Headaches
Almost everyone gets headaches, and most of the time the reason has nothing to do with the brain: too little sleep, a missed meal, not enough to drink, a…
Prescription review online
A doctor will review your case and issue a prescription if medically appropriate.
Talk to a doctor online
Discuss your symptoms and possible next steps with a doctor online.
On this page
Medicines commonly prescribed for Headaches
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: ORAL SOLUTION/SUSPENSION, 200 mgActive substance: ibuprofenManufacturer: Kern Pharma S.L.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 600 mgActive substance: ibuprofenManufacturer: Zambon S.A.U.Prescription requiredDosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Laboratorios Bluepharma, S.L.Prescription not required
Almost everyone gets headaches, and most of the time the reason has nothing to do with the brain: too little sleep, a missed meal, not enough to drink, a stiff neck, a hangover, a cold. That kind of headache settles on its own or with an ordinary painkiller. But there are a handful of patterns that mark a headache out as urgent, and there is one very common cause that people never suspect in themselves because it looks like treatment rather than trouble: overusing painkillers. Those two things are worth starting with.
When to call an ambulance
The single European emergency number is 112. Call without waiting for morning in these situations.
- Thunderclap headache. A headache that reaches full intensity within seconds — like being struck on the back of the head — and that the person describes as the worst of their life. This is how a subarachnoid haemorrhage announces itself, a vessel bursting beneath the coverings of the brain. Vomiting, dislike of light, a stiff neck and a brief blackout often come with it. What matters is not how long it lasts but how fast it climbs: a headache that arrives in seconds justifies the call even if it has eased half an hour later.
- Headache with a high temperature and a stiff neck, where the chin cannot be brought down to the chest. Add to that strong dislike of light, confusion, and a rash that does not fade when pressed with a clear glass. This is the picture of meningitis; in babies it is sparser — floppiness, refusing feeds, an unusual cry, a bulging soft spot.
- Headache with focal neurological symptoms: a drooping face, weakness or numbness of the arm and leg on one side, slurred speech, loss of part of the visual field, double vision, unsteadiness, a seizure, confusion.
- Headache after a blow to the head, particularly if the person takes blood-thinning medicines, or if the injury was followed by loss of consciousness, vomiting or increasing drowsiness. In someone on anticoagulants a bleed can build slowly and declare itself hours or days after a fall that seemed trivial.
- Headache with a suddenly red, painful eye, misty vision, coloured haloes around lights and vomiting; the eye feels hard. This is an attack of closed-angle glaucoma, in which sight is lost over hours.
Headaches that need a doctor without delay
An ambulance is not always required, but neither can these wait to see whether they pass.
- A severe headache appearing for the first time after the age of fifty. Especially with pain in the temple, a scalp that has become tender — combing the hair and resting the head on a pillow hurt — and a jaw that tires and aches while chewing. This is giant cell arteritis, inflammation of the arteries of the head. Its danger is that it can take the sight of one eye suddenly and permanently, and treatment started in time prevents that. Here the count is in days.
- Headache worst in the morning, waking you at night and worsened by coughing, sneezing, straining or bending forward, all the more so if it grows week by week and comes with vomiting without preceding nausea. That is how raised pressure inside the skull behaves.
- A headache that has changed character: someone has had their familiar headache for years and now it is a different one in site, severity or rhythm.
- A new headache in anyone with cancer, with a weakened immune system, or taking medicines that suppress immunity.
- Headache in the second half of pregnancy or soon after birth, particularly with flashing lights, swelling and pain under the right ribs: pre-eclampsia can start this way.
- In a child: a headache that wakes them at night or is already there on waking, that worsens with coughing or bending, that comes with vomiting, with a squint or with an inability to look upwards; and any headache starting in the first days after a head injury.
Migraine or tension-type headache
These two account for the overwhelming majority of recurring headaches, and they are confused constantly even though they behave quite differently.
Tension-type headache affects both sides, pressing or squeezing, like a tight band around the head. It is moderate, does not worsen with ordinary walking or climbing stairs, brings no nausea, and lets you carry on working even while it spoils the day. It often starts from the neck and shoulders, towards the end of the day, after long hours at a screen or during a fraught week.
Migraine is usually one-sided and throbbing, moderate to severe. It is recognised not by its force but by three companions: it worsens with movement, so that you want to lie down; nausea or vomiting appears; and light and sound become intolerable, so you seek a dark, quiet room. An attack lasts from a few hours to several days. In roughly one person in five the pain is preceded by an aura — a shimmering zigzag or a blank patch in the field of vision, less often numbness of the hand and face or trouble finding words; it builds over minutes and clears in under an hour.
