Headache

Date Updated: 06/03/2020

Definition

Headache is pain in any region of the head. Headaches may occur on one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a viselike quality.

A headache may appear as a sharp pain, a throbbing sensation or a dull ache. Headaches can develop gradually or suddenly, and may last from less than an hour to several days.

Causes

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:

Primary headaches

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
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
Stress

Secondary headaches

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
Brain AVM (arteriovenous malformation)
Brain tumor
Carbon monoxide poisoning
Chiari malformation (structural problem at the base of your skull)
Concussion
Coronavirus disease 2019 (COVID-19)
Dehydration
Dental problems
Ear infection (middle ear)
Encephalitis (brain inflammation)
Giant cell arteritis (inflammation of the lining of the arteries)
Glaucoma (acute angle closure glaucoma)
Hangovers
High blood pressure (hypertension)
Influenza (flu) and other febrile (fever) illnesses
Intracranial hematoma
Medications to treat other disorders
Meningitis
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 (idiopathic intracranial hypertension)
Stroke
Toxoplasmosis
Trigeminal neuralgia (as well as other neuralgias, all involving irritation of certain nerves connecting the face and brain)

Some types of secondary headaches include:

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)

When to see a doctor

Seek emergency care

A headache can be a symptom of a serious condition, such as a stroke, meningitis or encephalitis.

Go to a hospital emergency room or call 911 or your local emergency number if you're experiencing the worst headache of your life, a sudden, severe headache or a headache accompanied by:

Confusion or trouble understanding speech
Fainting
High fever, greater than 102 F to 104 F (39 C to 40 C)
Numbness, weakness or paralysis on one side of your body
Stiff neck
Trouble seeing
Trouble speaking
Trouble walking
Nausea or vomiting (if not clearly related to the flu or a hangover)

Schedule a doctor's visit

See a doctor if you experience headaches that:

Occur more often than usual
Are more severe than usual
Worsen or don't improve with appropriate use of over-the-counter drugs
Keep you from working, sleeping or participating in normal activities
Cause you distress, and you would like to find treatment options that enable you to control them better