A headache is pain or dis­com­fort in the head, scalp, or neck. Seri­ous causes of headaches are extremely rare. Most peo­ple with headaches can feel much bet­ter by mak­ing lifestyle changes, learn­ing ways to relax, and occa­sion­ally by tak­ing medications.

Com­mon Causes

Ten­sion headaches are due to tight, con­tracted mus­cles in your shoul­ders, neck, scalp, and jaw. They are often related to stress, depres­sion, or anx­i­ety. Over­work­ing, not get­ting enough sleep, miss­ing meals, and using alco­hol or street drugs can make you more sus­cep­ti­ble to them. Headaches can be trig­gered by choco­late, cheese, and monosodium glu­ta­mate (MSG). Peo­ple who drink caf­feine can have headaches when they don’t get their usual daily amount.

Other com­mon causes include:

* Hold­ing your head in one posi­tion for a long time, like at a com­puter, micro­scope, or type­writer
* Poor sleep posi­tion
* Overex­ert­ing your­self
* Clench­ing or grind­ing your teeth

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 and sore.

Migraine headaches are severe, recur­rent headaches gen­er­ally accom­pa­nied by other symp­toms like visual dis­tur­bances or nau­sea. They tend to begin on one side of your head, although the pain may spread to both sides. You may have an “aura” (warn­ing symp­toms that start before your headache) and feel throb­bing, pound­ing, or pul­sat­ing pain.

For infor­ma­tion on migraine, see migraine headache.

Other types of headaches:

* Clus­ter headaches are sharp, extremely painful headaches that tend to occur sev­eral times per day for months and then go away for a sim­i­lar period. They are far less com­mon.
* Sinus headaches cause pain in the front of your head and face. They are due to inflam­ma­tion in the sinus pas­sages that lie 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. Post­nasal drip, sore throat, and nasal dis­charge usu­ally occur with these headaches.

Headaches may occur if you have a cold, the flu, fever, or pre­men­strual syndrome.

If you are over age 50 and are expe­ri­enc­ing headaches for the first time, a con­di­tion called tem­po­ral arteri­tis may prove to be the cause. Symp­toms of this con­di­tion include impaired vision and pain aggra­vated by chew­ing. There is a risk of becom­ing blind with this con­di­tion. There­fore, it must be treated by your doc­tor right away.

Rare causes of headache include:

* Brain aneurysm — a weak­en­ing of the wall of a blood ves­sel that can rup­ture and bleed into the brain
* Brain tumor
* Stroke or TIA
* Brain infec­tion like menin­gi­tis or encephalitis

Home Care

Keep a headache diary to help iden­tify the source or trig­ger of your symp­toms. Then mod­ify your envi­ron­ment or habits to avoid future headaches. When a headache occurs, write down the date and time the headache began, what you ate for the past 24 hours, how long you slept the night before, what you were doing and think­ing about just before the headache started, any stress in your life, how long the headache lasts, and what you did to make it stop. After a period of time, you may begin to see a pattern.

A headache may be relieved by rest­ing with your eyes closed and head sup­ported. Relax­ation tech­niques can help. A mas­sage or heat applied to the back of the upper neck can be effec­tive in reliev­ing ten­sion headaches.

Try aceta­minophen, aspirin, or ibupro­fen for ten­sion headaches. DO NOT give aspirin to chil­dren because of the risk of Reye syndrome.

Migraine headaches may respond to aspirin, naproxen, or com­bi­na­tion migraine medications.

If over-the-counter reme­dies do not con­trol your pain, talk to your doc­tor about pos­si­ble pre­scrip­tion medications.

Pre­scrip­tion med­ica­tions used for migraine headaches include ergo­t­a­mine, dihy­droer­go­t­a­mine, ergo­t­a­mine with caf­feine (Cafer­got), isomethep­tene (Midrin), and trip­tans like suma­trip­tan (Imitrex), riza­trip­tan (Max­alt), eletrip­tan (Rel­pax), almotrip­tan (Axert), and zolmitrip­tan (Zomig). Some­times med­ica­tions to relieve nau­sea and vom­it­ing are help­ful for other migraine symptoms.

