DefinitionA headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are very rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and sometimes by taking medications.
Alternative NamesPain - head; Rebound headaches; Medication overuse headaches
Common CausesThe most common type of headaches are likely caused by tight muscles in your shoulders, neck, scalp, and jaw. These are called tension headaches. They may be related to stress, depression, anxiety, a head injury, or holding your head and neck in an abnormal position.Tension headaches tend to be on both sides of your head. They often start at the back of your head and spread forward. The pain may feel dull or squeezing, like a tight band or vice. Your shoulders, neck, or jaw may feel tight or sore.Migraine headaches are severe headaches that usually occur with other symptoms such as vision changes or nausea. The pain may be throbbing, pounding, or pulsating. It tends to begin on one side of your head, although it may spread to both sides.You may have an "aura" (a group of warning symptoms that start before your headache). The pain usually gets worse as you try to move around. These headaches may be triggered by foods such as chocolate, certain cheeses, or MSG. Caffeine withdrawal, lack of sleep, and alcohol may also trigger them.Rebound headaches -- headaches that keep coming back -- may occur from overuse of painkillers. These may also be called medication overuse headaches. Patients who take pain medication more than 3 days a week on a regular basis can develop this type of headache.Other types of headaches:Cluster headaches are sharp, very painful headaches that tend to occur several times a day for months and then go away for a similar period of time. Sinus headaches cause pain in the front of your head and face. They are due to swelling in the sinus passages behind the cheeks, nose, and eyes. The pain tends to be worse when you bend forward and when you first wake up in the morning.Headaches may occur if you have a cold, the flu, a fever, or premenstrual syndrome.A swollen, inflamed artery (which supplies blood to part of the head, temple, and neck area) can occur with a disorder called temporal arteritis.Rarely, a headache may be a sign of a more serious cause, such as:Brain infection like meningitis or encephalitis, or abscessBrain tumorHydrocephalusProblems with the blood vessels and bleeding in the brain, such as arteriovenous malformation (AVM), brain aneurysm, or strokePseudomotor cerebriVery high blood pressure
Home CareThere may be things you can do to relieve the symptoms of a headache. Try to treat the symptoms right away. When migraine symptoms begin:Drink water to avoid getting dehydrated, especially if you have vomitedRest in a quiet, dark roomPlace a cool cloth on your headUse any relaxation techniques you have learnedIf your doctor has already told you what type of headaches you have, there are many things you can do to manage migraines or tension headaches at home. Your doctor may have already prescribed medicines to treat your type of headache.Keep a headache diary to help find the source or trigger of your symptoms. Then change your environment or habits to avoid future headaches. When a headache occurs, write down:The date and time the headache beganWhat you ate for the past 24 hoursHow long you slept the night beforeWhat you were doing and thinking about just before the headache startedAny stress in your lifeHow long the headache lastedWhat you did to make it stopTry acetaminophen, aspirin, or ibuprofen for tension headaches. Do NOT give aspirin to children because of the risk of Reye syndrome. Talk to your doctor if you are taking pain medicines 3 or more days a week.
Call your health care provider ifSome headaches may be a sign of a more serious illness. Anyone who has these danger signs should seek medical help immediately:This is the first headache you have ever had in your life and it interferes with your daily activitiesYour headache comes on suddenly and is explosive or violentYou would describe your headache as "your worst ever," even if you regularly get headachesYou also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headacheYour headache gets worse over a 24-hour periodYou also have a fever, stiff neck, nausea, and vomiting with your headacheYour headache occurs with a head injuryYour headache is severe and just in one eye, with redness in that eyeYou are over age 50 and your headaches just began, especially if you also have vision problems and pain while chewingYou have cancer and develop a new headache
What to expect at your health care provider's officeYour health care provider will take a medical history and will perform an examination of your head, eyes, ears, nose, throat, neck, and nervous system.The diagnosis is usually based on your history of symptoms. A "headache diary" may be helpful for recording information about headaches over a period of time. Your health care provider may ask questions such as:Is the headache located in your forehead, around your eyes, in the back of your head, near your temples, behind your eyeball, or all over?Is the headache on one side only?Is this a new type of headache for you?Would you describe the headache as throbbing?Is there a pressure or band-like sensation?When does the headache occur?How long have you had headaches?How long does each headache last?Does the headache wake you up from sleep? Are the headaches worse during the day and better at night?Did other symptoms begin shortly after the headaches began? Do you have repeat headaches?Does the headache reach maximum intensity over 1 to 2 hours?Are the headaches worse when you are lying down? Standing up?Are the headaches worse when you cough or strain?Do they occur at a specific time related to your menstrual period?What home treatment have you tried? How well did it work?Tests that may be performed include the following:Blood tests or a lumbar puncture if you may have an infectionHead CT scan
if you have any danger signs or you've been having headaches for a whileSinus x-rays
ReferencesDigre KB. Headaches and other head pain. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 405.Kwiatkowski T, Alagappan K. Headache. In: Marx JA, Hockberger Rs, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 101.