Headaches

Overview

A headache is pain or discomfort anywhere in your head, face, scalp, or neck. It is not a disease in itself — it is a symptom, a signal your body sends. Most headaches are not a sign of anything serious. They can be a dull ache, a tight band around your head, or a throbbing pain on one side. Some come and go in an hour; others last for days.

Yes, very common. Almost everyone has a headache at some point, and most adults get one now and then. Headaches are one of the most frequent reasons people visit a doctor or pharmacist.

Anyone can get headaches, at any age. Tension headaches are common in adults and teenagers. Migraine often starts in childhood or the teenage years and is more common in women, partly because of hormone changes. Some headaches are more likely as we get older, and a brand-new headache after age 50 always deserves a check-up.

Symptoms

Common symptoms

• A dull, pressing ache on both sides of the head, like a tight band — typical of tension headache
• Throbbing or pulsing pain, often on one side of the head — typical of migraine
• Feeling sick, or being sick, during a bad headache
• Sensitivity to light, sound, or smells
• Pain that gets worse when you move, bend over, or cough (in some types of headache)
• Tenderness in the scalp, neck, or shoulders
• Feeling tired, foggy, or unable to concentrate
• Pain behind the eyes, or a feeling of pressure in the face

Symptoms in children

• Young children often cannot say 'my head hurts' — they may be clingy, quiet, irritable, or sleep more
• They may point to their tummy or say they feel sick, because children's migraine often causes stomach pain and vomiting
• Attacks may be shorter than in adults, and they may look pale or want to lie in a dark room
• Some children get 'abdominal migraine' — repeated bouts of tummy pain with no headache, which a doctor may link to migraine
• Frequent headaches in a child should always be checked by a doctor, and school or eyesight problems are worth thinking about too

Symptoms in older adults

• A new type of headache starting after age 50 needs checking, because a few rare causes are more likely at this age
• Scalp tenderness, or jaw pain when chewing, together with headache — this needs same-day medical advice
• Headaches caused by taking pain relievers too often are common in older adults
• Changes in vision, or sudden blurred or double vision, should be checked quickly
• Neck problems and jaw (dental) problems can cause headaches that feel like they start in the head

Causes

Main causes

• Tension headache — muscle tightness in the head, neck, and shoulders, often linked to stress, poor posture, or long hours at a screen
• Migraine — a genetic tendency in the brain; attacks can be set off by many different triggers
• Pain reliever overuse headache — taking pain relievers for headaches on many days a month can itself keep the headache going
• Dehydration, skipped meals, low blood sugar, or too much or too little caffeine
• Poor sleep, or a change in sleep pattern such as at weekends or after night shifts
• Stress, anxiety, worry, and low mood
• Alcohol, especially red wine, and some food additives in people who are sensitive to them
• Hormone changes — around periods, in pregnancy, and around the menopause
• Sinus congestion, a cold, or an ear or tooth problem
• Eye strain or an untreated eyesight problem
• Raised blood pressure, which usually causes no symptoms but is worth checking
• Cluster headache — very severe pain around one eye, with a red or watery eye and a blocked or runny nose, often at the same time each day
• Rarely, a serious cause such as bleeding around the brain, an infection, or a growth — this is why some warning signs matter so much

Risk factors

• Being female — migraine is about three times more common in women
• A family history of migraine or other headaches
• High stress levels or a demanding job
• Long periods looking at screens or sitting with poor posture
• Irregular sleep, shift work, or travel across time zones
• Skipping meals or not drinking enough water
• Drinking a lot of caffeine, or suddenly stopping it
• Taking pain relievers on more than about 10 to 15 days a month
• Anxiety, depression, or ongoing worry
• Being overweight — linked to more frequent migraine
• Head injury in the past

When to see a doctor

See a doctor urgently if:

• Any of the emergency warning signs listed above — call your local emergency number
• A headache that is much worse than any you have had before
• Headache with fever, a stiff neck, or a rash
• Headache with confusion, drowsiness, or trouble speaking or walking
• Headache after a bump to the head that is getting worse
• A new headache in pregnancy or after childbirth
• New headache over age 50, especially with jaw pain, scalp tenderness, or vision changes

Book a routine appointment if:

• Headaches that keep coming back and get in the way of work, school, or sleep
• You need pain relievers more than a couple of days a week
• Your headaches are changing in pattern, location, or strength
• You have migraine with aura — for example, flashing lights or zigzag lines before the pain — especially if you also take hormonal contraception, as this is worth discussing
• Headaches are affecting your mood, appetite, or daily life
• You want to talk about prevention, or you are worried and would like reassurance

Diagnosis

Most headaches are diagnosed by talking. Your doctor will ask about the pain — where it is, what it feels like, how long it lasts, what sets it off, and what helps. They will ask about your sleep, stress, caffeine, screen time, and any medicines you take. Then they will do a short physical check, including your blood pressure, your neck, and a simple nerve and eye check. In most cases that is all that is needed, and no scan is required.

Tests that may be done

• A headache diary — noting the date, time, strength, triggers, and what helped — is the single most useful 'test'
• Blood pressure measurement
• A physical and nerve examination, including checking your eyes, neck, and balance
• Blood tests, if the doctor suspects a particular cause such as an infection or a hormone or thyroid problem
• An eye test, if eyesight or eye strain could be part of the picture
• A scan (CT or MRI) only if there are warning signs, a change in your usual pattern, or a finding on examination — most people with headache do not need one

What to expect at your appointment

Expect a conversation more than a battery of tests. Your doctor will usually be able to tell you what type of headache you have and talk through a plan. If you are asked to keep a diary, bring it back in a few weeks. If a scan is arranged, it is usually to rule things out — not because anything serious is suspected for certain. Ask questions if you are unsure what is happening next.

