches, a doctor will conduct a thorough evaluation, including reviewing the patient’s medical history and headache history, along with physical and neurological examinations. Diagnostic tests may be ordered to identify any specific underlying causes. These tests can include:
- Blood, Urine, and Fluid Tests: Laboratory tests to assess for infections or other abnormalities.
- Computed Tomography (CT) Scan: Imaging technique to visualize the brain and surrounding structures.
- Magnetic Resonance Imaging (MRI): Detailed imaging of the brain and nervous system.
- Electroencephalogram (EEG): Test to measure brain electrical activity.
For more information on neurological diagnostic tests and procedures, consult resources from NINDS.
Headache Journaling: A Diagnostic Tool
Keeping a headache journal can be invaluable in understanding headache patterns and triggers, aiding in diagnosis and treatment planning. After each headache episode, record the following information:
- Time of Day: When the headache occurred.
- Intensity and Duration: Headache severity and how long it lasted.
- Sensitivity Symptoms: Any sensitivity to light, smells, or sound.
- Preceding Activities: Activities immediately before the headache onset.
- Medications Taken: All medications taken, both prescription and over-the-counter.
- Sleep Quality and Duration: Quality and length of sleep the night before.
- Stress and Emotions: Any stressors or strong emotions experienced before headache onset.
- Weather and Routine Changes: Weather conditions or alterations in daily routines.
- Dietary Intake: Food and beverages consumed in the 24 hours prior to the headache.
- Other Health Conditions: Any other relevant health conditions.
For women, recording menstrual cycle dates can also be helpful. Noting family history of headaches or other relevant health conditions is also valuable. This detailed record can help identify patterns and triggers, facilitating the development of an effective headache management plan.
Treating Headaches
Headache treatment is a collaborative effort between the individual experiencing headaches and their healthcare provider. Open and honest communication is essential. It’s important to understand that finding the most effective treatment approach may take time and adjustments.
The initial step in headache treatment is to identify and address any underlying medical conditions that may be contributing to secondary headaches. Treating the underlying condition often resolves the associated headache symptoms.
Over-the-counter pain relievers like aspirin, ibuprofen, or acetaminophen can be effective for mild to moderate headache pain. Depending on the type and severity of headache, a doctor may recommend various prescription medications and procedures:
- Migraines: Triptans, which enhance serotonin levels, can help alleviate migraine pain during attacks. For migraine prevention, doctors may prescribe anticonvulsants, beta-blockers, calcium channel blockers, antidepressants, or calcitonin gene-related peptide (CGRP) inhibitors.
- Tension-Type Headaches: Antidepressants can be beneficial in managing tension-type headaches. For individuals experiencing both migraines and tension-type headaches, triptans, barbiturates (sedative medications), and ergot derivatives may be used.
- Cluster Headaches: Verapamil is often the first-line medication for preventing cluster periods. Other treatments include oxygen therapy (inhaling pure oxygen), triptans, lidocaine, ergots, and octreotide.
It’s crucial to be aware that regular overuse of headache medications can paradoxically worsen headaches or trigger new headache symptoms (medication overuse headache). A doctor can help create a safe medication plan and explore alternative treatment strategies.
Non-pharmacological approaches like biofeedback, relaxation training, meditation, and cognitive-behavioral therapy can assist individuals in managing stress associated with headaches.
A doctor may also recommend incorporating physical therapy, massage therapy, and gentle exercise into a comprehensive headache treatment plan. Further research is ongoing to evaluate the effectiveness of more invasive treatments such as surgery and neurostimulation for managing headache disorders.
Self-Care and Lifestyle Modifications for Headache Management
Maintaining adequate sleep is crucial for headache management. Both insufficient and excessive sleep can exacerbate headaches. Daytime naps can sometimes disrupt nighttime sleep patterns and trigger headaches in some adults. Regular exercise and a healthy diet are also important preventive measures.
Many individuals find support groups helpful in connecting with others who experience headaches and learning coping strategies. Adopting healthy coping mechanisms for life’s stressors can play a significant role in managing headache pain.
Recent Advances in Headache Research
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health (NIH), is a leading federal agency supporting research on the brain and nervous system. NINDS funds innovative research to improve our understanding, diagnosis, and treatment of headache disorders. These research initiatives encompass a wide range of topics aimed at developing new treatments and strategies for alleviating intense headache pain. Ongoing studies by researchers worldwide continue to expand our knowledge of headache causes and treatments.
Headache research is a dynamic field with ongoing investigations across numerous areas. Some current research highlights include:
Understanding Headache Mechanisms
NINDS-supported research has contributed to our understanding of the long-term effects of COVID-19 infections, known as Long COVID. Headaches are a recognized symptom of Long COVID, and researchers are investigating nervous and immune system changes that may contribute to or complicate this condition. These findings may lead to the development of treatments for Long COVID-related headaches.
NINDS also funds research exploring the link between the circadian rhythm (sleep-wake cycle) and severe headache disorders. Researchers are investigating how disruptions in the circadian rhythm are related to the timing of intense headache attacks and the role of specific genes in this relationship.
NINDS, in collaboration with the American Headache Society (AHS), convened experts, clinicians, scientists, patients, headache organizations, and industry representatives to establish headache research priorities. In 2024, NINDS and AHS published these priorities to guide future research on headache causes, treatment, and quality of life impact.
Developing and Evaluating New Therapies
NINDS supports numerous studies focused on headache treatment. While medications are effective for many, research is exploring other therapeutic options. Cognitive Behavioral Therapy (CBT) is being investigated for its potential to treat chronic headaches in young people, and research is aimed at tailoring CBT approaches for more complex headache conditions.
NINDS is also at the forefront of migraine research, conducting studies to advance diagnosis and management strategies. Stay updated on the latest migraine research findings.
Pain Research Coordination
NINDS actively coordinates pain research efforts, including research on headache disorders, across NIH and with other federal agencies.
For access to research articles and summaries on headaches, search PubMed, a comprehensive database of citations from medical journals and other scientific literature.
Participating in Clinical Trials to Improve Headache Care
Clinical trials are research studies that are crucial for advancing our understanding of disorders and improving patient care. They offer individuals the opportunity to access promising new treatment options.
Search for Headache Clinical Trials
Participating in clinical research is a valuable way to contribute to better care for people with headaches. Clinical research involving human participants helps researchers gain insights into diseases and develop safer and more effective methods for detection, treatment, and prevention.
Clinical trials require diverse participants – individuals who are healthy or have a specific illness or disease, representing all ages, genders, races, and ethnicities. This ensures that research findings are applicable to a broad population and that treatments are safe and effective for everyone who may benefit from them.
For more information about participating in clinical research, visit NIH Clinical Research Trials and You. To find clinical trials currently recruiting participants with headaches, visit Clinicaltrials.gov.
Resources for More Information About Headaches
For additional information and support, please refer to the following organizations:
American Headache Society (AHS)
856-423-0043
[email protected]
American Chronic Pain Association (ACPA)
913-991-4740
National Headache Foundation
312-274-2650
[email protected]
