This is when you should worry about a headache, says neurologist
Headaches are normally nothing more than a minor inconvenience, but if your headache is severe or unusual, you might worry about stroke, a tumour, or a blood clot. Fortunately, such problems are rare.
We’ve spoken to experts to find out what symptoms mean your headache may be a medical emergency, and how to control the vast majority of headaches that are not threatening to your health.
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What types of headaches are there?
Dr Steve Allder, consultant neurologist at Re:Cognition Health says headaches fall into two main categories: primary and secondary headaches. Primary headaches occur independently and are not caused by another medical condition. Allder explains the common types of primary headaches:
- Tension-type headaches are the most common and produce a dull, pressing, or tightening pain around the forehead, temples, or back of the head. They are often triggered by stress, poor posture, or muscle tension in the neck and shoulders and are usually mild to moderate in intensity.
- Migraines are typically more severe, often affecting one side of the head, and can be accompanied by nausea, vomiting, sensitivity to light or sound, and visual disturbances known as auras. They can last from a few hours to several days and frequently interfere with daily activities.
- Cluster headaches are less common but extremely painful, occurring in cyclical patterns around the eye or temple. They are often accompanied by symptoms such as tearing, nasal congestion, or drooping of the eyelid on the affected side, and can occur several times per day over a period of weeks.
Secondary headaches are a symptom of an underlying condition. Allder explains, ‘These can result from infections such as meningitis, vascular problems like stroke or aneurysm, head injuries, brain tumours or medication. Identifying secondary headaches is critical because they may indicate serious or life-threatening conditions.’
What causes headaches?
Allder says there are more than 150 types of headaches, but only about 10% of headaches have a known cause. ‘Headache pain results from signals interacting among your brain, blood vessels and surrounding nerves. During a headache, multiple mechanisms activate specific nerves that affect muscles and blood vessels. These nerves send pain signals to your brain, causing a headache,’ says Allder.
Some common causes of headaches, like having a cold or flu, drinking too much alcohol, and dehydration, are fairly obvious, but other headache triggers to look out for are:
Anger: When you're angry, muscles in the back of your neck and scalp tense up, causing a tight band-like sensation around your head. This is a sign of a classic tension headache.
Poor posture: Poor posture causes tension in your upper back, neck, and shoulders, which can lead to headaches. Typically, the pain throbs in the base of the skull and sometimes flashes into the face, especially the forehead.
Strong smells: Household cleaners, along with perfumes and fragranced air fresheners, contain chemicals that can bring on headaches.
Grinding teeth: Grinding your teeth at night causes your jaw muscles to contract, resulting in a dull headache.
Bright lights: Bright lights and glare, especially if flickering, can induce migraines. This is because bright and flickering lights boost the levels of certain chemicals in the brain, which then activate the migraine centre.
Food triggers: Turkey, cheese and dark chocolate all contain chemicals that can bring on a migraine. Other culprits include aged cheeses like Stilton and Brie, diet fizzy drinks, and processed meats and fish.
Should I see my GP about headaches?
If you frequently suffer from headaches, you may not want to bother your doctor. However, GP Dr Asimah Hanif advises that you should contact your GP if your headache persists, painkillers are ineffective, and your headache worsens, causing nausea, vomiting, and sensitivity to light or noise.
Dr Hanif recommends keeping a simple headache diary makes a big difference. Try to note:
- When they happen, how long they last, and how bad they feel (0–10 scale).
- What the pain feels like (throbbing, pressure, one side or both).
- Any warning signs (aura, vision changes, sickness, sensitivity to light/sound).
- Possible triggers (stress, lack of sleep, certain foods, alcohol, periods, skipping meals).
- What helps (rest, tablets, fluids, quiet/dark room).
- How much does it interfere with daily life.
- What medication have you taken, how often, and whether it helps.
This gives your GP a clearer picture of the type of headaches you are experiencing and how best to manage them.
Headaches that require urgent medical attention
Dr Hanif says most headaches are harmless, but there are a few red flags to watch out for. You should seek urgent medical attention if you have:
- A headache that comes on suddenly and feels like ‘the worst one you’ve ever had’ – this may be caused by a subarachnoid haemorrhage (bleeding in the brain).
