Headaches

What is a headache?

A headache is pain or pressure that you feel somewhere between your scalp and your jaw. Almost everyone gets one from time to time, and in the vast majority of cases there's nothing worrying behind it.

What are the common causes of headaches?

Day-to-day factors are behind most headaches:

• stress and tension
• dehydration, or not drinking enough fluids generally
• poor or disrupted sleep
• skipping meals
• alcohol, especially red wine or after a heavy drinking session
• too much caffeine, or stopping it suddenly
• poor posture or eye strain, including long periods looking at a screen
• smoking
• hormonal changes around your period or menopause
• taking painkillers very often, which can itself trigger more headaches
• a cold, flu, or other minor infection.

Certain foods and environmental triggers can also set off migraines specifically, including chocolate, cheese, citrus fruit and processed foods, as well as bright lights, strong smells, and loud noise. Headaches can sometimes be linked to an underlying condition such as sinusitis, an eye or dental problem or, very occasionally, high blood pressure.

Are there different types of headaches?

Headaches are broadly grouped as primary, meaning the headache itself is the problem, or secondary, meaning it's a symptom of something else going on.

The three most common primary headaches are:

• Tension headache: This is the most common type, felt as a dull, pressing band across your forehead that tends to build through the day
• Migraine: Typically a throbbing pain on one side of your head, often with nausea and a strong dislike of light or noise, lasting at least a few hours – it may be preceded by an aura, consisting of visual or neurological symptoms
• Cluster headache: This is a rare but very severe type causing sharp, concentrated pain focused around one eye, often with a watering or red eye, blocked nose, or drooping eyelid on that side, coming in bouts over several weeks.

Common secondary headaches include ones linked to sinus problems and to overusing painkillers, both of which tend to clear up once the underlying cause is treated.

A small number of secondary headaches point to something more serious, which is why certain warning signs (covered below) are always worth acting on.

How are headaches diagnosed?

For most headaches, a clinician can make a diagnosis simply by talking to you and carrying out an examination. They'll usually ask what the pain feels like, where it is, how often it happens, how long it lasts, what seems to trigger it, and about your sleep, stress and caffeine habits, alongside checking for any physical or neurological signs.

Scans don't actually help confirm tension headaches, migraines or cluster headaches, so they're not routinely used for these. If your clinician suspects an underlying cause instead, they might arrange a blood test, an X-ray of your sinuses, or a CT or MRI scan of your head.

How are headaches treated?

For an occasional headache, simple self-care is usually enough:

• drink plenty of fluids and rest somewhere quiet and dimly lit
• take paracetamol, ibuprofen, or aspirin if you're over 16
• hold a cold pack or a warm compress against your head, whichever feels better
• try gentle relaxation, a short walk, or a massage to your head, neck or shoulders.

Try to keep painkiller use to no more than around 10 days a month, since taking them too often can itself lead to a persistent headache. Keeping a diary of when your headaches happen and what you were doing beforehand can help you spot and avoid your own triggers.

If headaches keep coming back or are severe, your GP might suggest stress management or relaxation-based therapy, or prescribe specific medication such as triptans for migraine or cluster attacks. Regular medications to reduce the frequency of headaches can also be prescribed.

For cluster headaches specifically, breathing pure oxygen can also help during an attack. Where a secondary headache has an identifiable cause, such as sinusitis, treating that condition usually resolves the headache too.

When should you see a doctor?

Book a routine GP appointment if headaches keep recurring, one isn't easing despite treating it yourself, or you find yourself reaching for painkillers very often just to get through the day.

Ring NHS 111 or ask your practice for an urgent same-day appointment if you have a scalp that's tender to touch, or a headache that:

• brings new eye or vision trouble
• flares up with coughing, sneezing, bending over or exercise
• arrives together with being sick
• sits alongside jaw pain while eating.

For a child, urgent advice is also worth getting if their head pain is worsening or rousing them from sleep.

Treat it as a 999 or A&E emergency where a headache is joined by:

• a seizure, sudden numbness or weakness anywhere in the face or body
• a start that's both abrupt and agonising
• a head knock from within the past three months
• trouble getting words out, walking steadily or keeping your balance
• drowsiness or confusion
• any loss of sight
• a fever that won't shift alongside neck stiffness
• spots that stay put when you press a glass tumbler against them.