Treatment

Treatment depends on the type of headache and how much it affects your life. Most people do well with a mix of self-care, understanding their triggers, and simple pain relief used carefully. If headaches are frequent, your doctor may talk about daily medicines to prevent them rather than just treat them. The goal is fewer, shorter, and milder headaches — and getting your life back.

Self-care at home

• Rest in a quiet, dimly lit room when a headache starts
• Drink water — dehydration is a common and easily fixed trigger
• Eat regular meals and do not skip breakfast
• Keep regular sleep and wake times, including at weekends
• Try a cool or warm pack on your forehead or the back of your neck, whichever feels better
• Gently massage your neck and shoulders
• Take screen breaks — look away every 20 minutes or so, and check your posture and screen height
• Limit pain relievers to no more than about two days a week unless your doctor advises otherwise, to avoid overuse headache
• Keep a headache diary to spot patterns
• Cut back on caffeine slowly rather than stopping suddenly

Medical treatments

Your doctor or pharmacist can suggest pain relievers that are suitable for you, taking into account other conditions and medicines you take — always ask them rather than choosing alone, and follow the label. Taken too often, these medicines can cause more headaches, so the number of days you use them matters. If you get headaches often, your doctor may suggest a daily preventive medicine that is taken whether or not you have a headache; these are chosen to suit your type of headache, your age, and your health, and are usually started at a low level and reviewed after a few weeks. Some people are referred to a headache clinic or a specialist for further options, including specific treatments for migraine or cluster headache. Talking therapies such as cognitive behavioural therapy can help where stress or anxiety plays a part. Always check with your doctor or pharmacist before combining medicines, and ask what to do if an attack does not settle.

When is surgery considered?

Surgery is almost never used for common headaches. It may occasionally be discussed for a very specific, rare underlying cause found on a scan, or in a small number of specialist headache cases — your specialist team would explain this fully if it ever applied to you.

Living with this condition

Living with frequent headaches is about planning without letting headaches run your life. Many people find that a regular routine — meals, sleep, movement, and screen breaks — cuts the number of attacks. Keep a small supply of what usually helps you, plus water, to hand at work or school. Tell people close to you what helps during an attack, so they can support you. If attacks are unpredictable, build in a little flexibility around important days.

Lifestyle tips

• Keep a steady sleep schedule, even at weekends
• Eat at regular times and stay hydrated
• Build in short breaks from screens and from long stretches of close work
• Check your posture — feet flat, screen at eye level, shoulders relaxed
• Manage stress with breathing exercises, a short walk, or whatever calms you
• Be consistent with caffeine, or reduce it slowly
• Notice your triggers in a diary, but do not cut out lots of foods on guesswork — it can make life harder without helping
• Stay connected with friends and family; isolation makes pain feel worse
• Keep any regular health checks, including blood pressure

Diet and exercise

There is no special headache diet, but regular meals, plenty of water, and limiting alcohol can make a real difference. Some people find certain foods or additives trigger their migraine — a diary is the best way to check before cutting anything out. Regular, gentle-to-moderate activity such as walking, swimming, cycling, or yoga is linked to fewer and milder headaches. Warm up gradually, drink water, and avoid sudden very intense exercise if that triggers your attacks. If you are new to exercise or have other health conditions, check with your doctor first.

Mental health and emotional wellbeing

Frequent headaches and worry can feed each other. Pain is tiring, and fear of the next attack can make you anxious or low in mood — that is a very normal response, not a weakness. Tell your doctor if headaches are affecting your sleep, mood, or appetite, because treating anxiety or depression often helps headaches too. If you ever have thoughts of harming yourself, please reach out for help straight away — contact your local emergency number or a crisis support line in your country, or speak to someone you trust and your doctor. You deserve support, and it is available.

Prevention

You cannot prevent every headache, but you can often reduce how many you get and how bad they are. The basics are steady sleep, regular meals, enough water, screen breaks, gentle exercise, and managing stress. If you take pain relievers often, cutting back — with your doctor's or pharmacist's advice — can itself reduce headaches. If attacks are frequent, your doctor may suggest a daily preventive medicine, which is designed to lower the number of attacks over time rather than treat one.

Screening programmes

There is no screening test for headaches. What helps most is noticing patterns: a simple diary of dates, triggers, and what helped. Regular blood pressure checks are worthwhile for everyone, since high blood pressure usually causes no symptoms. If you have migraine with aura, talk to your doctor about contraception choices, as this is a known consideration.

Complications

If left untreated

• Headaches may become more frequent or more severe over time
• Pain reliever overuse headache — where the medicine itself keeps the headache going
• Missed work, school, or social events, and strain on relationships
• Poor sleep, low mood, and anxiety
• Rarely, a serious underlying cause may be missed if warning signs are ignored
• In migraine with aura, a very small number of people have a slightly higher risk of stroke — your doctor can talk this through with you calmly

Long-term outlook

The outlook is good for most people. Tension headaches and migraine usually improve with simple changes, a bit of patience, and the right support. Many people find that attacks become fewer and easier to manage once they understand their triggers. Some headaches fade with time on their own. If your headaches are frequent right now, that can change — talk to your doctor about a plan, and keep going back if it isn't working.

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