- A new or severe headache if you’re over 50 can be a symptom of potentially serious underlying conditions like stroke or brain tumour.
- A headache with fever, a stiff neck, rash, or feeling confused or drowsy are potential symptoms of meningitis.
- Any weakness, numbness, vision loss, speech problems, or a seizure with the headache – as these are potential stroke symptoms.
- A headache after an injury or fall may indicate skull fractures, bleeding or bruising to the brain.
- Headaches that worsen when you lie flat, cough, sneeze, or strain can indicate a cerebrospinal fluid (CSF) leak or a brain tumour.
- A new headache, if you have cancer or a weakened immune system, may be a symptom of serious conditions like cancer metastasis to the brain, brain swelling, or brain infections like meningitis or encephalitis.
- Severe headaches during pregnancy or just after giving birth can indicate serious conditions like pre-eclampsia.
Are headaches genetic?
Allder says genetics plays a big role in migraines. ‘This means that it is often inherited in families. It is estimated that up to 60% of the reason people get migraine is because of their genes. These genes make people more sensitive to changes in their environment such as lifestyle factors and triggers that can bring on an attack.’
Can you prevent headaches?
Dr Hanif says that most headaches are preventable if you remember to:
- Drink enough water, eat regularly, and don’t skip meals.
- Stick to a regular sleep routine.
- Exercise and manage stress.
- Limit alcohol.
- Identify and avoid your own personal triggers.
What’s the best treatment for headaches?
There is no one-size-fits-all treatment for headaches. GP Dr Tanya Paynter advises speaking to your doctor to determine the type of headache and receive a prescription tailored for the best results. Most headaches can be relieved with over-the-counter medications like paracetamol, aspirin, and ibuprofen, but others require a bit more assistance. Dr Paynter recommends:
For a migraine: Place a cold pack on your forehead. Ice cubes wrapped in a towel, a bag of frozen vegetables, or even a cold shower may ease the pain. Keep the compress on your head for 15 minutes, then take a 15-minute break.
For a tension headache: Place a heating pad on your neck or the back of your head. A few minutes of massaging your forehead, neck, and temples can help ease a tension headache, which may be caused by stress.
For light-sensitive headaches: Cover your windows with blackout curtains during the day. Wear sunglasses outdoors. You may also want to consider adding anti-glare screens to your computer and using daylight-spectrum fluorescent bulbs in your light fixtures.
For dehydration headaches: Besides water, try a sports drink to replenish electrolytes or an oral rehydration powder mixed with water. It's especially important if headache pain has caused you to vomit. That can quickly lead to dehydration.
Have a cup of tea to help your painkillers work better: If you drink it early enough after the pain starts, a cup of tea or coffee may help ease your headache pain. It can also help over-the-counter pain relievers, such as paracetamol, work better. Just don’t drink too much because caffeine withdrawal can cause its own type of headache.
Natural remedies for headaches
Natural remedies have been used to alleviate headaches for centuries. Here's what the science says about a few of them:
Lavender oil: As a form of aromatherapy, lavender oil can be used for headaches. One small study found that inhaling lavender essential oil for 15 minutes was more effective than a placebo in reducing migraine pain.
Eucalyptus oil: A compound in eucalyptus oil called cineole has been found to help alleviate the pain associated with a sinus headache when taken in capsule form. That's likely because it acts as a decongestant. You can try rubbing it on your skin or adding a few drops to a steam treatment to inhale.
Magnesium: Research has been conducted to investigate whether magnesium can help prevent or reduce pain associated with migraines. There isn't a clear-cut benefit, but experts say it's likely effective, and the recommended daily intake of around 300-400 milligrams for most adults is unlikely to cause harm.
Riboflavin: Also known as vitamin B2, this is a nutrient found in many foods, including dairy products, almonds, and fortified cereals. While there isn't a lot of evidence to support using it for headaches, some research has found that it can lessen migraine pain and lower the number of headaches you have in a month.
Coenzyme Q10: Your body makes this antioxidant naturally, and it's a popular dietary supplement. Clinical trials have shown that co-enzyme Q10 may help to reduce the frequency, severity and duration of migraine attacks.
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