headache

and Sabine Schrör, medical journalist

Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

Headache (medical: cephalgia) is the second most common form of pain after back pain. Both children and adults can suffer from it. Most headaches are only temporary and harmless. Then home remedies or simple pain relievers can help relieve the symptoms. Migraines and severe chronic headaches, on the other hand, require special therapy. The same is true if the headache is a symptom of a serious illness. Read everything you need to know about headaches here.

Brief overview

Description: Pain of different degrees (standing, drilling, etc.) and localization (e.g. unilateral, bilateral, forehead area). A total of more than 220 different types of headache, e.g. tension headache, migraine.
Causes: Primary headache: no recognizable cause, but triggers such as stress, lack of fluids, work at the screen, smoking. Secondary headaches: from high blood pressure, viral infections, sinus infections, strokes, head injuries, medication, drug withdrawal.
When to the doctor in the case of headaches that occur in children, pregnant women or after head injuries that recur for weeks or are accompanied by nausea, vomiting, fever or stiff neck. In the event of sudden, severe headaches or accompanying symptoms such as confusion, impaired vision, hearing, speech or consciousness, call a doctor or an emergency doctor immediately!
Diagnostics: Collection of the medical history, physical and neurological examination, possibly blood tests, imaging examinations (such as X-rays), examination of the nerve water (lumbar puncture), examinations by an eye, dental or ENT doctor
Treatment: depending on the type and severity of the headache, e.g. reducing stress, exercise, medication (such as pain relievers), home remedies and complementary procedures (such as peppermint oil, homeopathy, acupuncture), psychoanalysis or psychotherapeutic treatment
Prevention: adequate sleep, a healthy diet, plenty of drinking, avoiding alcohol and nicotine, constant caffeine consumption, regular exercise, office gymnastics, relaxation exercises

Headache: description

Headaches can start slowly or suddenly. They can be dull or piercing, very intense or barely noticeable. Almost no one is spared from them, most people suffer from them once or several times a year.

Overall, women are slightly more likely to experience headaches than men. But there are differences: While women suffer from migraines more often, men are more likely to experience so-called cluster headaches. Children can also develop headaches and migraines. However, the number of cases decreases with increasing age: Statistically speaking, anyone older than 45 suffers fewer headache attacks.

Headaches are divided into two groups: Primary headaches have no identifiable cause and form an independent clinical picture. Secondary headaches, on the other hand, are based on a different disease.

220 different types of headaches

90 percent of all people with headaches suffer from tension headaches. The second most common form of headache is migraine. Both forms are among the primary headaches. Secondary headaches occur much less frequently. Causes for this are, for example, drug side effects, excessive drug consumption, illnesses or injuries. The international classification distinguishes over 220 types of headache, most of which are related to a specific underlying disease.

Tension headache

These are occasional, mild to moderate headaches. They are probably due to a disturbed pain inhibition that can occur after an irritation. The intensity of tension headaches increases slowly. The pain occurs on both halves of the head, but often only affects certain regions such as the forehead, temples or crown of the head.

Tension headaches are dull and press on the brain like an over-tight helmet. Side effects are rare. The pain lasts between half an hour and a few days. Chronic tension headaches are when the pain occurs for at least ten days a month. They are rare.

migraine

Migraines afflict those affected on average one to six times a month. A single migraine attack usually lasts 4 to 72 hours. It gradually begins with a mostly one-sided headache. However, this can also change the half of the head or develop later on both sides.

Migraine pain is described as pulsating and is usually moderate to severe. The clinical picture always includes side effects such as nausea, vomiting, noise or light sensitivity. Between 10 and 15 percent of all migraine patients experience a so-called aura before a pain attack, which can be accompanied by visual disturbances such as flickering in front of the eyes, tingling in the arms and legs, and difficulty finding words.

Migraines and tension headaches can occur in combination.

Drug-induced headache

Those who take certain medications too often, especially pain relievers, are prone to headaches. This so-called drug-induced pain increases over time to moderate to severe, dull complaints that occur on both sides. Nausea or vomiting rarely occurs.

The pain always occurs after the person has taken medication. A vicious circle often develops: For fear of pain, painkillers are swallowed, which then cause the headache. Those affected then often increase the dose. Other drugs, for example some antihypertensive drugs, can also trigger headaches (nitrate headaches).

Cluster headache

Cluster headaches are very severe headaches that start unilateral and stabbing behind the eye. Most of the time, the affected eye is watering, the eyelid reddening, swelling and the nose is blocked.

