The location of head pain is often the first clue used to understand the type of headache being experienced. While location provides strong indications, it is important to remember that it is not a definitive diagnosis. Different headache disorders can have overlapping pain patterns. The true nature of the headache is confirmed by combining the pain’s location with its quality, intensity, and accompanying symptoms, which helps determine if medical evaluation is necessary.
Bilateral Pressure and Band-like Pain
The most common type of head pain is typically identified as a dull, non-pulsating ache that affects both sides of the head. This sensation is often described as feeling like a tight band or vice is squeezing the scalp and forehead. The discomfort can also radiate to the temples, the back of the head, or the neck muscles, indicating a tension-type headache.
The pain associated with this common headache is generally mild to moderate in intensity and does not worsen with routine physical activity, such as walking or climbing stairs. Unlike more severe headache disorders, tension-type headaches rarely cause nausea or vomiting. Their primary cause is thought to be related to muscle tension in the head and neck, often triggered by emotional stress, fatigue, or holding a strained posture for long periods.
A lack of significant sensitivity to light (photophobia) or sound (phonophobia) is a key diagnostic feature. The duration of these episodes is highly variable, potentially lasting from 30 minutes up to several days. This pattern of bilateral, pressing pain helps distinguish tension headaches from other types.
One-Sided Throbbing and Sensitivity
Head pain described as a throbbing or pulsating sensation, typically moderate to severe in intensity, frequently points to a migraine. The pain is classic for its unilateral presentation, affecting only one side of the head, though it can sometimes shift sides or involve both. This intense discomfort is considered a complex neurological event.
The distinguishing features of a migraine are the associated neurological symptoms that accompany the head pain. Attacks are often debilitating and are usually accompanied by nausea, sometimes leading to vomiting, and an extreme sensitivity to light (photophobia) and sound (phonophobia). Many individuals seek out a dark, quiet room to cope with the pain and heightened sensory input.
About one-quarter of people who experience migraines also report an aura, which is a temporary, reversible neurological symptom that occurs just before or during the headache phase. These auras most commonly involve visual disturbances, such as seeing flashing lights, zigzag lines, or experiencing blind spots. The pain is aggravated by routine physical exertion, reflecting the systemic nature of the neurological condition.
Intense Pain Behind the Eye or Across the Face
Pain concentrated around the eye or across the cheeks can signal different types of headaches. Excruciating, sharp, and stabbing pain focused around or behind one eye, often extending to the temple, is the hallmark of a cluster headache. This is recognized as one of the most severe forms of pain a person can experience.
Cluster headaches are short-lived, typically lasting between 15 minutes and three hours, but they occur in groups or “clusters” over a period of weeks or months. The pain is so severe that individuals often feel restless and unable to lie down. These attacks also feature distinctive symptoms on the same side as the pain, such as a drooping eyelid, a small pupil, tearing of the eye, and a stuffy or runny nostril.
In contrast, a duller, continuous pain felt as pressure across the forehead, cheeks, and the bridge of the nose is characteristic of a sinus headache. This facial pressure is caused by inflammation and congestion of the sinus cavities. Unlike cluster or migraine pain, sinus headache discomfort is almost always accompanied by symptoms of a sinus infection or allergy, such as nasal discharge, congestion, or fever.
When to Seek Immediate Medical Attention
Certain symptoms and pain characteristics require immediate medical attention to rule out a serious underlying condition. The most alarming symptom is the sudden onset of the worst pain ever experienced, often described as a “thunderclap” headache. This pain reaches peak intensity within seconds to minutes and can signal a life-threatening event, such as a hemorrhage in the brain.
Any headache accompanied by new neurological symptoms also warrants urgent evaluation. These deficits include confusion, difficulty speaking, weakness or numbness on one side of the body, or new visual changes like double vision. Immediate attention is also required for a headache that occurs alongside a high fever, a stiff neck (nuchal rigidity), or that begins following a head injury, or if a new type of headache develops in a person over the age of 50.