If you get headaches often, your doc­tor may pre­scribe med­ica­tion to pre­vent headaches before they occur. Exam­ples of these include:

* Anti­de­pres­sants such as nor­tripty­line (Pamelor), amitripty­line (Elavil), flu­ox­e­tine (Prozac, Sarafem), ser­tra­line (Zoloft), or parox­e­tine (Paxil) for ten­sion or migraine headache
* Beta-blockers such as pro­pra­nolol (Inderal) for fre­quent migraine headaches
* Cal­cium chan­nel block­ers such as ver­a­pamil for fre­quent migraine headaches
* Anti-epileptic med­i­cines such as top­i­ra­mate (Topamax)

If you are using pain med­ica­tions more than 2 days a week, you may be suf­fer­ing from rebound headaches. Rebound headaches are caused by a cycle of using pain med­ica­tions for short-term relief, fol­lowed by the headache pain return­ing for increas­ingly longer peri­ods of time despite tak­ing more pain medications.

All types of pain pills (includ­ing over-the-counter drugs), mus­cle relax­ants, some decon­ges­tants, and caf­feine can cause this pat­tern. If you think this may be a prob­lem for you, talk to your health care provider.
Call your health care provider if

Take the fol­low­ing symp­toms seri­ously. If you can­not see your health care provider imme­di­ately, go to the emer­gency room or call 911:

* Your headache comes on sud­denly and is explo­sive or vio­lent.
* You would describe your headache as “your worst ever”, even if you are prone to headaches.
* Your headache is asso­ci­ated with slurred speech, change in vision, prob­lems mov­ing your arms or legs, loss of bal­ance, con­fu­sion, or mem­ory loss.
* Your headache gets pro­gres­sively worse over a 24-hour period.
* Your headache is accom­pa­nied by fever, stiff neck, nau­sea, and vom­it­ing.
* Your headache occurs with a head injury.
* Your headache is severe and local­ized to one eye with red­ness in that eye.
* You are over age 50 and your headaches just began, espe­cially with impaired vision and pain while chewing.

See your provider soon if:

* Your headaches wake you up from sleep.
* A headache lasts more than a few days.
* Headaches are worse in the morn­ing.
* You have a his­tory of headaches but they have changed in pat­tern or inten­sity.
* You have headaches fre­quently, and there is no known cause.

What to expect at your health care provider’s office

Your health care provider will obtain your 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 doc­tor may ask ques­tions such as the following:

* Is the headache located in the fore­head, around the eyes, in the back of the head, near the tem­ples, behind the 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 awaken you from sleep? Are the headaches worse dur­ing the day and bet­ter at night?
* Did other symp­toms begin shortly after the headaches began? Do headaches occur repeat­edly?
* 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 effec­tive was it?

Diag­nos­tic tests that may be per­formed include the following:

* Head CT scan
* Head MRI
* Sinuses x-rays
* Tem­po­ral artery biopsy
* Lum­bar puncture

If a migraine is diag­nosed, med­ica­tions that con­tain ergot may be pre­scribed. Tem­po­ral arteri­tis must be treated with steroids to help pre­vent blind­ness. Other dis­or­ders are treated as is appropriate.

Prevention

The fol­low­ing healthy habits can lessen stress and reduce your chance of get­ting headaches:

* Get­ting ade­quate sleep
* Eat­ing a healthy diet
* Exer­cis­ing reg­u­larly
* Stretch­ing your neck and upper body, espe­cially if your work involves typ­ing or using a com­puter
* Learn­ing proper pos­ture
* Quit­ting smok­ing
* Learn­ing to relax using med­i­ta­tion, deep breath­ing, yoga, or other techniques