Why do I have a headache on the top of my head?

Headaches can present themselves in a variety of ways and locations. For example, a headache on the top of the head often feels like a heavy weight or a tightness on or around the top of the skull. It may also feel like a sharp pain radiating from another part of the head or spine. Common causes of a headache on top of the head include tension, nerve inflammation, migraine, and dehydration. Pinpointing the cause of the headache can help determine the best treatment method, which may include pain relievers, stretching, stress management, or hydration, among others. 

Types of headaches on top of the head

Several types of headaches can cause pain on the top of the head. Many of these headache types also affect one side of the face or behind the eyes. 

Tension headaches

A tension headache develops when the scalp and neck muscles become tense, often in response to stress or poor posture. The muscle tension can cause pain in any part of the head, including the top.

“Tension headaches are one of the most common types of headaches and often cause a band-like pressure or tightness around the head,” says Trent G. Orfanos, MD, the director of integrative and functional cardiology at Case Integrative Health. “The pain is typically mild to moderate and is often described as a constant ache.”

Other symptoms of tension-type headaches include neck, scalp, and shoulder pain, says Lauren R. Natbony, MD, headache specialist and medical director of Integrative Headache Medicine of New York.

Migraine headaches

Migraine is a headache disorder that causes moderate to severe pain. The exact cause of migraine is not fully understood, but migraine headache triggers include stress, hormone changes, and lifestyle changes such as missed meals or not getting enough sleep.

“Although migraine typically causes throbbing pain on one side of the head, it can also cause pain on the top of the head,” Dr. Natbony explains. “Symptoms accompanying a migraine may include nausea, vomiting, sensitivity to light, sound, and odors, and disturbed vision, among others.”

Occipital headaches

Also called occipital neuralgia, this type of headache involves inflammation or irritation of the occipital nerves, which run from the top of the spinal cord to the scalp. “This condition can lead to sharp, shooting pains that radiate to the top of the head,” Dr. Orfanos says

“The occipital nerve can be irritated in response to trauma (such as a head or neck injury), neck tension, or general inflammation,” says Dr. Natbony. 

Other headache types that may affect the top of the head

Sometimes, headaches centered on other parts of the head extend or radiate pain to the top of the head. In other cases, headaches can be generalized—on both the top and sides of the head.

Here are some headache types that are not known for occurring on the top of the head but that might radiate pain to the scalp area:

• Cluster headaches: These painful headaches typically occur behind one eye or around one temple. However, head pain may radiate from the side to the top of the head.
• Cervicogenic headaches: These one-sided headaches caused by neck or cervical spine issues may radiate to the top of the head. “ Poor posture, neck injuries, or abnormalities in the cervical vertebrae can contribute to cervicogenic headaches,” Dr. Orfanos says.
• Dehydration headache: “Inadequate fluid intake can lead to reduced blood flow to the brain, resulting in a headache,” Dr. Orfanos says, which may be felt at the top of the head.
• Sphenoid sinusitis headache: Sphenoid sinusitis occurs when the sphenoid sinuses inside the skull become inflamed. Symptoms include headache on top of the head, per Nishant Reddy, MD, an ear, nose, and throat specialist at NJ ENT in Marlton, New Jersey. Other symptoms include pressure behind the eyes, watery eyes, and nasal congestion. 

What causes a headache on the top of your head?

There are various reasons why you may feel a headache on the top of your head. Some, like physical trauma to the head, are more obvious than others. To determine the cause of your headache, think about any lifestyle factors that may have contributed to it, such as a lack of sleep or caffeine withdrawal. 

Other possible causes of a headache on the top of your head include the following:

• Stress and muscle tension
• High blood pressure
• Dehydration
• Migraine disorder
• Medication overuse
• A medication side effect

Related: What causes headaches every day?

Symptoms accompanying headaches on top of the head

Other symptoms often accompany pain at the top of the head, depending on the specific headache type. Keeping track of your headache location and additional symptoms can help a healthcare provider determine the underlying cause of the pain.

The following symptoms may accompany headaches on top of the head:

• Sensitivity to light or sound
• Dizziness
• Visual disturbances
• Nausea or vomiting
• Neck pain
• Shoulder pain
• Tired or sore eyes

When to see a doctor for a headache on top of the head

“For most routine headaches that are not severe or sudden, start by consulting your primary care physician,” Dr. Reddy says. If your headaches have become frequent or are gradually worsening, it can help to keep a headache diary of when the pain begins, possible triggers, and accompanying symptoms. Share your headache diary with the healthcare provider at your appointment, as this information could help pinpoint the type and cause of your headaches.

Dr. Orfanos advises seeking emergency medical help if any of the following symptoms accompanies the headache on top of your head:

• Head injury or trauma
• Difficulty speaking
• Sudden weakness or numbness
• Loss of consciousness
• Seizures
• Paralysis 

“If in doubt or if you are concerned about the severity of your symptoms, it’s better to err on the side of caution and seek emergency medical care,” Dr. Orfanos says.

How to get rid of a headache on top of the head 

According to Drs. Natbony, Orfanos, and Reddy, the treatment for a headache on top of the head always depends on the type of headache and its underlying cause. So, if OTC pain relievers don’t relieve the headache, or if it is severe or sudden in onset, consult a healthcare provider to help determine the cause and appropriate treatment.

Medications for the types of headaches that present on the top of the head may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
• Muscle relaxants
• Triptans (for migraine headaches)
• Decongestants, corticosteroids, or antibiotics (for sinusitis)

“It’s essential to consult with your primary care physician before starting any new treatment, especially if you have not received a diagnosis for your specific type of headache,” Dr. Natbony cautions.

Non-pharmacologic remedies for headaches might include the following, per Dr. Orfanos:

• Stress management, which could include breathing exercises or physical exercise
• Proper hydration
• Improving your posture
• Meditation
• Biofeedback, which involves soothing the nervous system before it responds with a migraine

“The most effective treatment can vary from person to person,” adds Dr. Orfanos. “What works for one individual may not work as well for another.”