Headaches are the most common type of pain. Read about the different types and when to seek help.
Headaches are a major reason why people miss work or school. Although most headaches are nothing to be concerned about, if you keep getting them you should talk to your healthcare provider about them.
Secondary headache disorders have a clear underlying cause and could have very serious consequences if the cause is missed.
(Ted-Ed, 2018)
Image credit: Canva
What can I do if I have a headache?
The treatment of your headache will depend on the cause and will vary depending on the specific type of headache. Here are a few general things you can do.
Drink a large glass of water as you may be dehydrated.
paracetamol, aspirin or ibuprofen are simple pain relievers (analgesics) that can ease occasional tension headaches
if pain relief is taken soon enough, it can help stop migraine. Read more about migraine medicines.
Rest in a dark, quiet room.
Have someone give you a head, neck and shoulder massage.
Relax in a warm bath.
If you keep getting headaches or migraines, track them with a headache diary to help you look for triggers or patterns. This can also be useful to show your doctor.
If you get headaches 3 or more times a month, your doctor may recommend preventive treatment.
When to get help
Usually, headaches go away given time, rest and/or treatment with a pain relief medication.
Contact a healthcare provider or call Healthline 0800 611 116 for advice if:
your headaches remain frequent, persistent or worsen
you get no relief from simple pain relievers
you take simple pain relievers more than twice a week
you were headache-free but now get them
your headache is triggered by standing up, coughing, straining, physical exertion or sexual intercourse
you are over 50 and start to get regular headaches or there is face or jaw pain.
Call 111 and ask for an ambulance or go to the nearest hospital if:
a really severe headache comes on suddenly and gets worse within minutes
you have changes in your vision or eyesight or changes in consciousness
you are feeling sick (nausea), have a stiff neck, rash, fever, shakes or sensitivity to light (these are warning signs of meningococcal disease or meningitis)
you have red eye, are feeling sick (nausea) or being sick (vomiting) – these are signs of some types of glaucoma
There are many types of headaches. These vary in their causes, how they feel, how severe they are, how long they last and how they respond to different treatments. Read more about the different types of headache and what causes them.
How can I describe my headaches?
Where is the pain? Is it on one side or both, behind your eye(s), forehead.
How severe are they? You can describe how severe your pain is using on a scale of 1 to 10. See ways to describe pain.
What do they feel like? Is it vice-like, stabbing, throbbing, splitting.
How long do they last? This could be minutes, hours or days.
How often do they occur? Are they daily, monthly, only at certain times of the day, only on weekends or weekdays?
When do they occur? Is it on waking, in the afternoon or at work?
How do they start? Does the pain develop over hours or does it begin suddenly?
When did you start getting headaches? Was it childhood, adolescence or middle age?
What triggers them? This could be some foods, alcohol, caffeine, exertion, noise, bright light, hunger, stress, tiredness, weather.
What else do you feel? This may include neck or shoulder tension, sinus pain, tender scalp, jaw pain, being sick (nausea or vomiting).
Is your vision affected? For example do you have blind spots, strange lights or patterns?
What treatment do you take?
How effective was the treatment?
When should I have an imaging test for headaches?
Not everyone with headaches needs to have an imaging test. In some cases, you may need a CT or MRI scan if:
your doctor could not diagnose your headache based on your history and examination
your doctor finds something abnormal in your examination
you have unusual headaches or headaches caused by a more serious problem.
Lifestyle changes can help prevent headaches. Getting more exercise, avoiding known stresses or triggers, improving your sleep and diet can all help a lot.
Avoid triggers
If you know what causes your headaches (eg, alcohol, chocolate, cheese) it’s best to avoid these things if you can.
Change what you eat
Keep your blood-sugar levels even by eating small amounts of a healthy, balanced diet regularly.
You may find keeping a headache diary useful to work out whether certain foods trigger your headaches and need to be avoided.
Reduce stress
try to make time in your day to do something you find relaxing – have a bath, go for a walk, laugh with friends.
Get regular exercise
Activities such as swimming or vigorous walking can help reduce how often you get headaches and how bad they are.
Dr Pyari Bose is a neurologist with special interest in headache disorders. He did headache research at King's College London, looking into the postdrome (recovery) phase of migraine using functional brain imaging.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Pyari Bose, Consultant Neurologist, Auckland City Hospital
Last reviewed: 04 Nov 2021
Information for healthcare providers on headache
The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.
Key information about headache provided by Dr Pyari Bose, neurologist, Auckland
Primary headache disorders
Primary headache disorders like migraine and cluster headache form the major bulk of referrals to a neurologist. Every year it is estimated that 3 billion people worldwide are affected. Though these disorders are not life threatening, they canlead to major disability with heavy socioeconomic consequences.
Patients sometimes find it hard to access resources for diagnosis, management and supportand hence raising medical awareness is paramount.New advances in the understanding of the disorders and novel therapeutic developments takes us to an exciting era in management.New acute therapies for migraine attackslikegepants, calcitonin gene-related peptide (CGRP) receptor antagonists, and serotonin 5-HT1F receptor agonists, offer novel approaches to the treatment.
