A Lexapro headache typically feels like a dull, persistent pressure across the forehead or temples, similar to a tension headache. It’s one of the most common side effects of the medication, affecting about 24% of people in clinical trials compared to 17% on placebo. For most people, these headaches show up within the first few days of starting the medication and fade within two weeks as the body adjusts.
How It Feels and Why It Happens
Most people describe a Lexapro headache as a steady, low-grade ache rather than a sharp or throbbing pain. It tends to settle around the forehead, behind the eyes, or across both temples. The sensation is closer to a tension headache than a migraine. You’re unlikely to experience the light sensitivity, nausea, or one-sided pain that comes with migraines, though some people do report mild dizziness alongside the headache.
The headache is a direct result of how Lexapro changes serotonin levels in the brain. Serotonin affects blood vessel tone throughout the body, including in the head. It causes larger arteries in the brain to constrict while smaller vessels dilate. This shift in blood flow, happening as your brain adjusts to higher serotonin availability, creates that pressure-like headache sensation. Think of it as your vascular system recalibrating. Once serotonin levels stabilize, the blood vessels settle into a new normal and the headaches typically stop.
When It Starts and How Long It Lasts
Lexapro headaches most commonly appear within the first few days of treatment. Some people notice them within hours of the first dose, while others don’t feel anything until day two or three. The headaches tend to be worst during the first week, when serotonin levels are shifting the most.
For the majority of people, these headaches resolve within the first two weeks. If your doctor increases your dose at any point, you may experience a brief return of headaches as your body adjusts again. The same pattern applies: a few days of discomfort that gradually fades. Headaches that persist beyond three or four weeks are less common and worth mentioning to your prescriber, since they may indicate the need for a dose adjustment.
Managing the Pain
Acetaminophen (Tylenol) is generally the simplest option for treating a Lexapro headache. It works well for the kind of dull, steady pain most people experience, and it doesn’t carry the interaction risks that some other pain relievers do.
Ibuprofen (Advil, Motrin) is worth being more cautious about. SSRIs like Lexapro already affect how platelets function, and ibuprofen adds to that effect, which can increase the risk of bleeding, particularly in the stomach lining. If you take ibuprofen occasionally for a stubborn headache, the risk is low for most people. But reaching for it daily during the adjustment period isn’t ideal. Ibuprofen can also cause stomach irritation on its own, which stacks on top of the nausea some people already experience when starting Lexapro.
Beyond medication, staying well hydrated makes a noticeable difference. Serotonin changes can subtly affect fluid balance, and even mild dehydration amplifies headache intensity. Drinking water consistently throughout the day, rather than catching up all at once, helps keep things steady. Some people also find that taking their dose at bedtime rather than in the morning lets them sleep through the worst of the headache, waking up with only mild residual pressure.
When a Headache Signals Something Else
In rare cases, a headache while taking Lexapro can be a sign of low blood sodium, a condition called hyponatremia. This is more common in older adults, people taking blood pressure medications that act as diuretics, or anyone who has been vomiting or dealing with severe diarrhea (both of which deplete fluids and electrolytes).
The key difference is in the accompanying symptoms. A typical Lexapro adjustment headache is just a headache, maybe with some mild fatigue or dizziness. A headache from low sodium comes with confusion, difficulty concentrating, memory problems, or feeling physically unsteady on your feet. If your headache is paired with any of those symptoms, that’s a different situation that needs medical attention promptly.
Headaches When Stopping Lexapro
Headaches can also appear when you stop taking Lexapro or reduce your dose too quickly. Withdrawal headaches feel similar to the startup headaches, that same dull, pressured sensation, but they can sometimes be more intense and last longer if the taper is abrupt. Current guidance favors a slow, gradual taper over weeks or even months rather than the faster reductions that used to be standard practice. A longer taper gives serotonin levels time to readjust without the sharp drops that trigger withdrawal symptoms.
During a taper, the same self-care strategies help: consistent hydration, regular sleep, light exercise, and a balanced diet. These won’t eliminate withdrawal headaches entirely, but they reduce their severity and duration.