Your day is going just fine—until you start to feel a dull ache in your temples, signaling the beginning of a headache. While headaches can be painful, they’re also very common and most aren’t cause for concern.
Stress, dehydration, certain foods, and spending too much time staring at electronic devices are common causes of headaches. While some types of headaches can be treated successfully with over-the-counter (OTC) medications, some headaches require a consultation with your healthcare provider. Learn more about the different types of headaches—and how to tell which is which.
5 common types of headaches
It’s easy to assume that your head pain is caused by seasonal allergies, but—because the symptoms are similar—it could easily be a tension headache.
There are two categories of headaches:
- Primary headaches: The headache is the condition itself—your pain isn’t triggered by something else, like allergies or dehydration.
- Secondary headaches: The headache is a symptom of something else that’s happening in your body. Treating the cause generally brings pain relief. For example, high blood pressure, hormone changes, or withdrawal from caffeine can all trigger secondary headaches.
Being able to correctly identify your specific category and type of headache can result in better treatments and quicker relief from that head pain.
1. Tension headaches
Tension-type headaches are the most common type of headache. “Typically, tension headaches start at the back of the head and are sometimes accompanied by stiffness in the shoulders and neck,” says Kathryn Boling, MD, a family practice physician at Mercy Medical Center in Baltimore, Maryland. “Some people describe tension headaches as feeling as if they have a rubber band around their head.” You may experience dull, squeezing pain on both sides of the head, almost like your head is in a vise.
OTC pain relievers such as Tylenol (acetaminophen), Advil or Motrin (ibuprofen), or Aleve (naproxen) usually work well on tension headaches and the accompanying stiff neck. In the event tension headaches persist, your healthcare provider may recommend a prescription pain medication such as Naprosyn (naproxen), which is stronger than Aleve. Sometimes, for chronic tension headaches, doctors will recommend an antidepressant—usually a tricyclic antidepressant such as Elavil (amitriptyline)—to prevent tension headaches.
Many lifestyle changes to reduce stress also work well in warding off tension headaches, like physical activity or extra rest. “Exercising, such as taking a walk outdoors, in nature, or taking time to de-stress through mindfulness or meditation can also provide relief from tension headaches,” Dr. Boling says. “In addition, staying well hydrated, getting a good night’s sleep, and eating a healthy diet can all help to prevent tension headaches.”
2. Sinus headaches
These painful headaches can feel like the bane of your existence. Located in the front of the head, often caused by inflamed sinuses or allergies, sinus headaches can feel like pressure behind the eyes. They can also accompany a sinus infection, also known as sinusitis.
You may be surprised to learn that a migraine can be mistaken for a sinus headache. “Both a sinus headache and a migraine can cause facial pain,” Jai Cho, MD, a San Francisco neurologist with The MAVEN Project, a telehealth non-profit. “But if a patient has a headache without congestion, a fever, or nasal mucus, it’s probably a migraine rather than a sinus headache.”
Sinus headaches may be treated with decongestants to reduce nasal congestion, but be sure to check with your doctor or pharmacist first as it could interact with other meds you’re taking. You can also apply a warm compress to painful areas of the face or use a saline nasal spray for sinus headaches.
3. Cluster headaches
These episodic headaches usually occur on one side of the head and can occur in cycles throughout the day. Cluster headaches tend to occur in a series around the same time of day, for several weeks or months. They can occur several times a day and can last anywhere from 15 minutes to several hours. “Cluster headaches aren’t as common as migraines and tension headaches, but they can be very painful,” Dr. Boling says.
While experts aren’t sure what causes cluster headaches, they may be triggered by certain factors such as alcohol use or smoking, bright light, or exercise. OTC medicines usually aren’t effective in treating cluster headaches, but your provider may suggest oxygen treatments and sumatriptan nasal spray. To prevent cluster headaches, your provider may prescribe medications such as Verelan (verapamil) or Lithobid (lithium). Emgality (galcanezumab) was approved in 2019 as an injection to relieve the symptoms and frequency of cluster headaches and migraines.
Migraine is often underdiagnosed and undertreated. Migraine headaches aren’t the same in everyone and symptoms can vary from one person to the next.
