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Most headaches are harmless and pass. A few are not, and a few are being treated as the wrong thing entirely. This page helps you work out which kind you have — and which warning signs mean today rather than next week.
These do not mean something serious is happening. They mean it needs ruling out the same day rather than at a clinic appointment.
Four types account for most headaches seen in a specialist clinic. They are distinguishable at the bedside far more often than people expect, and the distinction decides the treatment.
| Tension | Migraine | Cluster | Cervicogenic | |
|---|---|---|---|---|
| Side | Both | Usually one, can swap | One, same side in a bout | One, always the same |
| Character | Tight band, pressing | Throbbing | Drilling, boring | Steady ache |
| How long | 30 min to days | 4 to 72 hours | 15 min to 3 hours | Hours to days |
| During it | Carries on | Wants to lie still, dark room | Cannot keep still, paces | Neck stiff, guarded |
| Eye and nose | — | — | Watering eye, drooping lid, blocked nostril | — |
| Set off by | Stress, fatigue | Sleep, food, hormones, light | Alcohol during a bout | Neck movement, posture |
If more than one column sounds like you, that is common — the types coexist, and a headache that has changed its pattern is worth reassessing rather than continuing to treat the same way.
Two separate routes carry pain to the head. The trigeminal nerve supplies the face, scalp and the structures around the eye. The nerves of the upper cervical spine, around C2–C3, supply the back of the head and neck.
They converge before reaching the brain. Because the signals arrive together, the brain cannot always tell which route a pain came down — which is how a neck problem is felt as a headache, and why treating the head alone sometimes changes nothing.
Establishing which pathway is involved is most of the diagnostic work, and it is what an examination is for.
The first division a specialist makes is not between types but between two categories:
Getting this division right matters more than naming the exact type, because it determines whether investigation is needed at all.
Referred from the neck. One-sided, provoked by neck movement or held posture, with a stiff neck alongside.
Migraine aura — visual disturbance, tingling, speech trouble — without the headache that usually follows.
Not a headache but frequently confused with one — sudden electric-shock pain in one side of the face, triggered by light touch or chewing.
Migraine affecting balance rather than the head. Vertigo lasting minutes to days, about half the time with no headache at all.
Headache on 15 or more days a month for over three months. Often requires unpicking what began it and what is now sustaining it.
Painkillers taken more than two or three days a week can begin causing the headaches they were treating. Common, and reversible.
Starting days after a head injury or concussion, often with dizziness and concentration difficulty.
Tied to the menstrual cycle, pregnancy, menopause, or hormonal medication. When it falls around a period it is often menstrual migraine.
Brought on by physical effort, straining or sex. Usually benign, but first presentations are investigated.
Deep constant pain across the cheeks, forehead or bridge of the nose, with genuine sinus symptoms. Frequently the label given to a migraine that is not one.
Follows a lumbar puncture or spinal anaesthetic. Characteristically worse upright and better lying flat.
Continuous one-sided headache on the same side throughout, with flare-ups. Responds to a specific medication, which is part of how it is identified.
Assessment begins with the history and a physical examination — what the headaches are like, how long they last, where exactly they sit, what brings them on, and what has already been tried. That is usually where the diagnosis is made.
Investigation is used where the pattern is unusual, has changed, or the examination raises a question:
A headache diary is worth more than most tests. Note when each headache starts, how long it lasts, where it sits, what you had done beforehand, and what you took. Two weeks of that tells a specialist more than a scan in most cases.
Treatment divides the same way the diagnosis does — stopping an attack, and reducing how often attacks happen. Prevention is where most of the gain is for anyone with frequent headaches, and it differs by type: what prevents one kind can cause another.
Where headaches have not responded to medication, treatment can be directed at the nerves carrying the pain — nerve blocks, pulsed radiofrequency and neuromodulation. Those options are the main practical difference between specialist management and a repeat prescription.
Primary headaches do not cause permanent harm, but frequent or severe ones are genuinely disabling while they last, and most are manageable once correctly identified. For secondary headaches the outlook depends entirely on the cause.
When they are frequent enough to interfere with work or sleep, when they have changed in pattern or severity, when painkillers have stopped working, or when you have been treating the same diagnosis for years without improvement.
Usually not. Most headaches are diagnosed from the history and examination. Imaging is used to answer a specific question, not as a routine first step.
Yes. Taken more than two or three days a week, ordinary painkillers can begin causing a dull daily headache that worsens as each dose wears off. It is common, often missed, and it improves once recognised.
Often not. Migraine frequently produces facial pain and nasal symptoms and is regularly labelled sinus headache. Genuine sinus headache usually comes with fever and infected discharge.
No. You can book directly. Bring any scans and reports you have, and a record of your headaches if you have been keeping one.
Migraine · Silent migraine · Vestibular migraine · Trigeminal neuralgia · Tension headache · Cluster headache · Cervicogenic headache · Dizziness and vertigo · Concussion · Brain aneurysm · Neuromodulation
Bring your headache diary if you have one. You will leave knowing which type you have and what can be done about it.
