Headaches & Migraines
Symptoms, Causes & Treatment
Everything you need to know about headaches and migraines: what causes them, how to tell them apart, and when to seek treatment.
What Are Headaches & Migraines?
Headache is one of the most universally experienced symptoms in medicine. Almost everyone will have a headache at some point in their life, and for most people the vast majority of headaches are benign, short-lived, and self-resolving. However, for a significant proportion of the population, headaches are recurrent, severe, or associated with other symptoms that require clinical assessment and active management.
A headache is defined as any pain or discomfort in the head, scalp, or neck. Headaches are broadly classified into primary headaches – where the headache itself is the condition – and secondary headaches, which occur as a symptom of an underlying medical problem. The overwhelming majority of headaches encountered in clinical practice are primary in nature.
Migraine is a specific, well-defined neurological condition characterised by recurrent episodes of moderate to severe headache, typically on one side of the head, accompanied by nausea, vomiting, and sensitivity to light and sound. Migraine is not simply a bad headache – it is a distinct neurological disorder with a recognised pathophysiology that significantly impairs the daily lives of those affected. In the UK, approximately 10 million people live with migraine, making it one of the most prevalent neurological conditions in the country.
Both tension-type headaches and migraines can be episodic (occurring on fewer than 15 days per month) or chronic (occurring on 15 or more days per month). Chronic daily headache and medication overuse headache (MOH) – a paradoxical worsening of headache caused by the overuse of pain-relieving medications – are also important and frequently underrecognised presentations.
What Are the Symptoms of Headaches & Migraines?
Symptoms differ considerably between headache types. Recognising the pattern of your headaches is the first step towards effective treatment.
- Dull, aching pain or pressure across the forehead or sides of the head
- Sensation of tightness or a band around the head
- Tenderness in the scalp, neck, or shoulder muscles
- Bilateral (both sides) in most cases
- Mild to moderate intensity — does not usually prevent normal activity
- Not typically worsened by physical activity
- No nausea, vomiting, or light sensitivity in most cases
- Moderate to severe throbbing or pulsating pain, usually one-sided
- Nausea and/or vomiting
- Sensitivity to light (photophobia) and sound (phonophobia)
- Worsened by routine physical activity
- Aura in some people: visual disturbances, tingling, or speech changes lasting 20–60 minutes before headache
- Attack duration of 4–72 hours if untreated
- Significant impact on ability to function or work
Seek immediate medical attention if you experience a sudden, severe headache that reaches peak intensity within seconds (‘thunderclap’); a headache accompanied by fever, neck stiffness, or a rash; a new headache with weakness, slurred speech, or vision loss; a headache following a head injury; or a new or progressively worsening headache in someone over 50. These features may indicate a serious underlying condition requiring emergency assessment.
What Causes Headaches & Migraines?
Primary headaches arise from disturbances in brain chemistry, neural pathways, and muscle tension rather than from structural disease. Triggers are highly individual and understanding yours is key to effective management.
Emotional or physical stress is the most frequently reported trigger for tension-type headaches. Muscle tension in the neck and shoulders, driven by anxiety or prolonged strain, is thought to play a key role in generating the characteristic tightening pain.
Skipping meals causes blood glucose to drop, which can trigger headache and migraine in susceptible individuals. Dehydration, even mild, reduces blood volume and cerebral perfusion, both of which are well-established headache triggers.
Poor or insufficient sleep — as well as oversleeping — are common headache triggers. Migraines in particular are strongly associated with disrupted sleep patterns and changes to the normal sleep-wake cycle.
In migraines, hormonal fluctuations — particularly the drop in oestrogen before menstruation — are a potent trigger. Menstrual migraines affect approximately 60% of women with migraine and are often more severe and longer-lasting than non-menstrual attacks.
Taking pain-relieving medications (including paracetamol, ibuprofen, and triptans) on ten or more days per month can paradoxically cause Medication Overuse Headache (MOH), also known as rebound headache — a chronic daily headache that worsens when medication wears off.
Common migraine triggers include certain foods (aged cheese, processed meats, alcohol — particularly red wine), strong smells, bright or flickering lights, loud noise, and environmental changes such as weather pressure shifts. Triggers are highly individual and often cumulative.
Key Risk Factors
How Are Headaches & Migraines Diagnosed?
Most headache disorders are diagnosed clinically, based on a careful history of the headache pattern, associated symptoms, triggers, and response to treatment. Investigations are not routinely required for typical primary headaches but are essential when red flag features are present.
How Are Headaches & Migraines Treated?
Treatment depends on the type and frequency of headaches. Most people with infrequent tension headaches manage well with over-the-counter analgesics and lifestyle measures. Migraine requires a tailored approach combining effective acute treatment with preventive strategies if attacks are frequent or disabling.
Supportive Measures
Alongside medication, a number of supportive measures can reduce headache frequency and severity. During a migraine attack, resting in a quiet, dark room, applying a cold or warm compress to the head or neck, and staying hydrated can ease symptoms. Keeping a headache diary helps identify triggers and monitor treatment response. Regular meals, consistent sleep, adequate hydration, and stress management are the pillars of long-term headache prevention for most people.
Chronic Daily Headache & Medication Overuse
Chronic daily headache is defined as headache occurring on 15 or more days per month for more than three months. A significant proportion of cases are caused or perpetuated by medication overuse. If you are taking pain relief on more than ten days per month, this may be contributing to your headaches. Management involves supervised withdrawal of the overused medication — with temporary worsening expected — and introduction of appropriate preventive treatment. A clinician can guide you through this process safely.
