Almost no one goes through life without ever experiencing headaches. Most headaches are due to primary headache disorders — chief among them the dull, pressing tension-type headache and episodic migraine. Both are burdensome but generally well treatable. It is important to know the few warning signs that mean a headache should be promptly investigated — and recognising these depends above all on the pattern: how the pain feels, how often it occurs, and what accompanies it.
Possible causes
Tension-type headache
The most common headache of all: dull, pressing, usually on both sides, like a tight band around the head. It is often associated with stress, neck tension, screen work, lack of sleep or insufficient fluid intake, and is not dangerous.
Migraine
An episodic, often one-sided and throbbing pain that worsens with movement and is typically accompanied by nausea as well as sensitivity to light and noise. Some sufferers experience an 'aura' beforehand with visual disturbances. Migraine is an independent neurological condition, not imaginary.
Accompanying an infection
With colds, flu, or sinusitis, headaches often occur as an accompanying symptom and usually subside as the infection clears. If they increase significantly or are accompanied by neck stiffness, high fever, or confusion, they should be medically assessed.
Medication overuse
Frequently taken acute medications can, paradoxically, themselves sustain a chronic headache. The threshold depends on the substance: for triptans, opioids and combination preparations, it lies at at least 10 days of use per month, while for paracetamol and anti-inflammatory painkillers it lies at 15 days per month — in each case sustained over more than three months. In that case, medical accompaniment is important.
Typical steps at the doctor's office
- 1Your doctor will classify the type of headache based on pattern, frequency, duration and accompanying symptoms. A brief headache diary — when, how severe, what triggered it — can be surprisingly helpful.
- 2The few warning signs are systematically ruled out. With typical migraine or clear tension-type headache, imaging (CT/MRI) is usually not necessary — it is only used when warning signs are present or the course is atypical.
- 3Treatment depends on the type: recognising and avoiding triggers, adequate sleep, exercise and hydration, and for migraine, targeted acute treatment and, if needed, preventive measures as prescribed by your doctor.
What you can do yourself
- Drink fluids regularly, get enough sleep and make sure to exercise — a regular daily routine can reduce tension headaches for many people affected.
- Screen breaks and consciously relaxing the neck and shoulder area help prevent headaches.
- For migraine, many find relief in a quiet, darkened retreat during an attack.
- Take painkillers only when specifically needed and on as few days per month as possible to avoid chronic headache.
Seek medical advice if headaches are new and unusual, become more frequent or severe, you regularly need painkillers, or if they noticeably interfere with your daily life. With the warning signs mentioned above, every minute counts — call emergency services immediately.
Frequently asked questions
- How can I tell if it is migraine?
- Typical features of migraine are episodic, often one-sided, throbbing pain that worsens with movement and is accompanied by nausea as well as sensitivity to light and noise. Tension-type headache, by contrast, is more dull, on both sides and without these accompanying symptoms.
- Do I need imaging of my head?
- Usually not. With a typical pattern and no warning signs, a CT or MRI is not necessary. It is used when headaches are new, unusual, increasing or accompanied by neurological deficits.
- At what point do painkillers become problematic?
- Depending on the substance: for triptans, opioids, and combination preparations, the limit applies from 10 days of use per month, while for paracetamol and anti-inflammatory painkillers it applies from 15 days per month — in each case when this occurs over more than three months. Anyone who regularly needs painkillers for headaches should discuss this with a doctor regardless.
Not sure whether you should go or whom to see? Describe your symptoms — we'll find the right practice in your area.