Wonder why your head hurts? We've all reached for the painkillers at one time or another, and the NHS estimates that 10 million people in the UK alone suffer from regular headaches. Believe it or not, there are a staggering 150 types of the wretched things. Thankfully, most headaches are mild, short-lived and harmless – even a reassuring 99% of hospital-referred cases are benign.
Occasionally, however, a headache can signal a medical emergency. “It can rarely be a sign of something more serious,” says TV medic Dr Sarah Jarvis. Read on to discover 12 types of headaches, what they mean and whether they might indicate an underlying condition.
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We’ve all experienced this irritating run-of-the-mill headache. It feels like a vice slowly squeezing your head and can be caused by a range of factors, from stress, mild dehydration and tiredness, to skipping meals, poor posture and eye strain – all of which can trigger muscle contractions in the neck and head.
Most are mild, last no longer than a few hours (but can last for a day or two) and are easily treated with over-the-counter (OTC) painkillers.
According to the NHS, trusty paracetamol and ibuprofen work best. These drugs reduce the production of pain-causing messenger hormones called prostaglandins.
When to see your doctor: any new, unusual, long-lasting or debilitating headache that doesn't respond to OTC medication should be investigated. Some of us can have tension-types headaches many times a month for 3 or more months or more.
If you are having repeated severe headaches, particularly if they cause vomiting, make you feel confused and cause pain and stiffness in your neck, or other worrying symptoms, such as feeling confused and being unable to speak properly, see a doctor straight away.
Find out more about sleep apnoea
Intense pulsating pain on one side of the head, nausea and sensitivity to light are tell-tale symptoms of a migraine headache. Around 15% of the UK population experiences migraines, which can be severe and debilitating, and may not respond to the usual OTC painkillers. Migraines can cause an aura, where you have blurred vision, zig-zag patterns in your eyes and even slurred speech, dizziness and blind spots and other symptoms, which are known as an aura. Although their exact cause is unknown, migraines can be treated successfully with prescription medication.
When to see your doctor: dial 999 and ask for an ambulance if your headache is accompanied by confusion, slurred speech, severe vomiting and breathing problems, all of which are symptoms of potentially life-threatening alcohol poisoning.
When to see your doctor: See a GP if you’re experiencing migraine headaches, especially if they persist for longer than three days or if you have them on 5 days a month or more. Your doctor may prescribe stronger painkillers, anti-sickness tablets or triptans, drugs that work by constricting blood vessels and damping down inflammation.
What you need to know about migraine symptoms and treatments
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If you've ever had too much to drink, you'll know only too well how much your head can hurt the following day. Experts reckon a combination of dilated blood vessels, dehydration and hunger sets off the problem. Combat it with ibuprofen, but avoid paracetamol, which is metabolised by the liver and can put extra strain on the organ, and aspirin, which may upset the stomach. Drinking water and eating hearty comfort food can work wonders, too.
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Eat before you start on the wine or beer or any other favourite tipple. Carbohydrates, such as pasta, or rice should help your body to reduce the speed at which it absorbs alcohol. Pace yourself, so you don’t drink too much in a short space of time, and maybe think about how you felt last time you had a hangover. If you drink 14 units of alcohol a week, and would like to cut back, choose two or three days a week when you are going to be an alcohol-free zone.
Visit our hangover guide page for tips on dealing with a hangover
Inflamed sinuses caused by a common cold or flu, or allergens such as pollen or pet dander, can trigger a dull, throbbing headache at the front of the face. Other symptoms can include a blocked nose, toothache, not being able to smell as much as possible, and bad breath.
The NHS suggests paracetamol and ibuprofen to help relieve the inflammation and discomfort. Antihistamines and decongestants from your pharmacist can be useful, and steam inhalation may also help.
When to see your doctor: if the headache is particularly severe, lasts longer than a week or you can't shift it with OTC medication, you'll need to see your GP who may prescribe antibiotics and steroids. They may, if yours is a severe case, suggest you have surgery to deal with your sinus problems. The operation is called functional endoscopic sinus surgery (FESS), and will be done under a general anaesthetic.
Fairly uncommon, this affects around 1 in 500-1,000 people. Sufferers describe the pain, which is severe, tends to afflict just one side of the head, around the eye socket, as sharp, stabbing and agonising. You may also find that the affected eye may have a smaller pupil than the unaffected eye and may be red and watery.
