With a headache, the pattern tells the kind.
Almost everyone gets headaches. Most are tension headaches or migraine: painful and tiring, but not caused by anything dangerous inside the head. A few headaches are a warning of something serious, and those have clear signs. This page shows how to tell them apart.
In plain words.
A tension headache feels like a tight band or pressure on both sides of the head, often with a stiff neck and shoulders. It is usually mild to moderate, and you can carry on with your day. Stress, poor sleep, long hours at a screen, skipped meals and too little water set it off.
Migraine is a throbbing headache, often on one side, that lasts from a few hours to three days. It comes with nausea or vomiting, and light and noise hurt. About one in four people with migraine first see zigzag lights or blind spots for up to an hour, called an aura. It runs in families and is more common in women.
Taking painkillers for headache on more than 10 to 15 days a month can itself keep a headache going almost every day. This painkiller-overuse headache is common, and it usually settles when the painkillers are cut down with a doctor’s plan.
Blood pressure seldom causes a headache unless it is very high, so a headache is not a reliable sign of high BP: check it with a machine instead. And most headaches do not need a brain scan; a scan is for headaches with warning signs.
Three kinds, side by side
The commonest kind. It feels like a tight band pressing around the head, often with stiff neck muscles. Stress, poor sleep and long screen hours set it off.
Changes in the brain’s nerves and blood vessels set off a throbbing pain, often on one side, with nausea. Light and noise hurt. In some people, a slow wave crossing the brain first brings zigzag lights.
Painkillers taken on more than 10 to 15 days a month, month after month, can themselves keep a headache coming almost daily. It usually settles when they are cut down with a plan.
Go to hospital now if
- A sudden, severe headache that reaches its worst within a minute, like a thunderclap: call 112 or go to hospital now.
- Headache with fever and a stiff neck, a rash, drowsiness or confusion: go to hospital now.
- Headache with weakness or numbness of the face, arm or leg, slurred speech, loss of vision, or a fit: call 112. These can be signs of a stroke.
- Headache after a head injury, above all with vomiting, drowsiness or confusion: go to hospital now.
- Headache with a painful red eye, and blurred vision or haloes round lights: go to hospital now.
- Headache in more than one person at home, especially with a coal or wood heater in a closed room: get everyone into fresh air and call 112.
- Pregnant or recently given birth, with a severe headache, blurred vision or swelling of the face or hands: go to hospital now.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
See a doctor soon if
- You are over 50, with a new headache and a tender temple, pain on chewing or blurred vision: the same day, as eyesight can be at risk
- The headache is new and you are over 50
- It is getting steadily worse over days or weeks
- It is worse on waking, or on coughing, straining or bending, or it wakes you from sleep
- You have cancer or HIV, or take medicines that lower immunity
- You take painkillers for headache on more than 10 days a month
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Blood pressure | Checked at every visit. A very high reading with headache needs care the same day. |
| Headache diary | Days, triggers and painkillers taken: the most useful record for migraine and painkiller-overuse headache. |
| Eyesight test | For headaches after reading or screen work. An eye check also looks at the back of the eye when needed. |
| Blood tests (ESR, CRP, blood count) | For a new headache after 50, or with fever or weight loss. |
| CT or MRI of the brain | Only when there are warning signs or the pattern is unusual. Most headaches do not need a scan. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Try not to take painkillers for headache on more than two or three days a week. Taken more often, they can make headaches come almost every day.
A video call can
- Work out which kind of headache it is, from your story and diary
- Plan treatment for attacks, and preventive treatment if they are frequent
- Plan how to cut down painkillers safely
- Decide whether you need a scan, and which one
Needs a visit in person
- Examination of the nerves and the back of the eye, when there are warning signs
- A CT or MRI scan
- Blood tests, at a laboratory or by home collection
- Any sign in the red box: that is an emergency
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759