Headache: When to worry, what to do

Content provided by the Faculty of the Harvard Medical School

Nearly every man has had a headache, and most of us have had many. A minor headache is little more than a nuisance that's relieved by an over-the-counter pain reliever, some food or coffee, or a short rest. But if your headache is severe or unusual, you might worry about stroke, a tumor, or a blood clot. Fortunately, such problems are rare. Still, you should know when a headache needs urgent care and how to control the vast majority of headaches that are not threatening to your health.

Not brain pain

Doctors don't fully understand what causes nine out of 10 headaches. They do know that the brain tissue and the skull are never responsible since they don't have nerves that register pain. But the blood vessels in the head and neck can signal pain, as can the tissues that surround the brain and some major nerves that originate in the brain. The scalp, sinuses, teeth, and muscles and joints of the neck can also cause head pain.

When to worry

You can take care of many types of headaches by yourself, and your doctor can give you medication to control most of the tougher ones. But some headaches call for prompt medical care. Here are some warning signs:

  • Headaches that first develop after age 50

  • A major change in the pattern of your headaches

  • An unusually severe "worst headache ever"

  • Pain that increases with coughing or movement

  • Headaches that get steadily worse

  • Changes in personality or mental function

  • Headaches that are accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures

  • Headaches that are accompanied by a painful red eye

  • Headaches that are accompanied by pain and tenderness near the temples

  • Headaches after a blow to the head

  • Headaches that prevent normal daily activities

  • Headaches that come on abruptly, especially if they wake you up

  • Headaches in patients with cancer or impaired immune systems

Headache categories

There are more than 300 types of headaches, but only about 10% of headaches have a known cause. The others are called primary headaches. Here is a rundown on some major primary headaches.

Tension-type headaches

Occurring in about three of every four adults, tension headaches are the most common of all headaches. In most cases, they are mild to moderate in severity and occur infrequently. But a few people get severe tension headaches, and some are troubled by them three or four times a week.

The typical tension headache produces a dull, squeezing pain on both sides of the head. People with strong tension headaches may feel like their head is in a vise. The shoulders and neck can also ache. Some tension headaches are triggered by fatigue, emotional stress, or problems involving the muscles or joints of the neck or jaw. Most last for 20 minutes to two hours.

If you get occasional tension-type headaches, you can take care of them yourself. Over-the-counter pain relievers such as acetaminophen (Tylenol, other brands) and nonsteroidal anti-inflammatories (NSAIDs) such as aspirin, naproxen (Aleve, other brands), or ibuprofen (Motrin, Advil, other brands) often do the trick, but follow the directions on the label, and never take more than you should. A heating pad or warm shower may help; some people feel better with a short nap or light snack.

If you get frequent tension-type headaches, try to identify triggers so you can avoid them. Don't get overtired or skip meals. Learn relaxation techniques; yoga is particularly helpful because it can relax both your mind and your neck muscles. If you clench your jaw or grind your teeth at night, a bite plate may help.

If you need more help, your doctor may prescribe a stronger pain medication or a muscle relaxant to control headache pain. Many people with recurrent tension-type headaches can prevent attacks by taking a tricyclic antidepressant such as amitriptyline (Elavil, Vanatrip, generic). Fortunately, most people with tension-type headaches will do very well with simpler programs.


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