When Should You Seek Medical Advice for Headaches?
You have a sudden, severe headache that peaks within seconds (‘thunderclap’) · Headache is accompanied by fever, neck stiffness, or a non-blanching rash · You develop new neurological symptoms: weakness, slurred speech, or vision loss · Headache follows a significant head injury · You have a seizure associated with headache.
Your headaches are new, have changed significantly in character, or are progressively worsening · Headaches are not responding to over-the-counter treatment after several episodes · You are having four or more migraine days per month and wish to discuss preventive treatment · You suspect medication overuse headache · You have a new headache and are over 50 years old · Headaches are significantly affecting your ability to work or carry out daily life.
How Can You Prevent Headaches & Migraines?
While not all headaches can be prevented, identifying personal triggers and making consistent lifestyle adjustments can significantly reduce the frequency and severity of both tension headaches and migraines.
Keeping a headache diary — recording date, duration, severity, potential triggers, and medication taken — helps identify personal patterns and triggers, and is invaluable when discussing treatment options with a clinician.
Drinking adequate water throughout the day is one of the simplest and most effective ways to reduce headache frequency. Aim for six to eight glasses per day, increasing intake in hot weather or during exercise.
Going to bed and waking at the same time every day — including weekends — stabilises circadian rhythms and significantly reduces migraine and tension headache frequency in many people.
Eating regular meals prevents blood sugar dips that trigger headaches. Identifying and avoiding personal dietary triggers — such as alcohol, caffeine, aged cheese, or processed meats — can meaningfully reduce migraine frequency.
Stress management techniques including mindfulness, progressive muscle relaxation, and regular physical activity reduce the frequency of tension-type headaches and migraines. Even a 30-minute walk most days has evidence behind it.
Limiting analgesic use to no more than two days per week prevents Medication Overuse Headache (MOH), one of the most common and underrecognised causes of daily or near-daily headache.
Speak to a Clinician About Headaches and Migraines
Living with frequent headaches or migraines does not have to be the norm. Through The GP Service, you can consult with a licensed clinician in minutes — from home, on your lunch break, or wherever works for you. Whether you need a triptan prescription, preventive medication, or simply a clear diagnosis, a clinician can help.
Expert clinical advice, when you need it.
Headaches & Migraines FAQs
The most common types are tension-type headache, which produces a bilateral pressing or tightening pain of mild-to-moderate intensity, and migraine, which typically causes unilateral throbbing pain of moderate-to-severe intensity accompanied by nausea and sensitivity to light and sound. Other types include cluster headache (extremely severe, short-duration pain around one eye), cervicogenic headache (originating from the neck), and medication overuse headache. A clinician can help identify the type based on your symptom pattern.
Migraine is a neurological condition characterised by recurrent attacks of moderate-to-severe headache, typically one-sided and throbbing, lasting 4–72 hours and accompanied by nausea, light sensitivity, and sound sensitivity. Around one in three people with migraine also experience aura — temporary neurological symptoms such as visual disturbances, tingling, or speech changes that precede the headache. Migraine is significantly underdiagnosed and undertreated; effective acute and preventive treatments are available.
Triptans are a class of prescription medications specifically designed to treat migraine. They work by stimulating serotonin receptors, causing blood vessel constriction and blocking pain pathways in the brain. They are most effective when taken at the first sign of migraine headache (not during the aura). Common triptans include sumatriptan, rizatriptan, and zolmitriptan, available as tablets, nasal sprays, or injections. A clinician can prescribe the most suitable option for you.
Preventive treatment is worth considering if you experience four or more migraine days per month, if attacks are severely disabling, if acute treatments are insufficient or overused, or if you are having to miss work or significant activities regularly. Options include propranolol, topiramate, amitriptyline, and — for those who have not responded to other treatments — CGRP monoclonal antibodies such as erenumab. A clinician can assess whether preventive treatment is appropriate for you.
Medication Overuse Headache (MOH) occurs when pain-relieving medications — including paracetamol, NSAIDs, and triptans — are used on ten or more days per month. The brain becomes sensitised and begins generating a headache as the medication wears off. MOH is treated by gradually withdrawing the overused medication, which typically causes a temporary worsening before improvement. A clinician can support you through this process and prescribe preventive treatment if appropriate.
Menstrual migraines — attacks that occur in the two days before or three days after the start of menstruation — are driven by the drop in oestrogen that accompanies menstruation. They tend to be more severe, longer-lasting, and more resistant to treatment than non-menstrual migraines. Management options include taking a triptan or NSAID around the time of menstruation (short-term prevention), or hormonal approaches such as continuous combined contraception or oestrogen patches. A clinician can advise on the most appropriate strategy.
Most headaches, including tension headaches and migraines, do not require brain imaging. However, imaging is indicated when red flag features are present — such as a sudden-onset severe headache, headache with fever and neck stiffness, new headache after age 50, progressive worsening headache, headache associated with neurological symptoms, or headache following head injury. If any of these apply to you, seek prompt clinical assessment.
A sudden, severe headache that reaches maximum intensity within seconds to minutes — sometimes described as a thunderclap or ‘the worst headache of my life’ — requires immediate emergency assessment. It may indicate a subarachnoid haemorrhage (bleeding around the brain), which is a medical emergency. Other red flags include headache with fever and neck stiffness (possible meningitis), headache with confusion or loss of consciousness, and headache with new neurological symptoms such as weakness, slurred speech, or vision loss.