How to Tell What Type of Headache You Have, and When to See a Neurologist

Headache is one of the most common reasons people come to see us, and the diagnosis is almost always made from the story rather than from a scan. What the pain feels like, where it sits, what comes with it, and what pattern it follows tell you which one it is.

What headaches are

Headache is pain in the head or face. It can be a dull ache or a throbbing pulse, on one side or both, and it usually comes with other symptoms that identify the type.

The pain does not come from the brain, which has no pain receptors. It comes from the blood vessels, muscles, nerves, and coverings around it.

Types of headaches

Headaches fall into two groups. Primary headaches are the condition itself. Secondary headaches signal something else, which is why sorting out the group is the first job of any evaluation.

Our migraine guide covers the four phases, aura, and treatment.

Visual guide

A headache is more than its location

• Pain: How it feels and how long it lasts are useful clues.
• Symptoms: Nausea, light sensitivity, and other changes add context.
• Pattern: A headache history helps guide diagnosis and treatment.

What headache location tells you

Location narrows the type. It rarely identifies a cause by itself, which is why the rest of the pattern matters.

• Top of the head. Most often tension-type, sometimes migraine. On its own, rarely a reason for imaging.
• Temples. Tension-type and migraine. In someone over 50, new temple pain with a tender scalp, a jaw that tires when chewing, or any change in vision needs an urgent same-day medical assessment for inflammation of the temporal arteries, which can threaten sight. Blood tests and a temporal artery biopsy confirm it, but high-dose steroids are started on suspicion, before results, because that is what protects sight. Normal blood tests do not rule it out.
• Forehead and behind the eyes. Migraine, tension-type, and eye strain. True sinus headache comes with fever and congestion.
• Back of the head and base of the skull. Neck muscles and joints, tension-type, and occipital neuralgia, which sends brief electric jabs up from the base of the skull. A new severe headache here with a stiff neck is an emergency.
• One side. Migraine, which can switch sides between attacks, and cluster, which stays around the same eye. A headache on exactly the same side every time is worth mentioning.

What causes headaches

• Stress and posture: the usual driver of tension-type headache, and the most common cause overall.
• Dehydration and skipped meals: common and easy to fix. Irregular eating is a more reliable trigger than any single food.
• Sleep: too little, too much, or an irregular schedule.
• Environment: strong smells, loud noise, bright light.
• Hormonal changes: estrogen shifts around menstruation, pregnancy, or menopause.
• Overuse of pain relievers, which turns an occasional headache into a daily one.

Identifying your own triggers is the most useful thing you can do without us. A headache diary kept over a few weeks shows a pattern no single visit can.

Why you wake up with a headache

A headache that is there when you open your eyes has a shorter list of causes than headache in general, and most of them are fixable.

• Sleep apnea. Interrupted breathing lowers overnight oxygen and produces a dull headache on waking that fades within an hour or two. If you snore, wake unrefreshed, or have been told you stop breathing, a home sleep study is often the most useful test to order.
• Medication-overuse headache. Overnight is the longest gap between doses, so the rebound headache is waiting in the morning.
• Teeth grinding. A tight jaw, worn teeth, or a partner who hears it at night.
• Alcohol, oversleeping, and an irregular schedule. Weekend mornings are the classic time.
• Caffeine withdrawal, if you drink a lot of it during the day.
• Migraine, which often begins in the early morning hours.

One pattern is uncommon and important: a headache that is worst on waking or lying flat, eases when upright, and comes with nausea or visual change can mean raised pressure inside the head, and needs an examination and imaging rather than a stronger painkiller. Relieving a morning headache means finding which of these it is.

Natural remedies for headache relief

These have research support, and they work alongside medication rather than instead of it.

For prevention: biofeedback and relaxation techniques teach control over the muscle tension and stress responses that feed headaches. Acupuncture has beaten sham treatment in trials. Physical therapy helps when neck pain is part of the picture, and cognitive behavioral therapy helps with the disability of chronic headache, which we refer out for. A consistent sleep schedule, regular meals, and regular exercise matter as much.

Supplements. Several have been studied for prevention, and the evidence is specific to migraine. Our migraine page keeps the supplement table, with what the evidence shows for each and the one safety caveat that matters. Tell us what you are taking so we can check for interactions.

One caution on manual therapy. Massage and gentle work on the neck are safe for most people. We advise against high-velocity manipulation of the neck, because of a rare but serious association with injury to the neck arteries that can cause a stroke. Causation is not proven, but the association is enough for us to avoid it.

Medical treatment options

Treatment depends on the type, the frequency, and the disruption.

Over the counter. Ibuprofen or naproxen, acetaminophen, or a combination product with caffeine. These work well for occasional headaches. Taken too often they cause medication-overuse headache, which is defined as headache on 15 or more days a month with regular overuse for more than three months: 10 or more days a month for triptans, opioids, and combination painkillers, and 15 or more for simple painkillers. We use a lower bar in the clinic. Reaching for a pain reliever more than two or three days a week is the point to come in and talk, well before the definition is met.

Prescription. Acute treatments stop an attack: triptans, and the newer gepants. Preventives reduce how often attacks happen: certain antidepressants, anti-seizure medications, blood pressure medications, and the CGRP-targeted antibodies. Prevention is worth discussing once headaches occur more than a few times a month.

Prevention takes patience. Most preventives need several weeks at a steady dose before their effect is clear, so the plan is adjusted over follow-up.

Visual guide

A plan for attacks and prevention

• Attack care: Treatment may aim to relieve an individual headache.
• Prevention: Frequent headaches may call for a preventive approach.
• Review: Medication use and the headache pattern guide adjustments.

When to see a neurologist

Come in if your headaches are more severe or frequent than they used to be, the pattern has changed, they are there on waking most mornings, they started after a head injury or after age 50, they cause persistent nausea, or they have stopped responding to over-the-counter medication. The same goes for headaches with a stiff neck, confusion, numbness, weakness, or visual changes.

An evaluation at our headache neurology service is a 60-minute visit with Dr. Achillefs Ntranos, MD, in person in Beverly Hills or Los Angeles or by video anywhere in California. It centers on the history and a neurological examination, imaging is ordered only when the story warrants it, and you leave with a written plan. Our article on when to worry about a headache covers the warning signs in detail. You can request a visit whenever your headaches have started to run your week.

References

1. Cleveland Clinic. Headaches: types, causes, symptoms and treatment.
2. National Institute of Neurological Disorders and Stroke. Headache.
3. Cleveland Clinic. Six reasons why you wake up with headaches.
4. International Classification of Headache Disorders, 3rd edition. Medication-overuse headache.
5. Biller J, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2014.
6. Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis. Arthritis and Rheumatology, 2021.
7. Ponte C, et al. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Annals of the Rheumatic Diseases, 2022.