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Headache

April 6, 2021

Sorry to hear that your head hurts.

Our Health Decision Guide on Headache is designed for the person experiencing a headache that is either new or different from prior headaches. However, anyone with persistent headaches may also find some helpful information in the guide.

There are many possible reasons why you have a headache. By answering a series of questions, you will learn about the cause or causes likely to be most relevant to you.

This guide is a learning tool and not a substitute for consultation with your own doctor.

Let's get started.

Click here to begin.

Most headaches, even very severe ones, are not associated with a serious medical problem. But it is important to first identify a headache that needs immediate medical attention.

Sudden onset severe pain that is different from any type of headache that you have ever experienced before always requires medical evaluation.

Is this the worst headache of your life?

Yes, this is the worst headache ever.

No, this is not the worst one.

Another question to help determine if you need immediate medical attention.

Are you experiencing any of the following symptoms?

- A fever without any symptoms of the flu, a cold, or respiratory infection

- Marked increased pain when you bend your head forward

- Stiff neck

- Blurred or double vision

- Confusion

Yes, I am experiencing one or more of those symptoms.

No, I am not experiencing any of those symptoms.

It's quite predictable to have a headache following any blow to the head. But certain symptoms raise concern that brain injury may have occurred.

Are you experiencing any of the following symptoms?

- Nausea and vomiting

- Memory problems

- Difficulty communicating

- Blurred vision

Yes, I have one or more of these symptoms.

No, I don't have any of those symptoms.

Your headache is most likely related to the blow to your head.

Your symptoms should improve over the next 24 - 48 hours. If you are not improving, contact your doctor. Call sooner if the headache is getting worse or you develop new symptoms in addition to the headache.

It's possible that your headache is due to something else. To learn about other possible reasons for your headache.

Click here.

Here is another question to help determine if you need immediate medical attention.

Are you experiencing any of the following symptoms?

- Fever and severe headache without any symptoms of the flu, a cold, or respiratory infection

- Confusion

- Marked increased pain when you bend your head forward

- Stiff neck

- Uncontrolled vomiting

Yes, I am experiencing one or more of those symptoms.

No, I am not experiencing any of those symptoms.

Great. Let's continue.

Viral infections such as colds and flu often cause a headache.

Do you have symptoms suggestive of the flu or a cold, such as a sore throat, nasal congestion, cough, muscle aches, and fever?

Yes, I think I have a cold or the flu.

No, I don't have those symptoms.

So far, your answers indicate that you have a new or different headache without any fever, symptoms of infection or stiff neck. You also indicate that you are thinking clearly without confusion.

Next let's consider whether you rarely get headaches or you get headaches quite often. People who have migraine or get other types of headaches will almost always experience at least one headache that is more severe or feels a little different than prior headaches.

Do you have a history of migraine or recurrent headaches?

Yes, I have problems with recurrent headaches.

No, I rarely get headaches.

Sinus infections can cause a headache. However, the pain of a sinus infection is usually in the front and tends to be localized to one side of the forehead, around the nose or behind one or both cheeks. The pain from a sinus infection often gets worse when you bend forward. Also mucus from your nose changes color to yellow, green, or reddish-brown.

Do your symptoms suggest a sinus infection?

Yes, this sounds like me.

No, I don't have these symptoms.

Try your usual headache remedies. Call your doctor if you cannot get the head pain under control or you start to have nausea and vomiting.

There could be some other reason for your headache.

Click here to learn about other possibilities.

Sinus infections can cause a headache. However, the pain of a sinus infection is usually in the front and tends to be localized to one side of the forehead, around the nose or behind one or both cheeks. The pain from a sinus infection often gets worse when you bend forward. Also mucus from your nose changes color to yellow, green or reddish-brown.

Do your symptoms suggest a sinus infection?

Yes, this sounds like me.

No, I don't have these symptoms.

An important but uncommon cause of headaches is carbon monoxide exposure. Clues that carbon monoxide may be the cause include:

- Headaches that occur only in your home

- Cold weather requiring windows to be shut

- A gas smell in your home

- Using a wood burning or coal stove

- Other family members complaining of headache

Is there any chance that carbon monoxide levels are high in your home?

Yes, this may be true.

No, this does not apply to me.

Next, let's consider the time of day you have a headache. Headaches that occur when you wake up in the morning may indicate a problem with abnormal breathing during sleep. Sleep apnea has become a well known cause for early morning headaches.

