What kinds of headache there are
Headache is one of the most common symptoms and in the great majority of cases it is not dangerous. Doctors divide headaches into primary, where the headache itself is the condition (tension-type headache, migraine, cluster headache), and secondary, where it is a sign of something else: a cold, high blood pressure, problems with the neck or eyesight and, rarely, an infection or a blood vessel disease. It is hard to tell the type from the pain alone, so notice how the pain began, where it is, how long it lasts and what comes with it.
Tension-type headache
This is the most common type: a pressing, band-like pain on both sides, mild to moderate, which does not get worse with walking. It is triggered by stress, tiredness, long hours at a screen, a poor posture, lack of sleep, skipped meals and too little water. It usually passes with rest and a drink of water, but if it comes back often it is better to see a doctor.
Migraine
Migraine is a throbbing pain, more often on one side of the head, moderate or severe, often with nausea, vomiting and dislike of light and sound (see nausea and vomiting). Some people get an aura before an attack: shimmering in the vision or other visual changes. An attack lasts from a few hours to three days. Triggers differ from person to person: lack of sleep, stress, hormonal changes, certain foods. A headache diary helps find yours.
Headache with a fever
Headache often comes with a cold and influenza and then goes with the infection (see fever). But a severe headache with a fever, a stiff neck, dislike of bright light, a rash or confusion can be a sign of meningococcal disease or another form of meningitis: in that case do not wait.
Headache at the back of the head and neck
Pain at the back of the head is often linked to tense neck muscles from desk work and a poor posture, and to changes in blood pressure. If it comes with a stiff neck or a fever, or began after an injury, see a doctor.
Morning and night headaches
Morning headaches occur with lack of sleep, sleep apnoea, changes in blood pressure and overuse of painkillers. If the pain wakes you at night or gets worse when you lie down, cough or strain, tell the doctor.
Headache in a child
In children headaches are more often caused by infections, tiredness, lack of sleep, eyesight problems and stress. See a doctor if the pain is getting worse, wakes the child at night, comes with vomiting, unsteady walking or vision changes, or began after a blow to the head.
What you can do before seeing a doctor
- Drink some water, rest in a quiet, darkened room and do not skip meals.
- Try to relax: stress makes the pain worse; a walk, gentle neck and shoulder stretches and a warm shower can help.
- Use an over-the-counter painkiller according to the leaflet and not more than a few days a week: frequent use can itself cause headaches.
- Take breaks from screens and have your eyesight checked if the pain appears towards evening.
- Keep a diary: when the pain began, what came before it, how long it lasted and what helped.
How a doctor looks for the cause
Most often the diagnosis comes from your story and an examination: the doctor will ask about the type of pain, how often it comes, triggers, medicines and injuries, and will measure blood pressure and check the nervous system, eyesight and neck. Further tests, such as blood tests and a CT or MRI scan of the brain, are not needed for everyone, only when there are warning signs or the pain is unusual or changing. Long-term headaches are usually looked after by a neurologist.