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Headache – overview

Key points about headaches

Headaches are the most common type of pain and a major reason why people miss work or school.
Although most headaches are nothing to be concerned about, if you keep getting them you should talk to your healthcare provider about them.
There are 2 main categories of headache:
- Primary headache disorders which have no clear underlying cause, trauma or systemic illness. These include tension headaches, migraine and cluster headache.
- Secondary headache disorders have a clear underlying cause and could have very serious consequences if the cause is missed.

Man sits on side of bed holding his head in pain

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Type of headache	Description
Tension headache	This is the most common type of headache. It usually begins with shoulder or neck tension and may feel like a tight band around your head, a dull ache on both sides of your head, or a heavy weight on top of your head. Tension headache can last for a few hours to days and they tend to develop later in the day. They are usually brought on by lifestyle issues such as working too much or not getting enough sleep, poor posture and emotional stress or anxiety. Read more about tension headache.
Migraine	In migraine the pain is usually one-sided, throbbing, quite intense and can make you feel weak and exhausted. Migraines last from a few hours to days. Migraine most commonly brings other symptoms, such as nausea, vomiting and aversion to light and noise. Some people may have a migraine aura before the headache begins, which could be problems with your eyes such as seeing zig-zag lines, dizziness, or a pins-and-needles feeling. More women than men suffer from migraine. It is common in children, teenagers and young adults, but may begin at any age. Treatment of migraines includes lifestyle changes and using medicines for relief or, in some cases, using preventive medicines to stop a migraine from happening. Read more about migraine.
Cluster headache	Cluster headaches often occur at night and usually cause sudden pain on one side of your head – often around your eye. They can happen several times a day for a period of time, then disappear for months or years. If you get cluster headaches, try to identify the triggers and avoid those things. If they become a problem, see your doctor. Read more about cluster headache.
Sinus headache	Sinus headache is pain around your eyes, forehead, cheeks or teeth that gets worse when leaning forward. It can be dull or severe. It is a secondary headache disorder caused by sinusitis. You often get other symptoms of sinusitis such as a blocked or stuffy nose, feeling of pressure inside your head, mucus from your nose and dripping from your nose. Read more about sinusitis.
Medication overuse headache	Medication overuse (or rebound) headache is a secondary headache disorder caused by using too much pain relief medicine to treat headaches. It may feel like a tension-type headache or migraine-like attack. Headaches often improve within 2–4 weeks of withdrawal of the overused medicine, but you can feel worse before you feel better. To avoid this, limit the use of pain relief medication. Use them for the shortest possible time, only when you have pain. For example, paracetamol and NSAIDs should not be taken for headache on more than 15 days per month and triptans for migraine should not be used for more than 10 days per month.
Post-traumatic headache	Post-traumatic headache (PTH) is a secondary headache disorder caused by mild traumatic brain injury (mTBI). It is the most common symptom of mTBI. Your headaches may go away within 3 months of the mTBI, but in some people this may last longer. Read more about traumatic brain injury.

The cause of headache will usually depend on the type of headache. There are many different causes of headaches including:

muscle tension
an infection elsewhere in your body
inflamed arteries (which cause migraine or cluster headaches)
the toxic effects of alcohol or other substances.

Headaches can be triggered by stress, tiredness, dehydration, hunger, certain foods, constipation, eyestrain, noise or bright light.

Video: What causes headaches?

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(Ted-Ed, 2018)

The treatment of your headache will depend on the cause and will vary depending on the specific type of headache. Here are a few general things you can do.

Drink a large glass of water as you may be dehydrated.
Take pain relief medication:
- paracetamol, aspirin or ibuprofen are simple pain relievers (analgesics) that can ease occasional tension headaches
- if pain relief is taken soon enough, it can help stop migraine. Read more about migraine medicines.
Rest in a dark, quiet room.
Have someone give you a head, neck and shoulder massage.
Relax in a warm bath.
If you keep getting headaches or migraines, track them with a headache diary [PDF, 229 KB] to help you look for triggers or patterns. This can also be useful to show your doctor.

If you get headaches 3 or more times a month, your doctor may recommend preventive treatment.

Usually, headaches go away given time, rest and/or treatment with a pain relief medication.

Contact a healthcare provider or call Healthline 0800 611 116 for advice if:

your headaches remain frequent, persistent or worsen
you get no relief from simple pain relievers
you take simple pain relievers more than twice a week
you were headache-free but now get them
your headache is triggered by standing up, coughing, straining, physical exertion or sexual intercourse
you are over 50 and start to get regular headaches or there is face or jaw pain.

Call 111 and ask for an ambulance or go to the nearest hospital if:

a really severe headache comes on suddenly and gets worse within minutes
you have changes in your vision or eyesight or changes in consciousness
you're feeling sick (nausea), have a stiff neck, rash, fever, shakes or sensitivity to light (these are warning signs of meningococcal disease or meningitis)
you have red eye, are feeling sick (nausea) or being sick (vomiting) – these are signs of some types of glaucoma
your headache follows a head injury.

There are many types of headaches. These vary in their causes, how they feel, how severe they are, how long they last and how they respond to different treatments.

Where is the pain? Is it on one side or both, behind your eye(s), forehead.
How severe are they? You can describe how severe your pain is using on a scale of 1 to 10. See ways to describe pain.
What do they feel like? Is it vice-like, stabbing, throbbing, splitting.
How long do they last? This could be minutes, hours or days.
How often do they occur? Are they daily, monthly, only at certain times of the day, only on weekends or weekdays?
When do they occur? Is it on waking, in the afternoon or at work?
How do they start? Does the pain develop over hours or does it begin suddenly?
When did you start getting headaches? Was it childhood, adolescence or middle age?
What triggers them? This could be some foods, alcohol, caffeine, exertion, noise, bright light, hunger, stress, tiredness, weather.
What else do you feel? This may include neck or shoulder tension, sinus pain, tender scalp, jaw pain, being sick (nausea or vomiting).
Is your vision affected? For example do you have blind spots, strange lights or patterns?
What treatment do you take?
How effective was the treatment?

Not everyone with headaches needs to have an imaging test. In some cases, you may need a CT or MRI scan if:

your doctor could not diagnose your headache based on your history and examination
your doctor finds something abnormal in your examination
you have unusual headaches or headaches caused by a more serious problem.

Your doctor will advise what is best for you. Read more about when you should have an imaging test for headaches(external link) Choosing Wisely, NZ

Lifestyle changes can help prevent headaches. Getting more exercise, avoiding known stresses or triggers, improving your sleep and diet can all help a lot.

Avoid triggers
- If you know what causes your headaches (eg, alcohol, chocolate, cheese) it’s best to avoid these things if you can.
Change what you eat
- Keep your blood-sugar levels even by eating small amounts of a healthy, balanced diet regularly.
- You may find keeping a headache diary useful to work out whether certain foods trigger your headaches and need to be avoided.
Reduce stress
- try to make time in your day to do something you find relaxing – have a bath, go for a walk, laugh with friends.
Get regular exercise
- Activities such as swimming or vigorous walking can help reduce how often you get headaches and how bad they are.