See the following for more information about specific primary headache disorders:
These are headaches caused by an underlying condition. Clinicians who evaluate patients with headache should be alert to signs that suggest a serious underlying disorder. Missing a secondary headache disorder can have devastating consequences for the patient. The disorders that fall in this category include brain tumours, brain bleeds, brain infections.
Red flag signs
The presence of the following red flag signs in the context of headache could indicate a serious underlying disorder and warrants an urgent medical review:
Headache with systemic symptoms including fever.
Headache in apatient with prior history of cancer.
Headache with clinical signs on examination including decreased consciousness.
Onset of headacheis sudden or abrupt(i.e.,headache peaks in intensity over few minutes rather than several minutes or hours).
New onset headache after age 50 years- this would be unusual for a primary headache disorder like migraine.
Pattern change of usual headachesor recent onset ofdifferent type ofheadache.
Positional headache i.e.,headaches that worsen onlyingflat or come on within few minutes of standing up.
Headaches precipitated by sneezing, coughing, or exercise.
Headache with evidence of swelling behind the eye (papilledema) detected at the opticians.
Headache onset during pregnancy or following delivery.
Headache associated with a painful eye, eye swelling or with autonomic features like watering from the eye, redness of the eye, running nose.
Headache that developed following head trauma,\.
Headache onset in the context of an immune deficiency state such as HIV.
Post-traumatic headache
Post-traumatic headache (PTH)is the most frequent symptom after mild traumatic brain injury (mTBI). It is estimated that annually 69 million suffer from TBI worldwide, mostly attributable tomTBI.InNew Zealand it is estimated that up to 36,000 people suffer TBIs each year, of which 95% are mild.
The leading causes of TBI in New Zealand are falls,mechanical forces, driving-related accidents andassaults.Just over 20% of all TBIs in New Zealand are sustained through sport-related activity.(7)
The underlying cause of PTH is not fully known. It is thought thatmechanisms related toboth migraine and traumatic brain injury (TBI) are implicated. These include impaired descending paincontrol networks in thebrain,neurochemicalchanges, neuroinflammation, cortical spreading depression, and release of thepain protein-calcitonin gene-related peptide (CGRP).
The treatment would be determined by evaluation of the underlying headache phenotype. Common patterns of PTH include migraine type and tension type headache patterns. Part of the management also includes addressing if patients are overusing pain medications.
Headachesmay resolve within 3 months of the traumatic brain injury but in some patients this may last longer.
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
Professor Alan Barber presented on common CNS issues such as headache, seizures, turns and tremors through case-based learning to increase practitioner confidence in assessment and management.
(Goodfellow Unit Webinar, NZ, 2020)
PHARMAC seminars
1. Neurology basics (parts 1 & 2) – Dr Anna Ranta (27 minutes + 30 minutes = 57 minutes)
(PHARMAC Seminars, NZ, 2019)
(PHARMAC Seminars, NZ, 2019)
2. Interactive cases, including headache and epilepsy (parts 1, 2 & 3) – Dr Anna Ranta (38 minutes + 28 minutes + 17 minutes = 83 minutes)
It usually begins with shoulder or neck tension and may feel like a tight band around your head, a dull ache on both sides of your head, or a heavy weight on top of your head.
Tension headache can last for a few hours to days and they tend to develop later in the day.
They are usually brought on by lifestyle issues such as working too much or not getting enough sleep, poor posture and emotional stress or anxiety.
In migraine the pain is usually one-sided, throbbing, quite intense and can make you feel weak and exhausted.
Migraines last from a few hours to days.
Migraine most commonly brings other symptoms, such as nausea, vomiting and aversion to light and noise.
Some people may have a migraine aura before the headache begins, which could be problems with your eyes such as seeing zig-zag lines, dizziness, or a pins-and-needles feeling.
More women than men suffer from migraine. It is common in children, teenagers and young adults, but may begin at any age.
Treatment of migraines includes lifestyle changes and using medicines for relief or, in some cases, using preventive medicines to stop a migraine from happening.
Sinus headache is pain around your eyes, forehead, cheeks or teeth that gets worse when leaning forward. It can be dull or severe.
It is a secondary headache disorder caused by sinusitis.
You often get other symptoms of sinusitis such as a blocked or stuffy nose, feeling of pressure inside your head, mucus from your nose and dripping from your nose.
Medication overuse (or rebound) headache is a secondary headache disorder caused by using too much pain relief medicine to treat headaches.
It may feel like a tension-type headache or migraine-like attack.
Headaches often improve within 2–4 weeks of withdrawal of the overused medicine, but you can feel worse before you feel better.
To avoid this, limit the use of pain relief medication. Use them for the shortest possible time, only when you have pain. For example, paracetamol and NSAIDs should not be taken for headache on more than 15 days per month and triptans for migraine should not be used for more than 10 days per month.
Post-traumatic headache
Post-traumatic headache (PTH) is a secondary headache disorder caused by mild traumatic brain injury (mTBI).
It is the most common symptom of mTBI.
Your headaches may go away within 3 months of the mTBI, but in some people this may last longer.
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