Most headaches are not dangerous, but they can make life miserable. The two most common types, tension-type headache and migraine, feel different and are treated differently, so it helps to know which one you have.
Spot the difference
| Tension-type headache | Migraine | |
|---|---|---|
| Feels like | Pressure or a tight band | Throbbing or pulsing |
| Where | Both sides of the head, forehead or neck | Often one side, but can be both |
| Severity | Mild to moderate | Moderate to severe |
| Physical activity | Not usually worse | Usually worse |
| Other symptoms | Rarely any | Nausea or vomiting, sensitivity to light and sound |
| Duration | 30 minutes to several days | Usually 4 to 72 hours |
About a quarter to a third of people with migraine have an aura beforehand, most often visual: zigzag lines, flashing lights or blind spots that build up over several minutes and last up to an hour.
Common triggers
Triggers vary from person to person, and often several combine:
- Irregular or short sleep, and lie-ins.
- Skipped meals and dehydration.
- Stress, and the let-down after stress, which is why some people get "weekend migraines".
- Hormonal changes, such as around periods.
- Alcohol, especially for some people red wine.
- Bright or flickering light, loud noise and strong smells.
A big night out can stack many of these together. A casino floor, for example, combines bright, flashing displays, constant noise, late hours, free drinks and long stretches without food. If you are migraine-prone, eat regularly, drink water between cocktails, take short breaks somewhere quieter and pack your usual treatment.
Treatment
- Tension-type headache: simple painkillers, rest, gentle exercise, posture and stress management.
- Migraine: take painkillers early in an attack. If they do not work, a doctor may prescribe a triptan. Anti-sickness medicine can help with nausea. People with frequent migraines can be offered preventive treatment.
- Avoid overuse. Taking painkillers on many days a month (roughly 10–15 days or more, depending on the drug) can cause medication-overuse headache.
- A headache diary helps identify triggers and patterns.
Red flags: get urgent help
Call emergency services for a sudden, severe "thunderclap" headache that peaks within seconds or minutes; a headache with a stiff neck, fever and rash; confusion, weakness, slurred speech or loss of vision; or a headache after a head injury. See a doctor soon about a new headache if you are over 50, if headaches are changing pattern or getting worse, or if they wake you from sleep.
Based on guidance from: NHS, World Health Organization, International Headache Society.
