Headache

What is a headache?

A headache refers to pain or discomfort felt in the head, scalp or face. It is one of the most common medical complaints across all age groups, and while usually mild or short-lived, it can occasionally become severe, persistent or disabling. 

Most headaches are not caused by serious medical conditions and can be effectively managed. However, for some individuals, frequent or intense headaches may disrupt work, school and daily life, and may be associated with underlying neurological conditions that require medical evaluation.

How common are headaches?

Headaches are among the most prevalent neurological disorders globally. A global review estimated that 52% of the world’s population lives with an active headache disorder at any given time. Migraine affects approximately 14%, tension-type headache affects 26% and chronic headache occurring on 15 or more days per month affects about 4.6%.

In Singapore, the lifetime prevalence of headache is reported to be 82.7%, with migraine affecting 9.3% of the population.

What are the types of headaches and their associated symptoms?

Symptoms vary depending on the type of headache and its underlying cause. Pain may range from dull pressure to sharp, throbbing sensations. It may be felt on one side or both sides of the head, and may last from a few minutes to several hours or even days. Identifying the correct headache type is essential for effective treatment.

Here are the hallmark symptoms associated with different types of headaches:

Migraine

• Moderate to severe throbbing pain, usually on one side
• Worsens with physical activity
• Nausea and/or vomiting
• Sensitivity to light, sound or smells
• May be preceded by aura (flashing lights, zigzag lines, visual disturbances)
• Tingling or numbness in limbs in some cases

Tension-type headache

• Dull, non-throbbing ache on both sides of the head
• Often described as a tight band around the head
• No nausea or vomiting
• May involve neck or shoulder tightness

Cluster headache

• Sudden, severe pain on one side, usually around one eye
• Tearing and redness of the eye on the affected side
• Runny or blocked nostril on the same side
• Drooping eyelid or facial sweating

Sinus headache

• Pressure or pain around the forehead, eyes, cheeks or bridge of the nose
• May be associated with nasal congestion, fever or post-nasal drip

Medication-overuse headache

• Daily or near-daily headache often present on waking
• May resemble tension or migraine headaches
• Associated with frequent use of pain relief medications (more than 10 days per month for over three months)

Other headache types

• Exercise headache: Throbbing pain on both sides triggered by physical exertion
• New daily persistent headache (NDPH): Sudden onset of continuous headache that lasts more than three months
• Hemicrania continua: Persistent one-sided headache that responds well to indomethacin
• Thunderclap headache: Sudden, severe headache that peaks within one minute; may indicate a serious underlying condition

Types of Headache

When should you see a doctor?

Seek medical attention if you experience:

• Frequent headaches occurring more than once a week
• A reliance on painkillers for more than once a week
• A significant change in the pattern of a usual headache
• Headaches that do not respond to usual medications
• Headache with fever, stiff neck, confusion or visual disturbances
• New or worsening headaches after age 50
• Headache following a head injury
• Headaches that wake you from sleep or worsen on coughing or exertion
• A sudden, severe headache
• New headache in individuals with cancer, HIV or autoimmune diseases

Knowing when to seek help for a severe or persistent headache can prevent complications and ensure timely care.

Can headaches be prevented?

While some headaches are unpredictable, many can be prevented with lifestyle strategies and trigger management. Understanding and avoiding personal headache triggers is key to prevention.

The following strategies may help reduce headache frequency: 

• Maintaining regular sleep and meal schedules
• Staying well hydrated throughout the day
• Limiting intake of caffeine and alcohol
• Managing stress through relaxation techniques, meditation or counselling
• Exercising regularly, but avoiding overexertion
• Monitoring for triggers using a headache diary 

Women who experience menstrual or hormonal migraines may benefit from medical review to discuss preventive options.

What causes headaches?

Headaches can be classified as either primary or secondary depending on their origin:

Primary headaches
These are headaches that occur independently and are not symptoms of another disease. They include:

• Migraine
• Tension-type headache
• Cluster headache
• New daily persistent headache

They are often associated with:

• Overactivity of pain-sensitive structures in the head
• Sleep disturbances
• Stress and emotional factors
• Hormonal changes
• Dietary and environmental triggers

Secondary headaches
These are often related to other medical conditions such as:

• Infections (e.g., sinusitis, meningitis)
• Head injuries
• Medication overuse
• Eye strain
• Brain tumours
• High blood pressure
• Stroke or other vascular conditions

Understanding whether a headache is primary or secondary is key to guiding treatment.

What are the risk factors for headaches?

