Headache: common types, triggers, self-care and warning signs

Almost everyone has a headache at some point. Most are harmless and pass on their own, but a few are a sign of something that needs urgent attention. This article describes the main types of headache, what can trigger them and when to seek help, using information from the NHS, MedlinePlus and the US National Institute of Neurological Disorders and Stroke (NINDS).

1. Introduction

MedlinePlus describes headache as the most common form of pain and a major reason people miss work or school or visit a doctor. MedlinePlus says headaches sometimes signal a more serious disorder, though not all need a doctor ^[2]. The NHS says most headaches go away on their own and may last from 30 minutes to several hours, and occasionally several days ^[1].

NINDS divides headaches into two groups. Primary headaches are the condition itself, for example tension-type headache and migraine. Secondary headaches are a symptom of another problem that irritates pain-sensitive parts of the head ^[3].

2. Types of headache

Tension-type headache is the most common. It is linked with tight muscles in the neck, scalp, face and jaw. Pain is usually mild to moderate, feels like constant pressure or a tight band and usually affects both sides of the head. Episodes can last from 30 minutes to 7 days ^{[2, 3]}.

Migraine causes repeated attacks of moderate to severe throbbing pain, usually on one side of the head. It affects children and adults and occurs more often in women ^[3].

Cluster headache is less common but can be the most severe of the primary headaches. Attacks are sudden and very painful, usually around or behind one eye, and can come with a red, watery eye or a runny nose on that side. Attacks occur in periods lasting weeks and often wake people from sleep ^[3].

The NHS also mentions hormone headaches linked to periods or menopause ^[1]. MedlinePlus lists sinus headache, cough headache, exercise headache and thunderclap headache, which comes on suddenly and severely, as other forms ^[2].

3. Causes and triggers

The NHS lists common causes and triggers including colds and flu, stress, alcohol, poor posture, eyesight problems, skipping meals, dehydration, taking too many painkillers and hormone changes ^[1]. The NHS also names straining the eyes for long periods, for example at a screen ^[1]. NINDS adds poor sleep, straining postures when reading or using a computer or phone, sun exposure, certain foods, caffeine or caffeine withdrawal, weather changes and changes in routine such as fasting ^[3].

Secondary headaches can be caused by conditions such as stroke, brain injury, high blood pressure, infection or a brain tumour. These are less common ^[3].

4. Diagnosis and tests

A doctor usually starts with your medical history, your headache history and a physical and neurological examination. Tests such as blood tests, a CT or MRI scan, which are types of imaging of the brain, or an EEG, which records brain activity, may be ordered ^[3].

A headache diary is a simple tool that helps. NINDS suggests noting when headaches begin, how severe they are, how long they last, what you were doing, medicines taken, sleep, stress, food and drink, and for women the timing of periods ^[3]. The NHS also recommends a diary to find triggers ^[1].

5. Treatment and self-care

For an ordinary headache, the NHS suggests drinking plenty of water, trying to relax and using an over-the-counter pain reliever, and resting if you also have a cold or flu. It advises not skipping meals, not sleeping more than usual, avoiding long periods of eye strain such as screen use, and avoiding alcohol ^[1].

Treatment depends on the diagnosis ^[2]. For migraine and cluster headache, doctors may use specific medicines to treat attacks or prevent them, and your doctor decides what is suitable ^[3]. Non-drug approaches such as relaxation training, biofeedback, gentle exercise, physiotherapy and cognitive behavioural therapy may help stress-related headaches ^[3].

Taking headache medicines too often can itself make headaches worse or cause new ones. NINDS says a doctor can help make a safe plan ^[3].

6. Prevention

• Keep regular sleep times, because too little or too much sleep can worsen headaches ^[3].
• Eat regular meals and drink enough water ^[1].
• Manage stress and take breaks from screens ^{[1, 3]}.
• Exercise regularly ^[3] and avoid bad posture, which the NHS lists as a cause ^[1].
• Limit alcohol and avoid overusing painkillers ^[1].
• Use a diary to spot and avoid your own triggers ^{[1, 3]}.

7. Special groups

NINDS says children may find it hard to describe a headache, and drawing where it hurts can help the doctor. Always ask a doctor before giving headache medicine to a child ^[3]. A new, constant headache after age 50, or a new headache in someone with a history of cancer or HIV, should be checked promptly ^[3].

8. When to see a doctor

The NHS advises an ordinary appointment if self-care is not helping, the headache is getting worse or you get headaches regularly ^[1]. NINDS lists two or more headaches a week as a reason to seek care ^[3].

Ask for urgent advice if the headache comes with vision problems, is triggered by coughing, sneezing, bending or exercise, comes with vomiting, causes jaw pain when eating or a tender scalp, or in a child wakes them at night or keeps getting worse ^[1].

Seek emergency help if a headache comes with any of these ^{[1, 2, 3]}:

• A seizure
• Numbness or weakness in the face or body
• A sudden, extremely painful onset
• A head injury
• Trouble speaking, walking or balancing, or confusion
• Loss of vision
• A stiff neck with fever or sensitivity to light
• A rash that does not fade when pressed with a glass

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Most headaches are harmless and pass on their own, and fluids, regular meals, good sleep and stress management are the steps suggested. Keeping a diary helps find triggers, and frequent or changing headaches deserve a medical check. Learn the warning signs, because sudden severe pain, weakness, confusion or a stiff neck with fever need emergency care.