Headaches Explained: Which Type You Have and What Actually Helps

KEY TAKEAWAYS

•     Most headaches are primary, meaning the headache is the condition rather than a symptom of something else

•     Tension type headaches are the most common. Migraine is the most disabling

•     Location and character matter more than severity when working out the type

•     Painkillers taken more than about 10 to 15 days a month can cause medication overuse headache

•     A headache diary is the single most useful thing you can do before seeing a doctor

•     A sudden, severe headache that peaks within seconds is a medical emergency

Almost everyone gets headaches, which is exactly why they are so easy to ignore. The useful question is not how bad it hurts but what kind it is, because the types respond to completely different things, and a few of them need urgent attention.

Primary and secondary headaches

Primary headaches are conditions in themselves. Tension type, migraine and cluster headaches fall into this group, and they account for the large majority of headaches.

Secondary headaches are caused by something else: an infection, sinus inflammation, medication, dehydration, an injury, or rarely something serious. The warning signs later in this article are mainly about spotting the serious secondary causes.

Telling the common types apart

Feature	Tension type	Migraine	Cluster
Location	Both sides, band like	Usually one side	Around one eye
Character	Pressing, tightening	Throbbing, pulsating	Severe, boring, piercing
Severity	Mild to moderate	Moderate to severe	Very severe
Duration	30 minutes to several days	4 to 72 hours untreated	15 minutes to 3 hours
Movement	Usually no worse	Typically worse	Restlessness, pacing
Other symptoms	Few	Nausea, light and sound sensitivity, sometimes aura	Watering eye, blocked nostril, drooping eyelid on one side
Who	Very common, all ages	More common in women	Rare, more common in men

The movement question is often the quickest discriminator. If walking upstairs makes it noticeably worse and you want a dark quiet room, migraine is more likely than tension type.

Migraine in more detail

Migraine is a neurological condition, not simply a bad headache. It commonly runs in stages, though not everyone experiences all of them.

1.   Prodrome, hours to a day before: mood changes, food cravings, yawning, neck stiffness

2.   Aura, in some people: visual disturbances such as zigzag lines or blind spots, tingling, or speech difficulty, usually lasting under an hour

3.   Headache: throbbing pain, often one sided, with nausea and sensitivity to light and sound

4.   Postdrome: a washed out, foggy day afterwards, sometimes called the migraine hangover

Aura without headache is possible, and a first episode of aura should always be discussed with a doctor to rule out other causes.

Common triggers

Triggers vary enormously between people, and most attacks need more than one trigger to line up, which is why the same coffee or cheese seems to cause a headache only sometimes.

•     Irregular sleep, both too little and too much, and changes at weekends

•     Skipped meals and dehydration

•     Stress, and the letdown after stress, which is why weekend headaches are so common

•     Hormonal changes, particularly around menstruation

•     Alcohol, especially red wine

•     Caffeine, both excess and withdrawal

•     Screen time, glare and poor posture, particularly for tension type

•     Weather changes in some people

•     Strong smells and bright or flickering light

Keep a headache diary

This is the most useful thing you can do, and it makes any eventual medical appointment far more productive. For two to three months record:

•     Date, time it started and how long it lasted

•     Where the pain was and what it felt like

•     Severity out of ten

•     Other symptoms, such as nausea or light sensitivity

•     Sleep, meals, stress and menstrual cycle

•     What you took, when, and whether it helped

Patterns appear that are invisible day to day, and the medication record is what identifies medication overuse headache.

What helps

For tension type headaches

•     Simple pain relief, used sparingly and according to the label

•     Regular breaks from screens, and checking screen height and seating

•     Neck and shoulder stretches

•     Hydration and regular meals

•     Managing stress, which is the most common underlying driver

For migraine

•     Treat early. Medication taken at the first sign works considerably better than medication taken once the attack is established

•     A dark, quiet room where possible

•     Cold or warm compresses, whichever you find helps

•     Consistent sleep and meal times, which reduce attack frequency more than most people expect

•     Preventive medication, if attacks are frequent. This is a conversation to have with a doctor

Medication overuse headache

This one catches people out, because the behaviour causing it feels entirely sensible. Taking painkillers frequently for headaches can itself cause a persistent headache.

As a general guide, taking simple painkillers on more than about 15 days a month, or stronger headache medicines on more than about 10 days a month, for three months or more puts someone at risk. The pattern is a daily or near daily headache that improves briefly with medication and returns.

Do not stop prescribed medication on your own. Treatment usually involves withdrawing the overused medicine under medical guidance, and symptoms often worsen before improving.

When to see a doctor

Make a routine appointment if headaches are becoming more frequent or more severe, disrupting work, school or sleep, requiring painkillers more than twice a week, or if they are new for you and you are over 50.

Warning signs that need urgent care

Seek emergency medical attention for a headache with any of the following.

•     Sudden and severe, reaching maximum intensity within seconds to a minute, sometimes described as the worst headache of your life

•     Fever with a stiff neck or a rash

•     Confusion, drowsiness or difficulty waking

•     Weakness, numbness or difficulty speaking

•     Vision loss or double vision

•     Seizure

•     After a head injury

•     Worse when lying down, coughing or straining, or waking you from sleep

•     A new headache alongside cancer, HIV or a weakened immune system

•     A new headache in pregnancy with swelling or visual changes

These are uncommon, and they are the reason not to dismiss an unusual headache. Most headaches are not serious. The ones that are tend to announce themselves by being different from your normal pattern.

Everyday prevention

For people with frequent headaches of any type, routine matters more than any single remedy. The most common preventable triggers are ordinary.

Habit	Why it matters
Same sleep and wake time daily	Irregular sleep is one of the most consistent triggers, and weekend lie ins are a common cause
Regular meals	Skipped meals and low blood sugar trigger attacks in many people
Steady water intake	Dehydration is a frequent and easily avoided cause
Consistent caffeine	Both excess and withdrawal cause headaches. Pick an amount and keep it steady
Screen breaks and screen height	Reduces the postural and eye strain contribution to tension headaches
Regular movement	Associated with fewer headaches, though intense exercise can trigger them in some people
Limiting painkiller days	The single best protection against medication overuse headache

Myths versus facts

Myth	Fact
A migraine is just a bad headache	It is a neurological condition with several stages and other symptoms
Most headaches are sinus headaches	Many self diagnosed sinus headaches turn out to be migraine
Painkillers are always safe if over the counter	Frequent use can cause medication overuse headache
Headaches mean high blood pressure	Usually not. High blood pressure is typically symptomless
If you get headaches often, nothing can be done	Preventive treatments and trigger management help many people

Frequently asked questions

Can dehydration alone cause a headache? Yes, and it is one of the easiest causes to rule out.

Why do I get headaches at weekends? Often a combination of changed sleep times, later meals, caffeine withdrawal and the letdown after a stressful week.

Do screens cause headaches? Prolonged screen use contributes through posture, glare and reduced blinking rather than by damaging the eyes.

Should I get my eyes tested? Worth doing if headaches come with visual strain, particularly if you have not had a test recently.

Is coffee good or bad for headaches? Both. Caffeine can help an attack and can also cause withdrawal headaches if intake is irregular.

Can children get migraines? Yes. Attacks are often shorter and more likely to involve abdominal symptoms.

DISCLAIMER

This article is for general information only and is not a substitute for professional medical advice, diagnosis or treatment. Please consult a qualified healthcare professional before making decisions about your health. Seek urgent care for a sudden, severe headache.