Certain factors may increase the likelihood of experiencing headaches:

• Genetics: Family history of migraines or other headache disorders
• Gender: Women are three to four times more likely to develop migraines; men are two to five times more likely to develop cluster headaches
• Stress and sleep: Chronic stress and irregular sleep patterns are major contributors
• Diet: Alcohol, caffeine, MSG, processed meats, aged cheeses and skipping meals can trigger headaches
• Hormonal fluctuations: Common in women during menstruation, pregnancy or hormonal therapy
• Environmental stimuli: Bright lights, loud noises, strong smells, weather changes
• Medications: Overuse of painkillers can lead to rebound headaches

How are headaches diagnosed?

Doctors typically diagnose headaches by combining information from your symptoms, medical history and a physical examination. The purpose is to determine whether the headache is primary or secondary in nature, as well as to guide appropriate treatment.

• Medical history review: This involves a detailed discussion about the frequency, duration, severity, location and character of your headaches. Your doctor will also ask about associated symptoms such as nausea, visual changes or sensitivity to light, as well as any lifestyle or environmental triggers.
  
  
• Neurological exam: A neurological exam may be done to help assess whether the headache is linked to a problem in the brain or nervous system. It typically includes checks for reflexes, muscle strength, sensation, balance, coordination and mental status.
  
  
• Headache diary: You may be asked to keep a daily log of your headaches, including time of onset, symptoms, possible triggers and medication use. Over time, this helps identify patterns and informs long-term management strategies.
  
  
• Eye examination: Eye strain or problems such as glaucoma can cause or worsen headaches. An eye exam can help detect such conditions and assess for signs of raised intracranial pressure, particularly if visual disturbances are present.
  
  
• Blood tests: Basic blood tests may be ordered to check for signs of infection, inflammation, anaemia or other systemic issues that could be contributing to your headaches.
  
  
• Imaging (CT or MRI): If your symptoms suggest a possible secondary cause (such as a brain tumour, bleeding or structural abnormality), a brain scan may be necessary. Computer tomography (CT) scans are often used in emergency settings, while magnetic resonance imaging (MRI) scans provide more detailed images for complex cases.
  
  
• Lumbar puncture: Also known as a spinal tap, this test may be done if your doctor suspects conditions such as meningitis, encephalitis or subarachnoid haemorrhage. It involves collecting a sample of cerebrospinal fluid for laboratory analysis.

How is headache treated?

Treatment depends on the type, frequency and severity of the headache, as well as any underlying causes. Most people benefit from a combination of medication, lifestyle modifications and preventive strategies tailored to their specific condition.

Symptomatic treatment
These approaches may be used to relieve pain during a headache episode:

• Over-the-counter medications: Paracetamol, ibuprofen or aspirin (note: aspirin should not be used in children under 16) are often effective for mild to moderate headaches but note that frequent or excessive use can lead to medication-overuse headaches
• Prescription medications: Triptans (such as sumatriptan) are often prescribed for migraines while anti-nausea medications may be added if there is vomiting or queasiness
• Rest: Lying in a quiet, dark room may help ease symptoms, especially in migraine sufferers sensitive to light and sound
• Cold or warm compresses: Cold packs are often preferred for migraines, while warm compresses may help tension-type headaches by relaxing tight muscles

Preventive (prophylactic) treatment
These medications are taken daily to reduce the frequency, severity and duration of headaches. They are typically recommended for individuals with chronic or disabling headache patterns.

• Beta-blockers: Commonly used in migraine prevention, these help to regulate blood vessel dilation and reduce nervous system excitability
• Tricyclic antidepressants (e.g., amitriptyline): These may help prevent various types of headaches, especially if poor sleep or depression is also present
• Anticonvulsants (e.g., topiramate, valproate): Often prescribed for migraine prevention due to their stabilising effects on nerve activity
• Botulinum toxin (Botox): Approved for the treatment of chronic migraine, especially in cases unresponsive to other therapies
• Calcium channel blockers (e.g., verapamil): May be used to prevent cluster headaches by regulating blood vessel tone and reducing attack frequency

Non-medication approaches
These lifestyle and behavioural strategies can complement medical treatments and are especially useful for long-term management.

