Headache: what makes a headache serious?
Headaches are very common and have many causes. Although they are a frequent source of stress and anxiety, headaches are only very rarely a sign of serious illness.
Many headache sufferers worry about having a brain tumour, but this is a very uncommon event. There are many different types of headaches, including tension headaches, sinus headaches, migraine headaches and cluster headaches. Knowing what type of headache you have is important so that you get the right treatment.
The most common cause of pain in the head is tension headache. Most adults will have experienced a tension headache at some time. According to the World Health Organization, this type of headache affects more than one-third of all men and more than half of all women.
Tension headaches are usually felt as a dull pain on both sides of the head, or as a feeling of having a tight band around the forehead. Sometimes the pain extends to the neck and shoulders.
Tension headaches usually appear around times of stress. They may come on with tiredness and sometimes after prolonged reading. Poor posture can also trigger these headaches. Taking exercise or drinking alcohol does not usually make these headaches any worse.
Tension headaches were previously thought to be due to contraction (tightening) of the neck muscles, but research now suggests this is not the cause. In fact, the exact cause is not known.
For tension headache treatment, simple over-the-counter painkillers such as ibuprofen, paracetamol or aspirin usually provide relief. (Aspirin should not be used in children aged 16 years and younger).
Hot showers, stretching and massage may also help. Chronic sufferers should beware of becoming too reliant on painkillers and look for ways of relaxing and avoiding stress.
Sinus headache is a common problem, which many people will recognise, particularly when they have a bad cold or flu. A ‘stuffy’ head and pain above or behind the eyes, or on either side of the nose, are the usual symptoms. Pain is often worse when the head is bent forward or when lying down.
Migraine is a common cause of headache, affecting at least one in 7 people. Migraines are about 3 times more common in women than in men.
Migraine headaches are often throbbing, one-sided, associated with nausea (feeling sick) and vomiting, and worse with bright light and noise. They may be preceded by an ‘aura’ of symptoms such as seeing a moving pattern or blinking lights in front of you.
Migraines can be brought on by stress, certain foods, changes in the weather, lack of food, lack of sleep, as well as a range of other factors.
Specific migraine treatment options are available. Many attacks can be relieved by taking medicines as soon as symptoms start and lying down in a dark, quiet place.
Cluster headaches are a rare type of headache, affecting men much more than women. Cluster headaches can affect people of all ages, but onset is most common between the ages of 20 and 40.
Cluster headaches are one sided, and are usually felt around the eye. The pain is usually intense and stabbing in nature. There may be a feeling of a blocked or runny nose and a watery eye on the affected side. They tend to last between 15 minutes and 3 hours.
Cluster headaches occur once or several times per day for weeks or months at a time (in a ‘cluster’), and then disappear for months or even years. The headaches usually happen at the same time every day during a cluster, often at night.
Cluster headaches can be brought on by alcohol.
Chronic daily headache
Chronic daily headaches can occur on and off, every day. They can be associated with anxiety or depression, or due to ‘rebound’ headache, which results from overuse of pain medicines. Symptoms may be similar to tension headache or migraine, or a mixture of both.
Some women experience severe headaches including migraines at times when their hormones fluctuate, for example, around the time of their period each month or around the time of ovulation.
Exertional headache including ‘sexual’ headache
Some people get a headache associated with exercise, sport or sexual activity. A ‘sexual headache’ can occur before or after orgasm; it can be severe and last for several minutes to several hours. Some people experience a sudden, severe headache at the point of orgasm.
Eye strain headache
If you have visual problems that have not been addressed by prescription glasses or contact lenses, you can get an eye strain headache, which typically causes pain and a heavy feeling around the eyes.
Temporomandibular joint headache
Some people may get muscle tension and pain related to a disorder of the temporomandibular joint (TMJ), the joint just in front of each ear, where your jaw bone connects to your skull.
Ice cream headache
Eating something very cold can cause a sharp pain in the middle of your forehead or over one temple. People who get migraines may be more likely to get an ice cream headache — so-named because the pain comes on immediately after eating ice cream.
Many other headaches are a secondary effect of another disorder, such as:
- a neck problem;
- irritation of nerve fibres, e.g. trigeminal nerve neuralgia;
- eye, ear, sinus, tooth and jaw problems;
- inflammation of an artery in the head (temporal arteritis);
- a head injury;
- a hangover from drinking excessive alcohol; or
- withdrawing from drugs such as caffeine or narcotics.
When to see your doctor
Sometimes headaches may be due to a serious problem, like a brain tumour, a brain haemorrhage or a brain infection such as meningitis. While these are uncommon causes of headache, it’s important to know the warning signs.
Seek medical attention if you:
- have a headache that’s ‘the worst you’ve ever had’;
- start getting regular headaches, especially if you are aged 50 years or over;
- have a change in the pattern of your headaches, for example, from mild and occasional headaches to severe and frequent headaches;
- get a sudden severe headache ‘out of the blue’ that may be accompanied by a stiff neck;
- have a constant headache that is gradually getting worse over days or weeks;
- develop a severe headache accompanied by fever, neck pain or stiffness, nausea or vomiting;
- have a headache together with drowsiness, confusion, or memory loss;
- have a headache following a head injury;
- have a headache together with loss of sensation or weakness in any part of your body, coordination problems, blurred or double vision, slurred speech or difficulty speaking;
- have a headache associated with coughing, physical exertion or sexual activity;
- have a headache associated with being short of breath; or
- develop a headache that is associated with convulsions (fits).
Drowsiness, visual symptoms, vomiting and dislike of bright light may all be symptoms associated with migraine. However, in other situations, particularly after head injury, they may indicate an underlying brain disorder. If you are experiencing these symptoms for the first time or are in any doubt, seek medical attention.
You should also see your doctor if you have headaches that are different from or worse than other headaches you have experienced. Indeed, any headache that is worrying you warrants a visit to your doctor.
Last Reviewed: 31/05/2017
1. Headache (published July 2011; amended February 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2017 Mar. http://online.tg.org.au/complete/ (accessed May 2017).
2. World Health Organization (WHO). How common are headaches? (updated Feb 2014) http://www.who.int/features/qa/25/en/index.html (accessed May 2017).
3. The International Classification of Headache Disorders. 3rd edition. 2018: ICHD-3. https://www.ichd-3.org/