A real pain in the brain

Actually structures in the head region, rather than the brain itself, are usually responsible for the pain of a headache. Common sources are muscles and associated tissues (tension headaches) and blood vessels (migraine headaches), although some new evidence is beginning to suggest that neurons in the brain may play a role in causing pain.

The most common headaches are migraines and tension headaches. Headaches can have other causes, though, most of which are far more rare. Headaches can arise from general system infection and fever; from eye, ear, or dental disease and pain; and from exposure to or withdrawal from various substances (nitrates, alcohol, MSG).

Fortunately, most headaches are not caused by serious disease. Still, these "benign" headaches can be very inconvenient. The good news is that many avenues of relief are available.

Detailed Description

Headache is an almost universal ailment, which can range from an occasional inconvenience to a frequent, impairing state. Primary headaches are those that are not due to underlying disease. Their causes are not fully understood, though much research continues.

The great majority of headaches are of two types: tension headaches and migraine (vascular) headaches. The pain of tension headaches is usually less severe than that of migraines, and is typically located on both sides of the head. Parts of your scalp or your neck may feel tense and sore, or your head may feel as if it is in a vise. The headache may be brief or last for quite a long time. Internal and external strains such as fatigue and worry can trigger tension headaches. Even staying in a posture that strains your neck, such as reading with your chin down, may trigger a headache.

Persistent headaches in people suffering from depression are often included in the category of tension headaches. Depression is a widespread condition, so depression associated with headache is also common. Insomnia, "flat" mood, malaise, or suicidal thoughts are signs of clinical depression.

Variants of the tension headache include TMD/TMJ (temporomandibular joint dysfunction), which usually causes pain in the temples, jaw, and ear, either on one or both sides. Post-traumatic headache follows head injury, tends to be dull and aching, and is located more generally across the head.

Migraine headache often affects only one side of the head. The pain is linked to an abnormal expanding and contracting of blood vessels in the head. Migraines are more common in women, and up to 80% of people who suffer them have a family history of them. They may cause nausea and vomiting, sensitivity to light, blurred vision, or bright spots in vision.

Other vascular headaches that share this pulsing or throbbing kind of pain include:

  • Cluster headaches. These are attacks of pain on one side of the head of short duration that happen several times a day for weeks, only to vanish for months or years before re-appearing. They can cause persistent pain around one eye, along with tearing and redness of the eye, and they may also cause congestion of nasal passages on the affected side.
  • Hypertension headache. These are associated with episodes of marked high blood pressure.
  • Exertional, orgasmic, and cough headaches: These are vascular headaches brought on by these activities.
  • Carotodynia. This type of headache involves pain in the front of the neck.

How Common Are Headaches?

Headaches affect most people at some point in their lives, and are one of the most common reasons for a visit to a physician. Recent estimates indicate that more than 45 million people in the United States suffer from chronic headaches, and that 11 million have vascular or migraine headaches that are at least moderately disabling.

Conventional Treatment

Goals of Treatment

Pain relief is the goal of most headache treatment. With more intense types, such as migraines, the goal may be to avoid future attacks or to halt oncoming headaches during the "aura," or warning, period.

Treatment Options

Drugs most commonly prescribed

For tension headache:


Off-Label Efficacy


Off-Label Efficacy


Off-Label Efficacy

For cluster headache:


Off-Label Efficacy
Secondary choices

For tension headache:


On-Label Efficacy
Dietary modifications

Some researchers suspect that food plays a role in headaches, particularly migraines. Therefore, consider reducing or avoiding particular foods that contain:

  • MSG (monosodium glutamate)
  • Nitrates (used in cured and processed meats)
  • Aspartame (Nutrasweet)
  • Aged cheeses
  • Chocolate
  • Alcoholic beverages (especially red wine)
  • Peanut butter and nuts
  • Caffeine-containing beverages

Self care & Prevention

Preventive Measures

For some tension headaches, prevention might be as simple as adjusting a work-station area, sitting in an ergonomic chair, or trying relaxation techniques such as behavioral modification, therapeutic counseling, and biofeedback.

You can sometimes prevent vascular headaches by avoiding triggers (toxic fumes, intense noise or light, certain foods and medications), increasing resistance through behavioral and relaxation techniques, and using various medications.

Self-Care Measures

  • Taper off the coffee. If you're a regular coffee drinker, don't stop suddenly. If you do, you're likely to experience a "caffeine-withdrawal headache," which can last several days. If you want to quit caffeinated coffee, do it gradually over time. The same goes for tea, though tea has only about half as much caffeine as coffee, so the withdrawal headache is usually less severe.
  • Try ice. When you get a headache, trying cooling your forehead. Lie down and apply an ice pack to it for 15 minutes at a time, with 15-minute breaks between applications. To make an ice pack, place a handful of ice cubes in a plastic bag, then wrap the bag in a cloth. Or wrap a commercial cold pack in a cloth.
  • Chart your headaches. Jot down when you get headches and note any foods, emotional upsets, drugs, menstruation, or other factors that might have triggered them. You might see a pattern you can change.

