What’s Causing Your Headache?

Headaches are part of being human—one of the less fun parts, for sure. Just about everybody gets a headache now and then. Whether you crawl under the covers in a dark room, call your doctor or just power through, headaches impair your quality of life.

In fact, headache is one of the most common reasons people visit a primary care doctor or neurologist, says UNC Health neurologist Gary W. Jay, MD.

But “headache” is a broad term—before knowing how to treat your pain, you have to understand what is causing it. We asked Dr. Jay to describe the differences.

Tension-Type Headache

What does it feel like? This most common type of headache may feel like a tight band is around your head. It is caused by muscles contracting, Dr. Jay says.

What causes it? Stress and anxiety can lead to tension-type headaches.

What can you do to feel better? “If you get a tension-type headache, the best thing to do is sit down and relax,” Dr. Jay says.

Relaxation techniques such as meditation, yoga and stretching can help. Some people find relief by using a heating pad, hot water bottle or warm compress on their neck and shoulders.

Over-the-counter pain medication, such as ibuprofen (Advil) and acetaminophen (Tylenol), can be helpful if other pain relief methods fail, Dr. Jay says. But he recommends taking no more than one tablet two times a week because taking too many medicines may increase the number and severity of headaches. This is known as a medication overuse headache or rebound headache.

If you spend hours driving or sitting in front of a computer or other screen, make sure to take breaks often to stretch and refocus. This can help prevent tension headaches.

Migraine Headache

What does it feel like? Migraines cause moderate to severe pain that often is disabling. The pain may be on one or both sides of the head, in the front or back of the head, or around the eyes or behind the cheeks. Your head may throb or pound.

Migraines typically last from four to 72 hours, Dr. Jay says. Nausea, vomiting, and sensitivity to light, smells and sounds are common. Exertion makes the pain worse.

About 1 in 5 people with migraines will experience an aura before the pain starts, he says. It may be visual aura (seeing dark, light or zigzag spots, or losing vision in the center or sides) or sensory aura (feeling like pins are being stuck into your arms, legs or sides). Sometimes people won’t understand what others are asking them, or they may understand but not be able to find words to answer.

Aura usually lasts between five and 55 minutes, and the headache typically starts within an hour after the aura is over, Dr. Jay says.

What causes it? Migraine triggers are unique to each person, but they can include certain foods, smells, or changes in weather or barometric pressure.

One of the most common causes are hormonal changes, especially in women. Although both men and women have migraines, three times more women than men experience them. Often, the headaches start when a girl gets her first period and are most common during her childbearing years.

What can you do to feel better? Doctors may treat migraines by prescribing medications that either prevent the pain from starting or stop the pain once it has begun. If possible, avoiding triggers is important. Some people get relief by putting an ice pack or cold compress on their heads. Avoiding bright light, heat and loud noises helps, too. Many times, people just go to sleep.

“People with migraines often will lie in a cool, dark room,” Dr. Jay says.

Cluster Headache

What does it feel like? Cluster headaches usually last 45 minutes to three hours, and they come in clusters, recurring one to eight times a day. The cycles of cluster headaches may occur daily or every other day for weeks or months, then patients can go weeks or months without having another cycle. Cluster sufferers are more likely to be men than women.

Patients are restless, often pacing or even hitting their heads against the wall because the pain is so severe.

“They’re so agitated, they can’t lie down or sit still,” Dr. Jay says.

What causes it? The exact cause of cluster headaches is unknown, but patterns suggest that abnormalities in parts of the brain that control the circadian rhythm—when various biological processes happen—play a role.

Unlike migraine and tension headaches, cluster headaches generally aren’t associated with triggers, such as foods, hormonal changes or stress.

What can you do to feel better? Some drugs prescribed to treat migraines can also help with cluster headaches. However, these medications may take as long to work as the cluster episode lasts. Because the headaches tend to occur about the same times every day (usually at night), patients may be able to anticipate the pain and take medication before it starts.

One of the most effective treatments is oxygen therapy, Dr. Jay says. Attacks often can be stopped within 20 minutes if the patient is using a non-rebreather mask with a high rate of oxygen flow. A non-rebreather mask is a medical device that helps deliver oxygen in emergency situations. It is a face mask connected to a bag that’s filled with a high concentration of oxygen. However, this treatment can be expensive and often is not covered by insurance.

Cluster headaches are not very common, Dr. Jay says. Fewer than half of patients who are referred to him for suspected cluster headaches actually receive the diagnosis.

Thunderclap Headache

What does it feel like? If you have sudden onset of intense pain that feels like a thunderclap in your head, you may be experiencing bleeding around your brain.

What causes it? The bleeding could stem from a stroke or a blood vessel bursting (a cerebral aneurysm).

“This is a very different type of headache than migraine or cluster,” Dr. Jay says. “At this point, the goal is to save the patient’s life.”

What to do to feel better: If you or someone around you experiences sudden, severe head pain, call 911 immediately.

Long COVID and Other Headache Causes

Although the exact cause is unknown, headaches are a common symptom of long COVID. To treat these headaches, doctors must figure out what type of headache the person is experiencing, such as migraine or tension-type, and treat the patient accordingly.

New daily persistent headache (NDPH) is treated the same way, by choosing medications based on headache type. Patients with NDPH have no history of recurring headaches when they strike, and their symptoms may be like either migraines or tension-type. To be diagnosed with NDPH, the headache has to last continuously for at least three months. It is more common in children than adults. Fortunately, it is a rare condition.

Sinus infections, colds and flu, other viruses, becoming overheated, drinking too much alcohol, listening to loud music or other sounds (hammering, loud machinery) can all cause your head to ache. Drinking water to prevent dehydration, getting adequate rest and taking a pain reliever as directed can all help. If your headache persists, see your doctor.

If you have frequent or painful headaches, talk to your doctor, or find one near you.