Does it press like a band that's too tight around your head – or does it throb on one side while you feel sick and the light hurts? Not all headaches are the same: more than 200 types have been described, but two of them account for the lion's share. Telling them apart is worth it, because tension headache and migraine need different treatments – and if you keep reaching for the wrong pill, you can even train your body into an additional headache.
Key takeaways
- Tension headache: both sides, dull and pressing, mild to moderate – you can usually go about your day, and movement doesn't make it worse.
- Migraine: comes in attacks, often throbbing on one side, with nausea and sensitivity to light and noise – movement makes the pain worse.
- Cluster headache: rarer, but unmistakable – excruciating one-sided pain around the eye with tearing and restlessness.
- Pain relievers on more than 10 days a month can themselves cause a constant headache.
- A thunderclap headache and a headache with neurological symptoms are emergencies.
Tension headache: common and annoying
The most common headache of all feels like a hat that's too tight or a band around your head: both sides, dull and pressing, mild to moderate. There's no nausea, and you can usually carry on with your day – fresh air and movement tend to help. Typical triggers are stress, neck tension, lack of sleep and screen work. Occasional episodes are harmless; if they occur on more than 15 days a month, it's called chronic tension headache – and then you need a treatment plan that involves more than pills.
Migraine: more than “a bad headache”
Migraine is a neurological condition in its own right that comes in attacks: the pain is often one-sided, throbbing or pounding, moderate to severe – and gets worse with physical activity. Typical companions are nausea, sometimes with vomiting, and sensitivity to light and noise; many people have to retreat to a darkened room. In about one in five people, an aura comes first: flickering vision, zigzag lines or tingling sensations that spread over minutes and then fade again. Untreated, an attack lasts four hours to three days.
Other important types
- Cluster headache: excruciating, boring pain strictly on one side around the eye and temple, lasting 15 minutes to 3 hours, often at night and in series (“clusters”) – with a watering eye, a drooping eyelid and marked restlessness. Rare, but heavily underdiagnosed and very treatable.
- Medication-overuse headache: develops gradually when acute pain relievers or triptans are taken on more than 10 days a month – the constant headache from your own medicine cabinet.
- Headache from muscle tension and the jaw: neck and chewing muscles like to radiate pain into the head – one reason posture and teeth grinding are part of the conversation.
The vast majority of headaches are harmless. Call emergency services immediately if you have:
- A sudden, devastating headache (“thunderclap”) – at maximum intensity within seconds
- A headache with paralysis, trouble speaking or seeing, confusion or a seizure
- A headache with a high fever and a stiff neck
- The worst headache of your life, for the first time, after a fall or accident
These situations are emergencies:
Call 112 (emergency)
