Overview
Headache is one of the most common neurological symptoms. The majority are primary headaches, meaning they are not caused by another condition. Tension headache is most common. Migraine affects about 1 in 7 people and can be debilitating. Distinguishing headache types guides effective treatment.
How common is it?
Headaches are common. Migraine can be disabling, while cluster headaches are rare. Frequency varies widely between people.
Causes and risk factors
Primary headaches arise from activation of pain-sensitive structures in the head and neck. Tension headaches involve muscle tension and central pain sensitisation. Migraine involves complex brain neurological changes including vascular and cortical spreading depression.
Common risk factors
- Stress and muscle tension
- Poor posture
- Dehydration
- Sleep disruption
- Hormonal changes (particularly in women)
- Certain foods and drinks: caffeine, alcohol, aged cheese
- Bright lights, loud noises, strong smells (migraine triggers)
- Weather changes
Symptoms
- Tension headache: bilateral dull pressure or tightening around the head
- Migraine: typically one-sided, pulsating, moderate to severe, with nausea, sensitivity to light and sound
- Some people with migraine have aura, such as zigzag lines, flashing lights or tingling. New weakness, speech difficulty or vision loss must not automatically be assumed to be aura.
- Cluster headache: excruciating pain around one eye with watering, lasting 15 to 180 minutes
When to see a doctor
Seek emergency help now for a headache that starts suddenly and is extremely painful, or one accompanied by a seizure, new weakness, difficulty speaking or walking, confusion, marked drowsiness, loss of vision, a stiff neck with fever, or a non-fading rash. A concerning headache after a head injury also needs emergency assessment. Do not drive yourself. Seek medical advice for recurrent headaches, a changing pattern, or symptoms that do not improve.
Diagnosis
Most headaches are diagnosed from the history and examination. Red flags or atypical symptoms may need urgent investigation, sometimes including brain imaging or blood tests. Tests are selected for the suspected cause; a normal blood test does not exclude every serious condition.
Treatments
Acute analgesics and triptans
Pain relief may help tension headache or migraine; triptans are an option for migraine after suitability is checked. Choice depends on other conditions, pregnancy and medicines. Cluster headache requires different acute treatment, such as prescribed oxygen or a non-oral triptan. Discuss frequent use to avoid medication-overuse headache.
Preventive migraine treatment
Preventive migraine treatment depends on attack frequency, disability, preferences and other conditions. Options include propranolol, amitriptyline or selected specialist treatments. Propranolol may be unsuitable with asthma. Topiramate must not be used for migraine prevention in pregnancy; anyone who could become pregnant must meet the pregnancy prevention programme requirements. Discuss pregnancy plans promptly with the prescriber.
Lifestyle and trigger management
Regular sleep, regular meals, adequate hydration, stress management, and a migraine diary to identify personal triggers can significantly reduce headache frequency.
Self-care and lifestyle
- Keep a headache diary to identify triggers and pattern
- Maintain regular sleep, eating, and hydration routines
- Discuss frequent painkiller or triptan use with your clinician. Medication-overuse headache risk depends on the medicine and use over several months; agree a treatment plan rather than stopping prescribed medicines yourself.
- Regular aerobic exercise reduces migraine frequency
Prevention
Identifying and managing personal triggers, maintaining regular routine, preventive medication for frequent migraines, and treating contributing conditions such as poor posture and sleep apnoea.
Sources for targeted updates
Updated: 24 October 2026. Targeted corrections to frequency, symptoms, diagnosis, treatment, self-care, key facts. This update covers the named sections; a full review of the remaining guide is pending.