A headache is pain or discomfort in the head or face, which can manifest as throbbing, constant, sharp, or dull pressure. Headaches vary in location, intensity, and frequency. While most headaches are not dangerous, noting where the pain occurs can offer clues about its potential cause, though location is just one piece of the puzzle.
Headaches in the Frontal Area
Headaches in the forehead, temples, or around the eyes are common. Tension headaches often feel like a band-like pressure across the forehead and temples, with a dull, aching sensation. These are the most common type of headache and are often linked to stress, anxiety, or muscle strain in the neck and shoulders.
Sinus headaches involve pressure and pain around the eyes, nose, and cheekbones, often worsening when bending forward or lying down. This pain arises from inflammation and congestion within the sinus passages, triggered by infections like colds or the flu, or by seasonal allergies. True sinus headaches are rare, and their symptoms can sometimes be mistaken for migraines.
Cluster headaches, while less common, cause intense, piercing or burning pain, frequently concentrated around one eye or temple. These severe headaches often appear suddenly and are accompanied by other symptoms on the affected side, such as eye tearing, eye redness, a drooping eyelid, or a stuffy or runny nose.
Headaches on One Side
Headaches affecting one side of the head can point to specific conditions, with migraines being a frequent cause. Migraine attacks are characterized by moderate to severe throbbing or pulsating pain, often localized to one side, though they can occur on both. This pain can worsen with physical activity and is commonly accompanied by sensitivity to light, sound, or smells, as well as nausea or vomiting.
Cluster headaches also cause severe, sharp pain on one side of the head, often around the eye, and can spread to other areas of the face or neck. These attacks usually last from 15 minutes to three hours and may occur multiple times a day during a “cluster period” lasting weeks to months.
Hemicrania continua is a rare disorder causing continuous, one-sided head pain, often for at least three months. The pain’s intensity can vary, with periods of increased severity. Patients may also experience tearing or redness of the eye, nasal congestion, or a drooping eyelid on the affected side.
Headaches in the Back of the Head or Neck
Pain in the back of the head or radiating from the neck can indicate several headache types. Tension headaches can manifest in this region, causing a dull ache or tightness across the back of the head and neck, often associated with muscle tension and stress. This pain is mild to moderate and may be accompanied by tenderness in the scalp, neck, and shoulder muscles.
Cervicogenic headaches originate from issues in the neck, such as muscle spasms, arthritis, or a pinched nerve, then refer pain to the head. This pain often starts in the neck and radiates upwards to the back of the head, potentially extending to the forehead or around the eyes. Movement of the neck can worsen the headache, and there may be a reduced range of motion in the neck.
Occipital neuralgia involves sharp, shooting, or shock-like pain in the upper neck, back of the head, or behind the ears, caused by irritation or injury to the occipital nerves. This pain can be continuous with intermittent severe spasms, and even light touch, like brushing hair, can trigger a painful episode. The scalp may also be tender to the touch, and sensitivity to light can occur.
Headaches Affecting the Entire Head
Headaches affecting the entire head are common and can arise from various non-specific causes. Tension headaches often present as a dull, aching, or squeezing sensation. These can be triggered by factors like stress, fatigue, or eye strain.
Other common causes for generalized head pain include dehydration, fever, or general illness. While the pain is widespread, accompanying symptoms like a stuffy nose, sore throat, or fatigue are often present and provide more specific clues about the underlying cause.
When to Seek Medical Attention
Certain headache symptoms warrant immediate medical evaluation, regardless of where the pain is located. A sudden, severe headache, often described as the “worst headache of your life” or a “thunderclap headache” that reaches maximum intensity within a minute, can signal serious conditions like bleeding in the brain and requires urgent medical attention.
Headaches accompanied by specific neurological symptoms also require prompt medical care. These include changes in vision such as blurred vision, double vision, or blind spots, as well as speech difficulties, weakness, numbness, or loss of consciousness. Confusion, seizures, or problems with balance and coordination alongside a headache also need immediate medical attention.
Other red flags include a headache occurring after a head injury, especially if it worsens, or a headache accompanied by a high fever and stiff neck, which could indicate meningitis. Any new headache in an older adult, or a headache that progressively worsens over time or significantly interferes with daily life, should also be evaluated by a healthcare professional.