Headache is one of the most common symptoms in medicine. Over nine in ten are primary headaches, where the headache is the condition itself: tension-type headache, migraine and the much rarer cluster headache. Secondary headaches are caused by something else, from a sinus infection to, rarely, bleeding or a tumour.
Headache on 15 or more days a month for over 3 months is called chronic daily headache. It usually develops from migraine or tension-type headache, and frequent use of painkillers is a leading reason it persists. The right diagnosis is made from your story far more than from a scan.
Symptoms
- Tension-type: a pressing band on both sides, mild to moderate, not worsened by activity
- Migraine: throbbing pain, often one-sided, with nausea and dislike of light and noise, lasting 4 to 72 hours
- Aura: zigzag lights, blind spots or tingling for 5 to 60 minutes before a migraine
- Cluster: severe stabbing pain around one eye with a watery eye and blocked nostril, in bouts at the same time each day
- Medication overuse: a dull headache on most days that returns as each painkiller wears off
- Neck-related: pain starting in the neck and spreading to the back of the head
Causes and risk factors
Primary headaches arise from the way the brain's pain pathways are wired; migraine runs strongly in families. Triggers include missed meals, dehydration, poor or irregular sleep, stress and its let-down, hormonal changes around periods, alcohol and too much caffeine. Taking simple painkillers on more than about 15 days a month, or triptans, codeine or combination tablets on more than 10, can itself cause daily headache. Secondary causes include sinus and dental disease, neck disorders, uncorrected vision, sleep apnoea, high or low spinal fluid pressure, temporal arteritis in people over 50, infection, bleeding and tumours.
How it is diagnosed
- Headache history: Pattern, duration, associated features and how many days you take painkillers. This gives the diagnosis in most people.
- Headache diary: Four weeks of notes reveal frequency, triggers and medicine use better than memory.
- Neurological and eye examination: Includes blood pressure and a look at the optic nerves for swelling.
- MRI or CT of the brain: Indicated for warning features, a new headache type after 50, or abnormal examination. Not needed for typical migraine with normal examination.
- Blood tests: Inflammatory markers urgently if temporal arteritis is possible.
Treatment options
- Acute treatment: Simple painkillers or anti-inflammatories taken early; triptans with an anti-sickness tablet for migraine; high-flow oxygen or injected sumatriptan for cluster attacks.
- Withdrawing overused painkillers: Headache often worsens for 1 to 2 weeks, then improves markedly. Best done with a plan and support.
- Preventive tablets: Propranolol, amitriptyline, topiramate or candesartan for frequent migraine; amitriptyline for chronic tension-type headache; verapamil for cluster.
- Botulinum toxin injections: Licensed for chronic migraine only, repeated every 12 weeks.
- CGRP-blocking medicines: Monthly or quarterly injections, or tablets, for migraine that has not responded to several preventives.
- Nerve blocks and lifestyle: Greater occipital nerve blocks can break a bad spell. Regular sleep, meals, exercise and caffeine limits reduce attacks.
When it is urgent
Call local emergency services for a sudden, severe headache that peaks within a minute; headache with fever, stiff neck, rash or confusion; with weakness, slurred speech, double vision or a seizure; after a head injury; or a new headache in pregnancy or shortly after birth. Anyone over 50 with new headache, scalp tenderness or jaw pain on chewing needs same-day assessment to protect their sight.
Travelling to Türkiye for treatment
Headache disorders are managed over months and years, so flying abroad for routine care makes little sense. A visit can offer a thorough one-off assessment by a headache neurologist, MRI where indicated, and a written plan for your own doctor to continue. Treatments that repeat, such as botulinum toxin every 12 weeks or CGRP medicines, need a provider at home. Pain clinics in any country that offer surgery for migraine should be viewed with caution, as the evidence is limited.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Could it be a brain tumour?
Very rarely. Tumours almost always produce other signs such as seizures, personality change or weakness. Isolated long-standing headache with a normal examination is reassuring.
How many painkillers are too many?
Try to keep acute headache medicines to no more than 2 days a week on average.
When should I start a preventive?
Commonly when you have 4 or more disabling headache days a month, or when acute treatment is failing. Each needs 2 to 3 months at a proper dose before judging it.
Does physiotherapy help?
It can for neck-related and tension-type headache, particularly alongside posture and exercise work.