Characterized by a pulsing or throbbing pain on one side of the head, migraines can be accompanied by nausea, vomiting, and sensitivity to light and sound. The American Migraine Foundation says 25% to 30% of people experience migraine aura, where they see sparks or bright dots or experience tingling on one side of their body. “Migraines are more than just a bad headache,” Dr. Cho explains. “They can be recurring, vary in intensity, and last from a few hours to several days.”
The Migraine Research Foundation estimates migraines affect 39 million men, women and children in the United States and 1 billion worldwide. Despite the high prevalence of migraine, many people with migraine go untreated. One recent study found that 1 in 5 people didn’t realize they could get preventive migraine relief. Others weren’t aware that migraines can often be triggered by things like hormones (especially during menstrual cycles and menopause), an irregular sleep schedule, dehydration, certain foods, alcohol and caffeine.
If you suspect that you have migraine, your physician will take your medical history and conduct a physical and possibly a neurological exam. They will ask how often you have symptoms, if you have a family history of migraines, and inquire about your “headache burden,” or how many days each month you experience migraines and the impact they have on your life (whether you’re forced to miss work and other events).
If OTC treatments haven’t worked and you experience severe pain from headaches, there are prescription acute and preventive medications that can improve your quality of life. “If patients are experiencing migraines two or more days a week, I’ll typically put them on a preventative (also known as prophylactics) medication,” Dr. Cho says. Acute prescription medications used to treat migraine include triptans such as Imitrex (sumatriptan) or Maxalt (rizatriptan), and newer medications such as Ubrelvy (ubrogepant) or Reyvow (lasmiditan). Preventive medications include pills taken orally such as Nurtec ODT (rimegepant) or Topamax (topiramate), or a monthly injection of a calcitonin gene–related peptide (CGRP) receptor inhibitor such as Aimovig (erenumab). Botox (botulinum toxin) injected into the face every three months has also been proven effective in some patients who experience frequent migraine attacks.
If you have tried a migraine medication in the past without success, talk with your doctor about some of the newer treatment options that have become available over the past few years. Many of the older medications used to prevent migraines were initially approved to treat other medical conditions such as depression or hypertension. These newer medications were developed specifically to treat migraines. “Among the newer class of prescription medications are calcitonin gene-related peptide (CGRP) inhibitors, monoclonal antibodies that block a pathway involved in the migraine process,” Dr. Cho says. “These are injectables administered every one to three months and have been shown to help some patients have fewer migraines.”
A 2017 study found that melatonin might also prove useful in treating migraines and cluster headaches. Talk to your physician or pharmacist about the appropriate dosage and whether melatonin might work as part of your migraine treatment plan.
RELATED: What is migraine?
5. Medication overuse headaches
While most people turn to medications at the first sign of a headache, this approach can also lead to rebound headaches, also known as medication overuse headaches. If you use headache medication more than two or three times a week, it could trigger medication overuse headaches when the medication wears off.
“Instead of relieving symptoms, this can cause a secondary or more frequent headache,” Dr. Cho says. “Breaking the cycle of rebound headaches involves working with your doctor to stop the acute drugs and to begin taking preventive medications for your headaches.”
RELATED: Rebound headaches, explained
When to see a doctor for a headache
If your headaches are infrequent, occurring only a few times each month, it’s likely that OTC medications are enough to manage. “If your headaches don’t respond to OTC medications, and occur three or more times a week, you should talk to your doctor,” says Dr. Cho. Or, if your headaches are causing severe pain or interfering with your life, it might be time to check in with a physician.
“I usually start by asking patients to use a calendar to circle how many days each week they experience a headache,” Dr. Cho says. “Then I ask them to rate the headache, one being mild, two as medium and three as severe.” Your healthcare provider may also ask you questions about your lifestyle—such as your caffeine intake and your sleep schedule—to help determine what could be causing your headaches.
Depending on the results of the initial examination, your primary care provider may refer you to a neurologist.
Some cases require immediate medical treatment in the emergency room. “If you experience a thunderclap headache, a severe headache that comes on suddenly, it’s important to immediately go to the emergency room,” Dr. Boling says. “This type of headache can signal a brain bleed and requires immediate medical care.” It’s rare, but this type of headache pain can be the warning sign of a life-threatening aneurysm or brain tumor. You should also seek emergency medical care right away if you have the worst pain you’ve ever had, lose vision or consciousness, have vomiting that won’t stop, or if your pain has lasted more than three days. Also, if you have headaches after a head injury, it’s also a good idea to seek medical attention.