About this symptom
A headache is pain anywhere in the head. It can be a dull ache, a tight band, a throb or a sharp stab, and can last from about half an hour to several days.
Most headaches are not caused by a serious illness. Tension headache is the most common type, and migraine is another. Triggers include stress, poor sleep, missed meals, too little water, eyestrain, colds, alcohol and too much pain relief. Rarely, a headache is a sign of a stroke, bleeding in the brain or an infection, which is why the warning signs below matter.
Possible causes
This is not a diagnosis. These are the causes doctors think about, with the ones that are most urgent to rule out first.
- StrokeSudden headache with weakness or numbness in the face or body, slurred speech, trouble with balance or confusion. A stroke is one of the serious causes of a sudden headache.Read about it
- Bleeding in or around the brainA sudden, extremely painful headache that does not go away, sometimes with neck stiffness, vomiting, fainting, drowsiness or confusion.
- MeningitisHeadache with fever, a stiff neck, dislike of bright light, or a rash that does not fade when a glass is pressed on it.Read about it
- Head injury and concussionA headache after a blow to the head in the last three months needs checking, especially if it comes with drowsiness, vomiting or confusion.Read about it
- MigraineThrobbing pain, often on one side, with nausea and discomfort from light or sound. Some people have visual warning signs (an aura) first.Read about it
- Tension headacheThe most common type: a dull, band-like pressure on both sides of the head, linked to tight muscles in the neck, shoulders and scalp, and to stress.
- Medicine-overuse headacheHeadaches on more days than not, often worst on waking, in someone who uses pain relief often. Tell the doctor how often you take it.
- DehydrationToo little water can bring on a headache, as can missed meals. Drinking plenty of water is part of the usual advice.Read about it
When to get help
Also get emergency care for:
- A headache that starts right after hard exercise, lifting or sex
- Severe pain in one eye, with that eye red
- A rash that does not fade when a glass is pressed on it
See a doctor soon, the same day if you can, if you have:
- A headache that is not getting better with rest, fluids and simple pain relief, or has lasted more than a few days
- Headaches that come often, wake you from sleep, or differ from your usual pattern
- A headache brought on by coughing, sneezing, bending down or exercise
- Headache with vomiting or eyesight problems, or with jaw pain when chewing or a tender scalp
- A first severe headache, or a new headache after age 50 or with cancer or a weak immune system
- A need for pain relief for headaches on several days a week
A mild headache with an obvious trigger, such as a cold, a missed meal or a long day, that is easing, can usually be managed at home.
What you can do at home
With any emergency sign, do not treat the headache at home: call for an ambulance first.
Do
- Drink water, rest in a quiet, dim room and try to relax
- Take simple pain relief such as paracetamol, following the label
- Eat regular meals, and keep a headache diary of when headaches come and what you did before them
Do not
- Do not rely on pain relief on several days a week: it can bring on more headaches
- Do not drive if you feel unwell or your vision is affected
- Avoid alcohol, skipped meals and long hours of screen use
What the doctor will do
The doctor will ask when the headache began, where it hurts, what it feels like, how long it lasts, what brings it on and what else comes with it. They will ask about your medicines, including how often you take pain relief, and examine you, including how your nerves are working.
Most headaches can be diagnosed from the story and the examination alone. Tests are needed if there are warning signs or the headaches last long. They may include:
- Blood tests
- A CT or of the head
- A lumbar puncture, a sample of the fluid around the spine, if an infection is suspected
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A bad headache must mean a brain tumour.”What is true?
Fact
Most headaches, such as tension headache and migraine, are not caused by a tumour or another serious illness. Serious causes are rare, but they are the reason a sudden severe headache, or a headache with weakness, confusion or a stiff neck, needs urgent care.
Myth“A sudden, terrible headache will pass with a rest, so it can wait until morning.”What is true?
Fact
A headache that starts suddenly and is extremely painful can be a sign of bleeding around the brain. It needs emergency care, so call for an ambulance and do not drive yourself.
Myth“Taking a painkiller every time the head hurts is the safest way to stay free of headaches.”What is true?
Fact
Taking pain relief too often can itself cause headaches, called medicine-overuse headache. If you need it on several days a week, see a doctor rather than taking more.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
When is a headache an emergency?
Call for an ambulance if a headache starts suddenly and is extremely painful, or comes with weakness or numbness, slurred speech, confusion, drowsiness, loss of vision, a seizure, or fever with a stiff neck. A headache after a head injury also needs urgent care. Do not drive yourself.
Can I take paracetamol or another painkiller for a headache?
For an ordinary headache, simple pain relief such as paracetamol can help if you follow the label. But taking it on several days a week can itself cause headaches, so see a doctor if you need it that often. If any emergency sign is present, call for an ambulance instead of taking a tablet.
Can stress or lack of sleep cause headaches?
Yes. Stress and tight muscles in the neck, shoulders and scalp are linked to tension headache, and poor sleep, skipped meals and too little water can bring headaches on. Regular sleep and meals, enough water and ways to relax help. A headache diary can show your own triggers.
Will I need a scan for my headache?
Not usually. Most headaches are diagnosed from your story and an examination. A CT or MRI scan is considered when there are warning signs or the headaches have lasted a long time.