Your head hurts. Maybe you were staring at your computer or phone too long. Or you skipped breakfast, didn’t sleep well, or got stressed fighting traffic. But now that it’s here, what can you do to get rid of that headache, and when is it a sign of something more serious?
From drugs to natural cures to behavioral therapy, there are more treatments than ever to relieve head pain. And that’s important, because almost everyone gets headaches, and some of us get them often. In fact, a 2022 Consumer Reports nationally representative survey (PDF) of 2,185 adult Americans found that 88 percent said they get a headache at least sometimes, and 1 in 5 get one at least once a week.
But people often minimize how severe the problem is and don’t seek help soon enough, says Teshamae Monteith, MD, chief of the headache division at the University of Miami Miller School of Medicine. Here, we’ll help you figure out what kind of headache you might have, how to get relief, what works, and when to know it’s time to get medical care.
Know Your Headache
The first step in dealing with a headache is knowing what kind you have. That’s a bit complicated because headaches come in lots of flavors. The International Headache Society has identified hundreds of types, from common tension headaches and migraines to less common but debilitating cluster headaches to oddballs like the one that comes after eating an ice cream cone too fast.
Knowing the variety is important. Treatment can vary by type as well as by how severe and frequent your headaches are and by what triggers them. Along with medication, there are some ways to treat them naturally without drugs. Here are the key features of some common or severe types of headaches, plus what to do about them.
Click HERE for signs that head pain is an emergency and when you should call 911 or go to the ER.
Tension
Symptoms: Mild to moderate pain at the front of your head or around your eyes that spreads as a tightening band. It often starts a few hours after waking and lasts 4 to 6 hours. They’re called chronic when you have them 15 days a month or more.
Causes: Stress, bad sleep, eye strain, overexertion, bad posture, and other causes can activate nerve endings called nociceptors. These send messages via the trigeminal nerve, which runs from the lining around your brain to your mouth, neck, ears, eyes, and throat, tensing your scalp and neck.
Treatments: Over-the-counter acetaminophen (Tylenol or generic) can help, as can an OTC nonsteroidal anti-inflammatory drug, or NSAID, like ibuprofen (Advil or generic) or naproxen (Aleve or generic). Beware: Taking NSAIDS in high doses or for more than nine days can trigger overuse, or rebound, headaches.
Migraine
Symptoms: Moderate to severe pain, usually on one side of the head and sometimes neck, lasting from a few hours to several days, worsened by even mild activity. Often accompanied by nausea and auras—seeing stars, zigzags, or flashing lights—which can affect vision, speech, and movement. The final stage can feel like a hangover: achiness, fogginess, and a stiff neck.
Causes: Stress, bad sleep, weather changes, strong smells, alcohol, certain foods (such as chocolate and cured meats), and exposure to sunlight or bright, flashing, fluorescent, or LED lights.
Treatments: Acetaminophen, an NSAID, or both might help, as might a pill such as Excedrin, which combines acetaminophen, aspirin, and caffeine. For severe migraines, drugs called triptans may be prescribed, or a newer class of drugs, calcitonin gene-related peptide (CGRP) antagonists such as Nurtec (rimegepant), Ubrelvy (ubrogepant), or Zavzpret (zavegepant). Side effects from triptans can include nausea, drowsiness, and dizziness, while side effects from CGRPs drugs can include nausea. Frequent use of NSAIDS and acetaminophen can trigger rebound headaches.
Allergy/Sinus
Symptoms: A dull pressure usually on one or both sides of the head and eyes. It’s often accompanied by congestion, fever, or sometimes discolored nasal phlegm, and can last for several days at a time.
Causes: Congestion and inflammation, called sinusitis, triggered by hay fever or another allergy, or a respiratory infection such as a cold or the flu.
Treatments: Try an over-the-counter decongestant containing pseudoephedrine—either as a stand-alone drug or in combination with a pain reliever like ibuprofen—available in pill or liquid form—to reduce nasal congestion. You could also consider a nasal spray like Afrin. To avoid nasal irritation and the risk of rebound headaches, don’t use a nasal spray for more than three days. (Read more about how to treat seasonal allergies.)
Source: November 2022 Consumer Reports nationally representative survey of 2,185 U.S. adults.
Cluster
Symptoms: An uncommon but very painful headache, officially called trigeminal autonomic cephalgia, that causes a sharp pain behind one eye or temple. It’s often accompanied by congestion, a runny nose, watery eyes, and a drooping eyelid. The intense pain typically lasts only a few minutes, up to several hours, and comes in waves. There may be daily attacks for a few weeks or months, then none for months or years.