Cluster headaches often occur several times a day and then go away for months. The pain increases to its maximum within a few minutes and usually lasts between 15 minutes and three hours.

Although the cause of these headaches is unclear, for some people alcohol, cigarette smoke, or flickering lights seem to trigger the seizures. Overall, cluster headaches are rare compared to tension headaches and migraines.

The different types of headaches

Headache occurs in different places. The localization and the nature of the pain provide information about the type of headache.

Concomitant symptoms of a headache

Nausea, nausea, vomiting, noise and light sensitivity can accompany headaches as well as visual disturbances or depression. These side effects as well as the location, type and duration of the headache give the doctor initial indications of the cause or trigger of the symptoms.

Headache: causes

Exactly how headaches arise has not been clearly clarified, despite intensive research. It is assumed that the processes of pain development, transmission and inhibition are disrupted.

Primary headaches have no identifiable cause. However, they can be triggered by various factors, for example:

stress
Dehydration
poorly ventilated rooms
Screen work
Weather change
Lack of sleep and irregular sleep
smoking
alcohol
In women: hormone fluctuations during the cycle

Secondary headaches, on the other hand, can always be traced back to an illness or external influences. The most common causes include:

Head and cervical spine injuries, e.g. B. Skull trauma
Inflammations: meningitis (meningitis), inflammation of the brain (encephalitis), temporal arteritis (inflammation of the temporal arteries), sinusitis (sinusitis), tooth root inflammation
Viral infections like flu
decreased ability of the blood to absorb oxygen, for example in the case of severe bronchial asthma, COPD, chronic bronchitis
high blood pressure
Herniated disc in the cervical spine
Tension of the neck muscles
Hypoglycaemia in diabetes
Trigeminal neuralgia, Costen's syndrome
heatstroke
Acute glaucoma (attack of glaucoma)
Brain aneurysm (abnormal expansion of the wall of a cerebral artery)
Stroke (ischemic stroke or cerebral haemorrhage)
Brain tumor
Pseudo-allergy due to the consumption of certain foods, such as glutamate ("China restaurant syndrome")
certain medications like nitrates, estrogens for contraception; frequent use of pain medication
drug withdrawal

Brain tumors are extremely rarely responsible for headaches. Even the most severe headaches usually have harmless triggers. In addition, there are usually numerous additional complaints with brain tumors.

Headache: when do you need to see a doctor?

If you rarely suffer from headaches, if they are tolerable and do not last long, home remedies or light pain relievers usually help. You should consult a doctor

if the headache keeps coming back for weeks and months

if the pain develops after a head injury or occurs one or more days after a concussion
when nausea and vomiting are added
if fever and / or a stiff neck accompanies the pain

Sudden, very severe headaches can be a warning sign of an acute, life-threatening process in the brain - especially in connection with other symptoms such as visual, hearing or speech disorders, motor failures, confusion, clouding of consciousness or loss of consciousness. Then call the emergency doctor immediately!

Headache in children

Children and adolescents suffer from headaches just as often as adults. Most of them are also harmless tension headaches or migraines. However, since children are often more difficult to assess and describe pain, it is advisable to always have headaches in children clarified by a doctor. This is especially true if they occur regularly.

Headache in pregnancy

Migraines are less common during pregnancy. In the last two trimesters in particular, pregnant migraineurs struggle with chronic headaches much less often. The situation is different at the beginning of pregnancy: Hormonal changes in the first few months increase the susceptibility to simple headache attacks.

You should discuss with your doctor whether pain medication is allowed so as not to endanger your child. The active ingredient paracetamol is most often used for headaches during pregnancy. Acetylsalicylic acid (ASA), ibuprofen, diclofenac and other so-called NSAIDs, on the other hand, should not be taken by pregnant women.

Effective and safe help are tried and tested home remedies for headaches, for example a peppermint oil for dabbing the temples, relaxation exercises and light movement in the fresh air.

Very rarely are more serious complications such as preeclampsia (pregnancy poisoning) behind headaches during pregnancy. When in doubt, you should always seek advice from your doctor.

Headache: Treatment & Tips

Treatment depends on the type and severity of the headache. In principle, non-drug and drug therapies are available.

For secondary headaches, depending on the cause, other treatment methods may be useful, for example surgery for a brain aneurysm.

Headache medication

There are several medications that can be used for different types of headache.