Do you have a headache when you wake up in the morning?

Yes, I have early morning headaches.

No, my headache occurs at different times.

Sleep apnea is less likely but still worth considering if you

- Snore loudly

- Feel drowsy all day

- Fall asleep during the day while watching TV, reading, or driving the car

Do your symptoms suggest sleep apnea?

Yes, I have these symptoms.

No, I don't have these symptoms.

Now let's explore some other common reasons why people have headaches.

Withdrawal from caffeine can cause headaches.

Have you recently cut back on caffeine containing products such as coffee, tea, or other caffeinated beverages?

Yes, I have cut back on caffeine.

No, my caffeine consumption has not changed.

Call your doctor's office to arrange an appointment.

Click here to learn about other common reasons for new or more severe headaches.

You may have sleep apnea. Other symptoms in addition to early morning headaches include:

- Loud snoring

- Feeling drowsy all day

- Falling asleep during the day while watching TV, reading, or driving the car

Call your doctor's office to arrange an appointment.

Click here to learn about other common reasons for new or more severe headaches.

Now let's explore some other common reasons why people have headaches.

Withdrawal from caffeine can cause headaches.

Have you recently cut back on caffeine containing products such as coffee, tea, or other caffeinated beverages?

Yes, I have cut back on caffeine.

No, my caffeine consumption has not changed.

Over use of alcohol can cause headaches. This can happen even if your alcohol consumption has not increased. Men should not have more than two drinks per day; women should average no more than one drink per day.

Do you think you are drinking too much alcohol?

Yes, my headache may be related to alcohol over use.

No, I don't drink more than what is recommended.

The headache should gradually improve as your body gets used to less caffeine. If the headache persists, you should consider some other reason for your headache.

To explore more reasons for headaches,

Click here to continue.

Over use of alcohol can cause headaches. This can happen even if your alcohol consumption has not increased. Men should not have more than two drinks per day; women should average no more than one drink per day.

Do you think you are drinking too much alcohol?

Yes, my headache may be related to alcohol over use.

No, I don't drink more than what is recommended.

Headache can be a side effect of many medications. Medicines that often cause headache include nitroglycerin, isosorbide and other longer acting nitrates, nifedipine, and birth control pills.

Have you started any new medications recently?

Yes, my headaches started at about the same time.

No, I don't think it is medication related.

An uncommon type of headache is cluster headache. Cluster headaches usually occur about the same time every day. They are often centered over or around one eye. The eye can turn red and tear. The headache is usually severe and lasts a couple hours, returning the next day. During the first week of new cluster headaches, the daily pattern may be less established.

Do your symptoms suggest cluster headache?

Yes, this sounds possible.

No, I don't think so.

We have covered the more common reasons for new onset headache. If your headache persists, contact your doctor's office.

Call your doctor. There are several treatments that can help.

Check with your pharmacist. If he or she thinks that this could be a side effect, call your doctor.

If you have been drinking heavily, contact your doctor for advice. Abruptly quitting on your own may be dangerous.

Get fresh air immediately and then make sure your family members also get fresh air.

Call immediately for medical advice or go to an emergency department.

Most sinus infections are caused initially by a virus or allergies. Swelling and mucous build up prevent the sinus from properly draining. Pressure increases inside the sinus causing pain. You can start with a decongestant, either orally or by nasal spray. If you think it is an allergy, you can take an antihistamine as well. If the symptoms are not improving over 2 - 3 days, contact your doctor. Call sooner if the pain is getting worse or you develop a fever.

The headache should resolve as your other symptoms improve. You can take over the counter pain relievers such as acetaminophen, ibuprofen, or naproxen for the headache. If the headache gets worse or doesn't resolve over the next several days, contact your doctor for advice.

You need immediate medical evaluation. The good news is that most headaches, even the very severe ones, are not caused by a serious medical condition. However, you do need to be evaluated because these symptoms sometimes indicate bleeding into the brain, a brain infection, or elevated pressure inside the brain.

Contact your doctor now or arrange for immediate evaluation. You may have a concussion or more serious brain injury.

You need immediate medical evaluation. Although most headaches, even the very severe ones, are not caused by a serious medical condition, bleeding into the brain or a brain infection needs to be considered.

Disclaimer:

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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