This headache strikes in groups or clusters – up to eight times a day – lasts from 15 minutes to three hours and may be accompanied by eye irritation and watering, as well as nasal congestion. A disorder of the hypothalamus, the part of the brain that regulates body temperature, hunger and thirst, could be to blame.
Around 80% of people who have cluster headaches tend to have them for a set time – usually around four to 12 weeks, (Spring or Autumn or common times to have these). This means that the other 20% of people may have ‘chronic cluster headaches, which can happen at any time of the year.
When to see your doctor: you should make an appointment to see your GP if you're experiencing cluster headaches. Your doctor will be able to rule out anything more serious and prescribe suitable treatment, which might include sumatriptan injections and oxygen therapy.
As many as five million women in the UK experience regular headaches due to hormonal changes during menstruation, pregnancy, perimenopause and the early stages of menopause. Fluctuating hormones are thought to disrupt headache-related chemicals in the brain. The symptoms tend to be similar to migraines.
When to see your doctor: any migraine-like headache should be evaluated by a GP, who may recommend hormone replacement therapy (HRT) if the symptoms are found to be triggered by fluctuating hormones during perimenopause or the early stages of menopause.
It may be worth keeping a diary of when you have a period (if you are still having them), and when you have a hormonal headache. You will need to do this for at least three months to get a clear picture of what is happening.
Learn more about menopause symptoms and what you can do about them
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This sudden excruciating, explosive headache has been likened to being hit very hard in the face. The pain usually peaks within 60 seconds but can last for days, accompanied by nausea, vomiting and even loss of consciousness. It can be a sign of bleeding in the brain, stroke, aneurysm or brain tumour, so dial 999 and ask for an ambulance.
When to see your doctor: a medical emergency, dial 999 straight away and ask for an ambulance if you're experiencing a thunderclap headache – you'll certainly know about it as the pain is so intense.
Post-head injury headache
Another medical emergency that requires prompt investigation and treatment, you'll need to get yourself to Accident and Emergency pronto if you experience a severe headache following a fall or blow to the head. A post-injury headache can be sign of concussion or bleeding on the brain in the worst case scenario.
When to see your doctor: always seek medical attention following a head injury that is accompanied by a severe headache. Casualty doctors can run tests to rule out anything sinister.
Headache with a stiff neck and rash
This is, of course, a typical symptom of the common cold and flu. However, if your headache is accompanied by an unusually stiff and sore neck – painful to the point you can't move it – and a rash that looks like tiny red pinpricks on the skin, you'll need to call an ambulance ASAP as these symptoms may indicate meningitis.
When to see your doctor: this sort of headache should always be evaluated by an Accident and Emergency medic, so don't hesitate to dial 999 and ask for an ambulance. It's far better to be safe than sorry.
This type, which may mimic a tension or migraine headache, can be caused by popping too many painkillers. People who take them more than twice a week over a three-month period or longer are most susceptible. The headache is actually drug-withdrawal symptoms.
A splitting headache may also be a side effect of medication, such as proton-pump inhibitors, which interfere with the absorption of magnesium, and erectile dysfunction medications such as Viagra.
When to see your doctor: always see your GP if you suspect your headaches may be caused by the medication you're on, whether you think you're overdoing it on the painkillers or your headaches are a side effect of other meds. Your doctor can help wean you off the offending painkillers or suggest an alternative course of treatment.
Read Dr Mark Porter's health Q&As on the topic of headaches and painkillers
Giant cell arteritis headache
Giant cell arteritis (GCA) affects 1 in 4,500 people in the UK, most of whom are over 50. A severe headache that comes on suddenly, accompanied by a sore, tender scalp, jaw pain when eating and vision problems, are the red flag symptoms. Giant cell arteritis (GCA) arises when the lining of the arteries, particularly those in the temples of the face, become severely inflamed. Scientists are uncertain about the underlying cause.
When to see your doctor: you must seek immediate medical attention if you think you might have GCA. The condition, which is easily managed with steroids, can lead to blindness if it isn't treated in time.
Alarm clock headache
An alarm clock – or hypnic –headache almost always affects people over 50. It develops at the same time each night, usually between 1am and 3am. The pain is described as dull and throbbing, similar to a mild migraine. The condition is benign, but it could be linked to REM sleep disorders.
When to see your doctor: Your GP will assess you to rule out any other secondary causes of headaches that start at night, such as drug withdrawal or sleep apnoea, then suggest appropriate drug treatments, including anti-inflammatories such as indomethacin, and the bipolar medication lithium carbonate.
Reviewed by Lesley Dobson 17/04/2020
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