Tension headache medication

The following remedies can relieve tension headaches:

Acetylsalicylic acid (ASA)
Ibuprofen
Naproxen
Paracetamol
Combination preparations made from acetylsalicylic acid, paracetamol and caffeine
Metamizole as a reserve drug (risk of agranulocytosis and thus massive immune deficiency)

Ask your doctor or pharmacist for advice on the selection and dosage of a suitable pain reliever. Also ask about possible side effects and interactions with other medications you may be taking.

Do not take pain medication for more than three consecutive days and a maximum of 10 days a month. Those who take too much pain medication can become addicted and increase the risk of drug-induced headaches.

To prevent addiction to pain medication, the doctor may prescribe so-called tricyclic antidepressants. They raise the pain threshold. However, the preventive medication often takes four to six weeks to take effect.

Medicines for migraines

The following remedies can help with mild migraines:

Acetylsalicylic acid (ASA)
Ibuprofen
Paracetamol
Diclofenac
Combination preparations made from acetylsalicylic acid, ibuprofen or paracetamol and caffeine
Antiemetics for nausea

Severe migraine attacks are often treated with so-called triptans in tablet form, as a nasal spray or injection. Alternatively, the doctor may prescribe lysine acetyl salicylate (ASA lysinate) as an injection.

Beta blockers such as metoprolol, propanolol or flunarizine are used as migraine prophylaxis (these are also used for high blood pressure). This prophylaxis is useful if migraine attacks occur more than three times a month, cannot be effectively treated, the attacks last a long time and if pain medication is withdrawn.

Cluster headache medication

For extreme cluster headaches, the doctor can also prescribe triptans. Acute attacks can also be interrupted by inhaling pure oxygen. For some patients, it also helps to spray a local anesthetic into the nostril on the affected side.

Injections with botulinum toxin (botulinum neurotoxin, botox)

Botox injections can help in severely affected migraine patients. For this purpose, botox injections are injected at various points in the head, neck and shoulder area. Botox is a powerful neurotoxin that paralyzes the nerves and can thus counteract tension. This can reduce the severity and number of migraine attacks. The syringes need to be refreshed regularly, as Botox is gradually broken down by the body.

Special case drug headache

Painkillers can't just relieve pain. Taking too many too often can cause headaches. The only way to stop them is through withdrawal. This can take place on an outpatient, partial inpatient basis (day clinic) or inpatient (e.g. in a pain clinic). Under no circumstances should those affected attempt withdrawal on their own - medical help is essential here and makes weaning easier.

Non-drug treatment

There are several ways to counteract headache without medication. Above all, these measures have a preventive effect: They can reduce the number and frequency of headache attacks.

Relaxation against headaches

Headaches are often stress-related. If you suffer from it frequently, you should learn a relaxation technique. Practiced regularly, this can reduce the number and severity of headache days. Suitable relaxation methods are, for example

Autogenic training
Progressive Muscle Relaxation
Mediation
Tai chi
Chi-gong

Biofeedback against migraines

Biofeedback can do a lot with migraines. With the help of a computer program that maps the brain waves, the patient learns to influence them at will. Children in particular respond very well to this non-drug procedure.

Acupuncture for headaches

If you have frequent tension headaches, you can try acupuncture. To do this, the acupuncturist inserts needles into certain acupuncture points. A large overview study by the renowned Cochrane Institute shows that acupuncture treatment with at least six treatment sessions offers a good chance of permanent relief.

Manual therapy and chiropractic therapy

It is believed that tension and blockages in the musculoskeletal system can cause tension headaches. In such cases, the physiotherapist can use mobilization techniques and special hand movements to loosen the muscles and release blockages.

Chirotherapy, which is one of the alternative medical forms of treatment, also has this goal. Above all, it removes blockages in the spine. Whether the method actually helps against headaches has not yet been clearly proven. Larger overview studies came to contradicting results.

Sports

Exercise also has a clearly positive effect on the strength, frequency and duration of headache attacks. This applies to tension headaches as well as migraines. The reason: whoever moves, breaks down stress hormones. As the tension subsides, headaches are less likely to occur. Endurance sports in particular have proven their worth.

Homeopathy for headaches

Some patients also swear by homeopathy to relieve their headaches. Exactly which globules you should take should depend on the exact form and cause of the pain, e.g. whether left or right, after alcohol consumption or too much sun. However, there is no scientific evidence that homeopathy can treat headaches.

Transcutaneous Electrical Nerve Stimulation (TENS)

Transcutaneous Electrical Nerve Stimulation (TENS) is also used to treat headaches. For this purpose, electrodes are stuck to certain areas of the skin, through which a weak current is conducted into the body. The procedure is gentle and inexpensive, and side effects are not to be expected. However, the effectiveness of the method has not yet been confirmed in studies.

