What Is Headache?

Headache is one of the most common causes of pain, and it can have a significant impact on your daily life. There are many different types of headache, and they vary in cause, frequency, severity, and duration.

There are two main categories of headache: primary and secondary. Primary headache is a headache that happens on its own. Secondary headache is a headache that happens because of another medical condition.

There is no cure for primary headaches, but medications, therapies, and lifestyle changes can help manage pain and reduce their frequency. Secondary headaches may go away after treating the underlying condition.

Types of Headaches

There are many different types of both primary and secondary headaches.

Primary Headaches

A primary headache is a headache that is not caused by another medical condition. Common types of primary headache include:

• Migraine causes moderate to severe throbbing headaches, usually on one side of the head. Other symptoms, such as visual disturbances (aura), nausea, vomiting, and sensory sensitivity, can occur along with head pain.

  [1]

• Tension-type headache (stress headache) is the most common headache condition. It is often triggered by stressors, such as a lack of sleep or emotional or physical stress. Pain from a tension-type headache is mild to moderate and feels like constant pressure, often on both sides of the head.

  [2]

• Cluster headache causes sudden, severe pain in or around the eye on one side of the head. It often occurs with allergy-like symptoms, such as a stuffy or runny nose and redness or swelling in the affected eye. Cluster headache belongs to a group of headaches called trigeminal autonomic cephalalgias. It is less common than tension-type headache or migraine.

  [3]

Other, less common types of primary headache include:

• New daily persistent headache (NDPH) is a rare type of headache disorder that occurs suddenly for unknown reasons. It causes a headache that won't go away and doesn't get better with common treatments. NDPH pain is moderate to severe, and symptoms typically last for months.

  [4]

• Nummular headache, also called coin-shaped headache, is a rare headache disorder that causes pain in a fixed, coin-shaped area of the head. Pain from a nummular headache is usually mild to moderate and typically lasts for months.

  [5]

• Paroxysmal hemicrania and hemicrania continua cause moderate to severe pain on one side of the head. They belong to the same group as cluster headache and cause similar symptoms, such as tearing or redness in one eye and a stuffy or running nose. Paroxysmal hemicrania causes sudden, intermittent attacks that may last for 2 to 30 minutes. Hemicrania continua causes continuous headache pain for three months or more. Both types of headaches respond to treatment with the nonsteroidal anti-inflammatory drug indomethacin.

  [6]

• Hypnic headache is a rare headache disorder that typically affects older adults. It is also called "alarm-clock headache," because it causes you to wake during sleep. Hypnic headaches are usually mild to severe and can last from 15 minutes to four hours.

  [7]

• SUNA/SUNCT, or short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome), are headache disorders that cause short, intense bursts of pain, typically around one eye. They are often confused with cluster headache due to symptoms like sweating, eyelid swelling, and tearing, but don't last as long.

  [8]

• Sex headache occurs just before or during orgasm. While sudden and severe, they are usually not serious and typically affect men more than women.

  [9]

Secondary Headaches

A secondary headache is a headache that is caused by another health issue, such as medication or an infection. Secondary headaches can be more concerning because they may be a sign of a more serious underlying condition.

Common types of secondary headaches include:

• Medication Overuse Headache Long-term use of pain-relieving headache medications can make them less effective and lead to withdrawal, causing medication overuse headaches.

  [10]

• Sinus Headache Sinus headaches are headaches that feel like a sinus infection. They cause symptoms like pain and pressure in the face, a stuffy or runny nose, and fatigue. Because they share some symptoms, sinus headache is often confused with migraine.

  [11]

Less common or rare types of secondary headaches include:

• Post-Traumatic Headache Post-traumatic headache is a headache that develops after trauma to the head, such as a concussion. Headache pain can resemble a migraine or tension-type headache.

  [12]

• Thunderclap Headache This is a rare, extremely severe headache that occurs suddenly. It is a medical emergency and commonly a sign of a life-threatening condition, such as a brain hemorrhage or constriction of the arteries in the brain.

  [13]

• Spinal Headache Spinal headache, also called post-dural puncture headache or hypotensive/low pressure headache, is an intense headache that can occur when spinal fluid leaks from its protective membrane. It typically occurs after a spinal tap. Most spinal headaches resolve with home treatment, but an untreated spinal headache may lead to life-threatening complications.