When to Call Your Doctor

  • If your headache's onset is abrupt and particularly severe
  • If your headache is accompanied by any visual disturbances (blurring or "stars"), mental confusion, numbing or partial paralysis
  • If your neck is very stiff, you have trouble turning your head, and also have a fever
  • If you are awakened by your headache in the middle of the night by its severity
  • If coughing, laughing, or sneezing consistently brings about a headache
  • If the headache keeps happening and is consistently in the same area, especially around the same eye
  • If you have a marked increase in the intensity and frequency of headaches

Last updated 25 May 2012


Possible Underlying Causes

Fever, infection, tension, and blood-vessel expansion (dilation) are most often the physical causes of headaches.

No one knows what causes migraine headaches, but researchers believe a combination of situational, emotional, hereditary, and dietary issues are involved.

As many different types of tension headaches exist as there are stress factors. Bad posture, an awkward sleeping position, and stress often contribute to developing a tension headache.

Drugs That Can Cause or Aggravate Headaches
A headache can be a side effect of many drugs, from antihypertensive agents to antidepressants to antibiotics. The possibility and frequency of developing a headache from a drug depends on your individual sensitivity to it. Based on your past medical history and drug sensitivities, your doctor can prescribe medications that you will be least sensitive to. If you develop a headache or other sensitivity reactions to a drug, call your doctor so that he or she can consider an alternative.

Diagnosing the Underlying Cause

The headache in a vast majority of people is tension, migraine or cluster headache. They are not caused by any underlying medical condition. On the other hand, headache can be a symptom of many diseases. The following list represents only some of the most common causes of headaches. Though many serious medical problems can cause headaches, you should not assume that you have one of these more worrisome diseases simply because you have a headache. If you are concerned about your symptoms, consult your doctor. He or she can carefully review your medical history and perform a physical examination to rule out the possibility of a serious medical condition.

Headache with no other symptoms

  • Glaucoma: increased pressure within the eye leading to severe headache and eye pain in later stages.
  • Hypertension: high blood pressure. Hypertension usually has no symptoms in its early stages but may cause headache, fatigue, chest pain, bloody nose, and dizziness later on.
  • Impacted teeth: accompanied by gum pain and headache.
  • Refractive disorder: near- or farsightedness, usually requiring eyeglass or contact lens correction. This may result in eyestrain and, secondarily, headache.
  • Brain tumor: this often-feared condition is actually quite rare. A brain tumor seldom causes headache alone. Seizures, weakness, or other neurological problems are common along with headaches.

Headache with fever

  • Common cold: headache with nasal congestion, sneezing, watery eyes, muscle aches, and possible low-grade fever.
  • Influenza (flu): in addition to headache, chills and muscle aches followed by cough, sore throat, congestion, and fever.
  • Lyme disease: small red bump at the location of a tick bite with fever, chills, and fatigue ensuing over the next month.
  • Mononucleosis, infectious: headache with a high fever, sore throat, and swollen glands.
  • Pharyngitis: sore throat and difficulty speaking with fever, headache, and sensitive glands.
  • Sinusitis: inflammation of the mucous membranes of the sinuses, causing a throbbing pain above or below one or both eyes. Nasal congestion and discharge accompany fever.
  • Tonsillitis: sore, inflamed throat with headache, difficulty swallowing, and swollen glands. May cause nausea and vomiting in children.

Headache with fever and nausea

  • Leukemia: variable symptoms may include loss of appetite/weight, increased bruising/bleeding, bone pain, abdominal pain, nausea, fatigue, joint pain, and gland enlargement.
  • Malaria: severe chills and shivering followed by a high fever and vomiting. Headache can be severe.
  • Lupus: known as systemic lupus erythematosus (SLE), a chronic inflammation of the connective tissues of the body. Accompanied by butterfly-shaped rash of the nose and cheeks, fatigue, fever, weight loss, and joint pain.
  • Meningitis: dangerous inflammation of the membrane covering the brain and spinal cord causing severe headache, nausea and vomiting, neck stiffness, possible confusion, loss of consciousness, and seizures.
  • Glomerulonephritis: inflammation of the filtering portion of the kidney. Symptoms may include fatigue, nausea and vomiting, loss of appetite, and impaired vision.

Headache with other symptoms

  • Temporal arteritis: severe, throbbing headache at the temples or other portion of the head. Often associated with fatigue, weight loss, and muscle aches in the chest and hip regions, and tenderness at the temples.
  • Fibromyalgia: muscle aches, fatigue, insomnia, stiffness, and pain in the back, neck, trunk, and shoulders.
  • Eye conditions: refractive errors (near- and farsightedness, astigmatism), eye muscle imbalance (strabismus).

Diagnostic Procedures

A careful history, physical examination and neurological evaluation are usually all that are needed in the diagnosis of the most common headache syndromes (such as migraine, tension and cluster headaches). Sometimes your physician may wish to perform diagnostic tests such as blood work to determine if some underlying disease may be the cause. Diagnostic testing varies depending upon suspected causes and the physical symptoms involved.