Causes: Despite the congestion and runny nose, these are not related to allergies. The cause is unclear, but it appears to be connected to both the trigeminal nervous system and the hypothalamus, a part of the brain that oversees hormone regulation.
Treatments: If this is your first attack, get immediate medical care to rule out a stroke or other serious problem. If it’s diagnosed as a cluster headache, you may be given 100 percent oxygen through a mask and, if that doesn’t help, possibly a triptan.
Caffeine Withdrawal
Symptoms: Headache pain that comes on within 24 hours of when you last consumed caffeine. It may be felt on both sides of the head and temples, along with fatigue, nausea, irritability, and a depressed mood.
Causes: Regular caffeine consumption affects the levels of certain chemicals in your brain, including adenosine, dopamine, and adrenaline, in complex ways. Depriving your body of caffeine can upset that chemistry, triggering headaches and other symptoms.
Treatments: Consuming a caffeinated beverage, or a pill like Excedrin, which contains caffeine, can help. Or you can try an over-the-counter pain reliever such as acetaminophen, ibuprofen, or naproxen. If you are trying to consume less caffeine, it’s better to slowly lower your intake than to go cold turkey. (Read more about the health effects of caffeine.)
Why Migraines Are Tough to Treat
Researchers now know that migraines are not, as previously thought, a psychological disorder unique to high-strung women, or even a problem of impaired blood flow to the brain. Instead, they’re understood as part of a central nervous system disorder that inflames nerve fibers in the blood vessels lining the brain’s protective outer membrane.
Migraines, which tend to run in families, are much more common in women than in men. In fact, migraines are the most common disabling condition among women ages 50 and under, and trail only back pain among the leading causes of disability in all women, says Teshamae Monteith, MD, chief of the headache division at the University of Miami Miller School of Medicine.
That could be because migraines can be triggered by changes in estrogen levels during menopause, menstruation, or pregnancy, as well as from fluctuating hormone levels caused by birth control pills or in vitro fertilization.
And as common as the headaches are, the actual number of people who have migraines may be much higher, Monteith says, because the condition is sometimes misdiagnosed. About a third of Americans think they’ve had a migraine at least once that was not diagnosed, according to CR’s 2022 survey.
That’s partly because migraines can be easily confused with tension headaches and especially sinus headaches, Monteith says. “People may see the sinus doctor because they have sinus symptoms, which is common in migraine,” she says.
And if they experience auras, which can cause flashes of light, for example, they may go to an eye doctor for guidance, she says.
If you have those symptoms, she recommends seeing your primary care provider or a neurologist. Also see one of those healthcare providers if your migraine symptoms are so severe that they interfere with your daily life at work or home, or they happen so often that you’re reaching for over-the-counter pain relievers more than once a week.
The doctor might prescribe a triptan such as sumatriptan or frovatriptan to treat severe attacks.
Or if you suffer from frequent migraines, ask your healthcare provider about prescription drugs recommended by the American Academy of Neurology to prevent attacks, such as metoprolol, propranolol, or another beta-blocker, or topiramate, divalproex sodium, or another anti-epileptic. Your provider may also prescribe a drug from a newer class called CGRPs such as Aimovig (erenumab), Ajovy (fremanezumab) , and Vyepti (eptinezumab).
Feel a Headache Coming On? Do This.
No single treatment works for everyone, but here are a few options to try. Whatever approach you take, do it as soon as you feel a headache coming, not after it has had a chance to grab hold. And, don’t reach for a leftover opioid in your medicine cabinet. If your usual treatments aren’t helping, see your doctor before trying anything new.
1. Take the max dose of an OTC painkiller. Advil, Aleve, or Tylenol, or a generic version, often helps, especially if you take it early and at the maximum recommended dose. Important caveat: Don’t overdo it. High doses increase the risk of side effects, and taking OTC pain relievers more than nine days a month can actually trigger headaches.
2. Hydrate. Dehydration can trigger migraines and worsen headaches. Try to drink at least eight 8-ounce glasses of water each day, and up to about 12.
3. Go quiet and dark. Lie down in a quiet room with the lights low or off to reduce stimulation and help you relax.
4. Use hot or cold. A hot pack or hot bath can help with a tension headache. An ice pack or ice face mask may ease a migraine.
5. Massage and stretch. For a tension headache, focus on neck and shoulder muscles. That might help with a migraine, too, as can massaging your temples and the back of your head.
6. Try ginger. Maybe it sounds odd, but several studies suggest that consuming this antiinflammatory spice, either the root itself or in powder form, can ease migraines.