  [14]

• Tumor-Related Headache In rare cases, a headache can be a symptom of a brain tumor. Headaches caused by a brain tumor tend to get worse over time and may occur with other symptoms, such as trouble understanding speech, memory problems, and motor issues.

  [15]

• Infection-Related Headache Headaches can sometimes be related to a bacterial or viral infection, such as Epstein-Barr virus (mononucleosis), Salmonella, COVID-19, or meningitis.

  [4]

• Neuropathy-Related Headache Some headaches can be caused by a type of nerve damage called neuropathy. These include trigeminal neuralgia, which causes sudden attacks of severe face pain, occipital neuralgia, which causes a shooting pain that starts in the neck, and cervical radiculopathy, which causes radiating pain due to compressed nerves in the neck.

  [2]

Signs and Symptoms of Headaches

Pain can range from mild to severe and may occur with other symptoms, such as nausea or increased sensitivity to light. Headaches can cause pain on one or both sides of the head and in other areas, such as the face, neck, top of the head, or around one eye.

• Vomiting
• Fatigue
• Increased sensory sensitivity
• Visual disturbances (aura)
• Stuffy or runny nose
• Eye redness or tearing
• Sweating
• Nervousness or restlessness
• Disturbed sleep

• A severe headache with unexplained fever, nausea, or vomiting
• A sudden, severe headache with a stiff neck
• A new, severe headache with confusion, weakness, blurry vision, or loss of consciousness
• A headache that gets worse or changes over days or weeks
• A headache after head trauma
• A headache with loss of feeling or weakness
• A headache with shaking or trouble breathing
• Two or more headaches a week
• A headache with speech difficulties
• A new, constant headache after age 50

Causes and Risk Factors of Headaches

• Mental and physical stress
• Sleep changes or lack of sleep
• Dehydration
• Poor posture
• Alcohol
• Smoking
• Skipped meals
• Certain foods
• Weather changes

• Substance misuse or withdrawal
• Infections, such as COVID-19, sinusitis, or meningitis
• Brain injury, such as a concussion or stroke
• Brain tumor
• Neuropathy

How Are Headaches Diagnosed?

• Blood and urine tests to check for infection, toxins, medication levels, and other health conditions
• Spinal fluid analysis to check for meningitis, encephalitis, viral infections, and neurodegenerative disorders, such as multiple sclerosis
• Imaging tests, which can detect physical changes in the brain, such as a tumor, stroke, brain injury, infection, and signs of neurodegenerative disorders. They include computerized tomography (CT) scans and magnetic resonance imaging (MRI).
• Electroencephalogram (EEG) to show changes in brain wave activity and which can help diagnose seizures and other disorders that disrupt brain activity

Treatment and Medication Options for Headaches

Headache treatment involves medications to prevent and manage symptoms, treating any underlying conditions causing headaches, and therapies to manage stress and other symptoms.

Medication Options

Several types of medication can help treat and prevent headaches. They are available as oral pills or tablets, nasal sprays, and injections.

Triptans

• sumatriptan (Imitrex, Onzetra, Tosymra)
• naratriptan (Amerge)
• zolmitriptan (Zomig)
• rizatriptan (Maxalt)
• almotriptan
• frovatriptan (Frova)
• eletriptan (Relpax)

Over-the-Counter Pain Relievers

Ergots

Calcitonin Gene-Related Peptide (CGRP) Inhibitors

Gepants are a type of CGRP inhibitor that provides pain relief during a migraine attack. They are available as oral pills and nasal sprays. They include:

• ubrogepant (Ubrelvy)
• rimegepant (Nurtec ODT)
• zavegepant (Zavzpret)

Monoclonal antibodies are another type of CGRP inhibitor. They can help prevent migraine and cluster headaches. Monoclonal antibodies are administered as an injection under the skin or as an intravenous infusion. Examples include:

• erenumab (Aimovig)
• fremanezumab (Ajovy)
• galcanezumab (Emgality)
• eptinezumab (Vyepti)

High Blood Pressure Medications

Other Medications

• Botox (Botulinum Toxin Type A) Injections Botox prevents the release of CGRP and other pain messengers. It is injected into the muscles of the forehead and neck every 12 weeks to prevent migraine attacks.

  [24]

• Nausea Relief Drugs These medications ease nausea symptoms of migraine headaches. Examples include chlorpromazine (Thorazine), metoclopramide (Reglan, Gimoti), and promethazine (Phenergan).