There is a third type, rare but very distinctive: cluster headache. One-sided pain around the eye, extremely severe, arriving in runs day after day and often at night; on that side the eye reddens and waters, the nostril blocks and the eyelid droops. Someone in a cluster attack does not lie still but paces. It is treated separately, and the treatment is chosen by a doctor.
The painkiller that causes the headache
This is the commonest reversible cause of daily headache and the one most often missed, because it looks like fighting the pain rather than being its source. The pattern is always the same: the head aches more often, the tablet is taken more often, the pain threshold drops, attacks multiply, tablets start being taken pre-emptively — and at some point the head aches every morning, dully and constantly, while the medicine that used to work no longer does.
Suspect it if painkillers are being taken regularly on several days a week for months on end. The quickest route there is by way of combination products — those with caffeine or codeine added to the painkiller — and specific migraine treatments; plain painkillers get there too, only more slowly.
The good news is that it is reversible: once the medicine is withdrawn the headaches gradually return to their old pattern. The bad news is that the first days without tablets are worse than usual, which is exactly why withdrawal is planned with a doctor. They will decide whether to stop at once or taper, what to cover those days with, and whether a preventive treatment is needed to thin out the attacks. There is one sensible thing to do yourself: count on a calendar how many days a month you actually take a painkiller. The number usually comes as a surprise.
What else sets headaches off
- Dehydration, missed meals, hangovers.
- Caffeine withdrawal: the regular coffee drinker gets a headache precisely at the weekend or on holiday, when the morning cup has slipped by a few hours.
- Too little sleep and, equally, too much of it.
- Tension in the neck and shoulders, a badly set-up desk, long screen sessions without breaks.
- Uncorrected short or long sight, particularly in children.
- Colds, flu and sinusitis: in sinusitis the pain presses into the face, worsens on leaning forward and comes with a blocked nose.
- Hormonal shifts: headaches before a period and in its first days, and the changes of the perimenopause.
- Grinding the teeth at night and problems with the jaw joint.
- Carbon monoxide poisoning stands apart. What gives it away is not the character of the pain but the circumstances: everyone in the household has a headache, the pets are unwell too, symptoms appear at home where there is a faulty boiler, stove or fire, and clear when the person goes out. On that suspicion, get into fresh air immediately and call for help.
Helping yourself
During an attack the simple things work: quiet, dim light, a cool cloth on the forehead or, if it suits better, warmth on the neck; a glass of water if you have not drunk for hours and something to eat if you have not eaten. In migraine a painkiller taken at the very start of an attack works far better than one taken hours in, and lying down in the dark often helps as much as the tablet. In tension-type headache it helps to stand up, stretch, look away from the screen and let the shoulders drop.
For occasional pain, paracetamol or an anti-inflammatory is usually enough. Check the choice and the dose with a doctor or pharmacist if you have stomach, kidney or liver problems, asthma, or if you take something regularly. Children and teenagers are not given aspirin for headache. And the rule that outweighs all the others: count the days you take something, not the tablets. Painkillers on several days a week for months lead straight to medication-caused headache.
Between attacks the dull measures work best: a steady sleep routine, regular meals, drinking enough, activity within your capacity, taking load off the neck, and dealing with stress levels. If attacks are frequent and severe there is preventive treatment — medicines taken daily to make attacks fewer, prescribed by a doctor.
A diary and investigations
Headache is diagnosed mainly from the account rather than from a scan, so a diary is worth keeping for at least a month. There is little to record: time of onset and duration, where it hurt and how (pressing, throbbing, stabbing), whether there was nausea and intolerance of light, what the day before was like, what you took and whether it helped, and for women the day of the cycle. On a separate line, mark every day on which you took a painkiller.
Scanning is not for everyone and not for every headache. It is arranged when the features from the first two sections are present, when the pattern has changed, or when examination turns up neurological abnormalities. In typical migraine and tension-type headache with a normal examination, a scan does not improve treatment, while it does turn up harmless incidental findings that then cause worry and further tests. A doctor will also check your blood pressure, look at the back of the eye, and examine the neck and temples.
Online consultation
Headache is an almost ideal subject for a remote appointment, because the diagnosis is built by asking questions. A doctor can go through the character of the pain with you, separate migraine from tension-type headache, look at your diary and count the days of painkiller use, find the medication cause if there is one, help you put together a plan for attacks and decide whether prevention is worthwhile; they will explain which warning signs apply to you in particular and whether a scan is needed, and if you have already had one, read the report and say what is significant and what is an incidental finding.
The limits of the format are worth stating plainly: a screen cannot show the back of the eye or allow a full neurological examination. And for a thunderclap headache, a headache with fever and a stiff neck, one with focal symptoms, or one after a head injury, what is needed is an ambulance rather than a message.
This material is for information only and does not replace medical advice.
Consult with a doctor about Headaches
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Headaches
Discuss your symptoms and possible next steps for Headaches with a doctor online.