Psychotherapy for headaches

Psychological factors often play a central role in the development, but also in maintaining tension headaches and migraines. Behavioral therapy measures aimed at dealing with stress in a healthier way, for example, can then significantly alleviate the severity and frequency of the attacks.

Headache diary / headache calendar

If you have frequent headaches or are affected by migraines, you can keep a pain diary. There you write down when the pain started and how long it lasted. You can also record possible triggers such as food, stress, weather and possibly the stage of the cycle. You should also note any accompanying symptoms and medication you have taken.

You may already be able to deduce the type of headache and possible triggers from the recordings. The headache diary makes diagnosis easier for your doctor and helps him find the right treatment for the headache.

Home remedies for headaches

A pain reliever doesn't always have to be used for headaches - home remedies can also help. But what really helps against headaches?

Drinking plenty of fluids is already an effective measure against headaches. If that's not enough, treatments with essential oils, cold, and even teas are effective. Read the best headache tips.

Cold for headache

Many patients find the cold to be soothing. Therefore, various cooling home remedies work against headaches.

Cool compresses on the forehead and neck can calm the overstimulated brain and are therefore a suitable home remedy for headaches. But other compresses also help against headaches. Are suitable:

Cool forehead compress

A cooling forehead compress dissipates heat and so relieves headaches. The home remedy is easy to use: put a cloth or washcloth in cold water, wring it out and place it on your forehead. Cover with a second cloth and let it work for as long as the cold is pleasant. A forehead compress can be used as often as you like.

Calf wrap

Calf compresses can also help against headaches - especially if they are a side effect of a febrile infection. Dip two cotton towels in cool (not ice-cold!) Water, wring them out and place them around the patient's calves. Cover with a dry cloth and let it work for about ten minutes.

You can read more about the correct application in the article Leg wrap.

Pulse wrap

Pulse wraps work in the same way. Place four thin strips of cotton cloth in lukewarm water. The water temperature for infants should be a maximum of five degrees Celsius below the measured body temperature, for older children it can be a little cooler.

Wring out the soaked strips, wrap them around the pulse points on the wrists and ankles and cover each with a dry towel. Let it work for ten minutes, then renew it twice (in total, apply the pulse wraps three times).

You can find more information about wraps and their application in the article Wraps (envelopes) and pads.

Cold grain pillow

A cold grain pillow (cherry stone pillow) on the forehead and neck is also suitable for headaches. It cools for a long time and continuously. Put the pillow in a plastic bag and place in the freezer for an hour. Then lay it on your forehead and let it work as long as the cold is pleasant.

Cold casts

You can also use cold sprays on the arms or legs or on the face as a home remedy for headaches.

Arm and leg casts

Cold rushes on the arms and legs stimulate the circulation and blood flow and can relieve headaches. The best water temperature is around 18 degrees.

Start with the water jet in the shower or bathtub on the hand or foot and slowly move the water jet on the outside of the arm or leg up to the shoulder or knee. Linger there briefly and walk on the inside with the water jet towards your hand or foot. Then wipe off the water (do not dry it off). You can do cold casts once a day.

Facial cast

To do this, with the upper body bent forward, allow water at about 18 degrees Celsius to flow over the right temple, the forehead, the left temple and then back again. Then move the right and left half of the face up and down three times with the water jet. At the end, circle the face three times. Then wipe off the water or dab lightly, do not dry off.

You can find out more about the treatments in the article hydrotherapy.

Essential oils relieve headaches

Various essential oils are quick relief from headaches.

Invigorating and cooling oils from peppermint, lavender, rosemary or tea tree can dispel headaches.

Forehead rubbing

Rubbing in the forehead with diluted lavender, tea tree or peppermint oil has a relaxing effect and can relieve headaches, among other things. To do this, rub the forehead (and possibly temples and neck) gently with a few drops of diluted oil. It is best to rest afterwards.

Foot rub

A foot rub with diluted lavender or rosemary oil promotes restful sleep, relaxes, warms cold feet and can also relieve headaches. To do this, warm a few drops of oil in your hands and then gently rub the foot from the ankle to the toe for three to five minutes. Do not apply too much pressure.Perform once or twice a day, preferably after waking up or before going to bed.

The essential oil must not get in the eyes or on the mucous membranes. Essential oils are also not suitable for babies and children, they can even be dangerous for them!