  [25]

• Antiseizure Medications Medications that commonly treat epilepsy may also help prevent migraine. Examples of antiseizure medications that treat migraine include topiramate (Topamax) and divalproex sodium (Depakote).
• Antidepressants Some antidepressant medications may help prevent migraine attacks. Examples include tricyclic antidepressants, such as amitriptyline and nortriptyline (Pamelor, Aventyl), and serotonin norepinephrine reuptake inhibitors, such as venlafaxine (Effexor).

  [26]

• Lidocaine Lidocaine is a type of local anesthetic. It has a numbing effect, which may help reduce cluster headache pain when taken as a nasal spray. It may also be administered as a nerve block (injection) to treat pain from headaches like occipital neuralgia.
• Corticosteroids Corticosteroids, such as prednisone (Prednisone Intensol, Rayos), are often used together with verapamil. They provide short-term relief for cluster headaches, but can cause serious side effects with long-term use.
• Lithium (Lithobid) Commonly used to treat bipolar disorder, lithium may also help prevent chronic cluster headaches when other medications aren't effective.

Complementary and Integrative Therapies

• Oxygen Therapy Breathing in pure oxygen through a mask can relieve symptoms of a cluster headache within 15 minutes.

  [2]

• Noninvasive Vagus Nerve Stimulation Stimulating the vagus nerve can help relieve headache pain. This involves using a handheld controller to send electrical stimulation to your vagus nerve through the skin. The vagus nerve connects your brain to the rest of your nervous system and plays a role in regulating pain.

  [27]

• Biofeedback This relaxation technique involves placing special sensors on your body to teach you how to monitor and manage physical stress from headaches.
• Cognitive Behavioral Therapy (CBT) This therapy involves learning how negative thought patterns and beliefs affect your body, emotions, and behavior. CBT can help you cope with headache pain and reduce headache-related psychological distress.
• Physical Therapy Physical therapies, such as massage and acupuncture, may help reduce stress related to headache pain.

Lifestyle Changes and Prevention of Headaches

• Reduce stress, such as with breathing exercises, meditation, and yoga.
• Maintain a regular sleep schedule.
• Get regular exercise.
• Eat a healthy diet.
• Drink plenty of water.
• Avoid alcohol and smoking.
• Avoid headache triggers, such as smells, foods, or beverages.
• Avoid or reduce medications that may cause headaches, such as those containing estrogen.

  [11]

How Long Do Headaches Last?

There is no cure for primary headaches, but medications and therapies can help manage pain and reduce headache frequency.

Because secondary headaches are caused by an underlying condition, headache symptoms may resolve once the condition is treated.

Complications of Headaches

Primary headaches typically don't cause serious complications, but they can have a significant impact on your quality of life. Without treatment, conditions that cause secondary headaches can become life threatening.

• Medication Side Effects Some headache medications can cause mild side effects, such as constipation, nausea, drowsiness, or fatigue. Long-term use of some headache medications may increase the risk of more serious side effects, such as diabetes, kidney problems, and gastrointestinal bleeding.

  [19]

• Mental Health Disorders Chronic headache pain is associated with higher rates of anxiety and depression.
• Sleep Disorders Headaches can cause disruptions with sleep. People with migraine or cluster headache more commonly experience sleep disorders.
• Increased Risk of Suicide Primary headache disorders, such as migraine, cluster headache, and chronic tension headache, are associated with a higher risk of suicide.

  [28]

• Status Migrainosus In rare cases, a migraine attack can cause debilitating pain and nausea that lasts for more than 72 hours. Symptoms may be so intense that a person requires hospitalization.
• Complications of Untreated Secondary Headaches Without treatment, conditions that cause secondary headaches can lead to serious or life-threatening complications, such as stroke, bleeding in the brain, and seizures.

  [14]

The Takeaway

• Headaches can be primary or secondary. Primary headaches occur on their own and include migraine, tension-type headaches, and cluster headaches. Secondary headaches are symptoms of an underlying medical condition, such as an infection, head trauma, tumor, or medication overuse.
• Headache pain can happen on one or both sides of the head and may occur with other symptoms, such as nausea or vomiting, visual disturbances, sensory sensitivity, and stuffy or runny nose.
• Treatment involves medications, therapies, and lifestyle changes to manage and prevent symptoms.
• Seek immediate medical attention if you experience a severe or worsening headache along with symptoms like an unexplained fever, stiff neck, weakness, or confusion.