How to Decode Your Headache

Your head is throbbing, the world is thrumming, maybe you feel nauseous or faint. When headaches strike, it can be difficult to determine whether the pain is a passing nuisance or the sign of something life-endangering.

If you’ve experienced head trauma and have a headache as a result, see a doctor immediately. Any personality changes, confusion, seizures or loss of consciousness with a headache needs to be addressed at once. Also, if your headache comes on suddenly and severely, in a kind of “thunderclap,” that might be a sign of bleeding in the brain. And if fever or stiffness in your neck accompany your headache, consult your doctor.

Other red flags include;

  • Headaches that first develop after age 50
  • Headaches occurring during pregnancy
  • A major change in the pattern of your headaches
  • An unusually severe headache
  • Head pain that increases with coughing or movement
  • Headaches that get steadily worse
  • Headaches that are accompanied by a painful red eye
  • Headaches that are accompanied by pain and tenderness near the temples
  • 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

Beyond those urgent situations, however, most headaches are just, well, headaches. Even if they are not life-threatening, some of our headaches can be baffling. Not just for you, but for your physician. In fact, of the 300 types of headaches that afflict us, only about 30 of them have known causes.

To help figure out what type of headache you have (and what treatment you might need), consider the frequency, severity and duration of your headaches.


Tension Headaches

Nearly 75% percent of us experience tension headaches lasting for 20 minutes to two hours. In most cases, these headaches are mild to moderate and occur infrequently. For some of us, though, tension headaches can hit us three or four times a week.

Severity runs the range between dull pain and vise-like grip. The causes of tension headaches might surprise you: Looking down at a keyboard all day can put the type of pressure on your neck that results in headaches. So can poor sleep posture. Caffeine withdrawal is another culprit.

These headaches are treatable with over-the-counter pain relievers such as acetaminophen and nonsteroidal anti-inflammatories, naproxen or Ibuprofen.


Cluster Headaches

An uncommon type of severe headache, cluster headaches can come on in clusters of one to eight headaches during the day in a one- to three-month period. These can be incredibly painful and debilitating, causing sufferers to become restless and agitated. Nausea and sensitivity to light and sound often accompanies the pain, which usually strikes one side of the head, very severely.

Other symptoms include a red, watery eye, droopy eyelid and nasal congestion. These attacks typically last a half-hour to an hour and are more likely to affect middle-aged men with a history of smoking.

Treatments include high flow oxygen, injections of sumatriptan, verapamil and other medications. To provide you with the most effective treatment for these types of headaches, your physician might refer you to a neurologist.



More women than men suffer from these famously severe and painful headaches. While these headaches strike suddenly, a variety of triggers might set off the pain, including changes in weather and nitrates in cured meats.

Migraines typically begin in the evening or during sleep, with pain typically striking one side of the head, often beginning around the eye. Nausea, watery eye, runny nose and congestion are common.

Untreated, migraine attacks can last four to 24 hours. In its earliest stages, a migraine might be controllable with nonprescription pain relievers. Past the early stage, doctors generally prescribe triptans. A neurologist can help you find the right treatment and work with you to help uncover and avoid potential triggers.


One Last Thing to Keep in Mind

What I tell my patients is that headaches can be anything and nothing. And even “textbook headaches” are far from textbook. That is why if you’re concerned about your headache, it is important to seek medical attention for it.

Your primary care physician can help, and if more specialized treatment is needed, he or she can refer you to someone who can help you relieve your pain.