Horseradish topping

Another home remedy for headaches is a horseradish topping. To do this, place a tablespoon of freshly grated horseradish on a gauze compress. Wrap the compress in and seal it. Place the horseradish toppings on the forehead or on the cart for a few seconds to a maximum of four minutes.

Then rub the reddened skin area with vegetable oil (e.g. olive oil) and rest for 30 minutes to an hour. You should only do a horseradish topping once a day.

The ingredients can irritate the mucous membranes. Therefore cover your eyes with petroleum jelly and cotton pads.

Mustard flour foot bath

A mustard meal foot bath can also help relieve headaches.

You can read how to use the foot bath correctly in the medicinal plants article mustard.

Coffee and tea for headaches

What else can you do about a headache? In some cases, having a cup of coffee can help relieve headaches. The contained caffeine stimulates the circulation, dilates the vessels in the brain and thereby increases the blood flow. That will ease the pain. Strong coffees such as mocha or espresso in particular should help. Coffee with a squirt of lemon can also ease the pain.

What else can you do against a headache? Tea can also have a relieving effect on headaches. Black tea also contains caffeine and thereby dilates the narrowed blood vessels in the brain.

Melissa tea

Lemon balm tea can also be used as a home remedy for headaches. To do this, pour 150 milliliters of hot water over 1.5 to 4.5 grams (corresponds to about three to seven teaspoons) of the dried leaves (loose or in the form of tea bags). Let the infusion steep for ten to 15 minutes and then strain the parts of the plant. You can drink a cup of lemon balm tea two to three times a day.

Does sex help against headaches?

It is not a classic home remedy, but sexual activity - whether with a partner or alone - can relieve headaches in individual cases. At least that applies to migraines and cluster headaches. This was the result of a study by the University of Münster.

About 60 percent of the migraine patients surveyed found the pain less severe after sexual activity. Traffic also affected 37 percent of those with cluster headaches. However, sex was not all positive. In other patients, the headache subsequently worsened.

Headache: diagnosis

To clarify the type of headache, the doctor will first ask you about your medical history (anamnesis):

Where exactly is the pain localized?
How does the pain feel and how intense is the discomfort?
How often does the headache occur and how long does it last?
Do you know possible triggers, e.g. B. Accident, stress, intense physical exertion or sensitivity to the weather?
What diseases and family history are there?
What medications (painkillers, etc.) are you taking?

If you keep a headache diary (see above), the included notes can also provide valuable information about your medical history.

A general physical exam follows after taking the medical history. For example, the doctor can measure your pulse and blood pressure and listen to your lungs and heart. A neurological examination is also useful, in which the reflexes, the sensitivity to stimuli and the ability to coordinate are checked. This can give clues to possible underlying illnesses as the cause of the headache.

The results of the anamnesis as well as physical and neurological examinations are often sufficient to clarify the type and trigger of the headache - especially in the case of tension headaches and migraines. Further examinations are rarely necessary, for example if there is a suspicion of a more serious underlying disease. For example, the following are used:

Blood tests
Ultrasound examination, especially of the neck organs and neck arteries
X-ray of the spine and skull (if injuries are suspected)
Magnetic resonance imaging (MRI)
Computed tomography (CT)
Electroencephalography (EEG)
Positron emission tomography (PET): a nuclear medicine method (examination using a weakly radioactive substance)
Lumbar puncture (extraction of spinal cord fluid) if inflammation of the nerves or meninges is suspected
Angiography (vascular imaging with contrast agent in the X-ray image) of the cerebral vessels for malformations, aneurysms and thromboses
further specialist examinations, for example eye examinations, ENT examinations or dental examinations

Preventing headaches

In many cases, you can prevent headaches from occurring in the first place with simple measures:

adequate sleep with constant bedtime
balanced and regular diet
Drink plenty of water, especially water, tea or juice spritzers
constant caffeine consumption
little alcohol
Refrain from nicotine
regular exercise in the fresh air
Endurance sports
Office gymnastics, five minutes several times a day
Stress reduction, for example with the help of relaxation techniques such as autogenic training or progressive muscle relaxation

You should also reduce other risk factors that experience has shown can cause you headaches, such as staying in stuffy or noisy rooms or consuming certain foods.

Additional information

Books:

Successful against headaches and migraines: Eliminate the causes, prevent them in a targeted manner, strategies for self-help by Hartmut Göbel, Springer
Headaches and migraines. The exercise book: Prevention, Relaxation, Pain Relief by Benjamin Schäfer, TRIAS