Headaches may occur bilaterally, unilaterally, or travel across the head. A headache may be sharp, throbbing or dull. They may appear gradually or suddenly and may last from minutes to several days. Usually, headaches do not result from a serious illness, but sometimes they may be a life-threatening, necessitating emergency care.

Primary headaches

Over-activity of or malfunction of pain-sensitive structures in your head causes a primary headache. It is not a symptom of an underlying disease. The brain’s chemical activity, the nerves or blood vessels encircling the skull, or the muscles of your head and neck can play a role in primary headaches. Sometimes genetics make it more likely to develop such headaches.

Common primary headaches are

Primary headaches that could be a symptom of an underlying disease include:

  • exercise headaches, and
  • cough headaches.

Primary headaches can be triggered by lifestyle factors such as

Secondary headaches

A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head.

Causes include

  • acute sinusitis,
  • carotid artery or vertebral artery dissections,
  • brain aneurysm,
  • brain arteriovenous malformation,
  • brain inflammation (encephalitis),
  • Brain tumor,
  • carbon monoxide poisoning,
  • Chiari malformation,
  • concussion,
  • dehydration,
  • dental issues,
  • ear infection,
  • febrile illnesses,
  • glaucoma,
  • hangovers,
  • high blood pressure,
  • increased pressure within the skull (pseudotumor cerebri),
  • inflammation of the arteries in the brain (giant cell arteritis),
  • influenza (flu),
  • intracranial hematoma (bleeding in or around the brain),
  • medications,
  • Meningitis,
  • monosodium glutamate (MSG),
  • overuse of pain medication,
  • panic attacks,
  • post-concussion syndrome,
  • pressure from tight headgear,
  • stroke,
  • Trigeminal neuralgia and other neuralgias of nerves joining the brain and face, and
  • venous thrombosis (blood clot within the brain).

Some secondary headaches include:

  • external compression headaches from pressure-causing headgear;
  • ice cream headaches (brain freeze);
  • sinus headaches (caused by congestion in sinus cavities), and
  • spinal headaches (caused by a spontaneous cerebrospinal fluid leak, spinal tap, epidural, or spinal block).

A headache can be a symptom of a serious condition, such as a stroke, meningitis or encephalitis.

Go to a hospital emergency room or call 911 if experiencing the most severe headache of your life, a sudden headache or a headache accompanied by

  • confusion;
  • difficulty seeing;
  • difficulty speaking and understanding speech;
  • difficulty walking;
  • fainting;
  • fever greater than 102 F (39 C);
  • nausea or vomiting;
  • numbness, weakness or paralysis; and
  • stiff neck.

See a doctor if your headaches:

  • occur more often than usual;
  • are more severe than usual;
  • do not improve with over-the-counter drugs; and
  • keep you from working, sleeping or taking part in normal activities of daily living.

Jose Veliz MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).



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