• Cognitive behavioural therapy (CBT): Helps patients identify and change thought patterns and behaviours that may contribute to headache frequency or severity
• Acupuncture or acupressure: Some individuals find relief through these techniques, which stimulate specific points on the body
  • Relaxation training and biofeedback: Techniques such as deep breathing or guided visualisation can reduce muscle tension and stress-related headaches
• Mindfulness meditation and yoga: Encourage mental relaxation and physical flexibility, potentially reducing headache triggers like stress or poor posture
• Regular exercise: Low-impact aerobic exercise (walking or swimming) may help prevent certain types of headaches by improving blood circulation and mood
• Dietary adjustments: Some individuals benefit from supplements like magnesium or riboflavin (vitamin B2), particularly for migraines. Always consult a doctor before starting supplements.

These holistic strategies can help prevent chronic headaches and reduce reliance on medication.

Treatment of specific causes (for secondary headaches)
When a headache is caused by another underlying condition, treating that condition is essential. For instance, antibiotics may be prescribed for sinusitis-related headaches, or a dental procedure may relieve headaches caused by jaw problems. In rare cases, surgery may be needed to address structural abnormalities.
 

Can children and adolescents experience headaches?

Yes. Children and adolescents can experience headaches, including migraine, tension-type and secondary headaches. In younger individuals, symptoms may differ slightly from adults. For example, children with migraine may appear pale, irritable or experience abdominal discomfort and vomiting. If headaches become frequent or interfere with school and daily life, medical evaluation is recommended.

What is rebound headache (medication-overuse headache), and how can it be avoided?

A medication-overuse headache, also known as a rebound headache, occurs when pain relief medication is taken too frequently, typically more than 10 days per month for over three months. Instead of relieving symptoms, the medication begins to contribute to headache recurrence. To avoid this, limit the use of acute headache medication and consult a healthcare provider for a long-term management plan if you require frequent pain relief.

Is it safe to treat headaches during pregnancy?

Headaches can occur during pregnancy due to hormonal changes, stress, fatigue or dehydration. Most are benign, but persistent or severe headaches (especially after 20 weeks of pregnancy) may indicate preeclampsia or other complications. Pregnant individuals should avoid self-medicating and consult a doctor. Some non-drug measures, such as cold compresses, hydration or adequate rest, may be recommended. Medications, if necessary, must be carefully selected for safety.

Can stress cause headaches?

Emotional factors such as stress, anxiety, depression and fatigue are common triggers for tension-type and migraine headaches. Stress can also exacerbate symptoms or reduce the effectiveness of treatment. Techniques such as cognitive behavioural therapy, relaxation training, breathing exercises and regular physical exercise may help in reducing stress-related headaches.

When is a severe headache a medical emergency?

Not all severe headaches are due to serious conditions, but certain features may indicate the need for urgent care. Seek immediate medical attention if the headache is sudden and severe, worsens progressively or is accompanied by fever, neck stiffness, visual disturbances, confusion or neurological symptoms. These signs may point to underlying issues such as brain bleeding, infection or stroke.

What is the outlook for individuals living with headaches?

With the right support, most people with recurring headaches can achieve good control over their symptoms. If you suffer from frequent headaches, it is important to:

• Keep track of symptoms and potential triggers using a headache diary
• Maintain a structured routine for sleep, meals and exercise
• Avoid overuse of pain relief medication
• Seek support from your healthcare provider if headaches affect your daily life

Most headaches are harmless and can be managed with simple interventions. However, persistent or severe headaches that affect your quality of life should never be ignored.

Certain headaches, such as thunderclap headaches or those with neurological signs, require immediate medical attention as they may signal life-threatening conditions.

• ​Download the Headache brochure
  
• Download the Headache Diary

References

Akgör, M. C., Ekizoğlu, E., & Özge, A. (2024). Dairy and Headaches: What is the Connection? Current Pain and Headache Reports. https://doi.org/10.1007/s11916-024-01303-w 

Fischer, M. A., & Jan, A. (2023, August 22). Medication-Overuse headache. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK538150/  

Fischera, M., Marziniak, M., Gralow, I., & Evers, S. (2008). The Incidence and Prevalence of cluster Headache: A Meta-Analysis of Population-Based Studies. Cephalalgia, 28(6), 614–618. https://doi.org/10.1111/j.1468-2982.2008.01592.x   

Legesse, S. M., Addila, A. E., Jena, B. H., Jikamo, B., Abdissa, Z. D., & Hailemarim, T. (2025). Irregular meal and migraine headache: a scoping review. BMC Nutrition, 11(1). https://doi.org/10.1186/s40795-025-01048-8   

Miller, E. C., & Vollbracht, S. (2021). Neurology of Preeclampsia and Related Disorders: an Update in Neuro-obstetrics. Current Pain and Headache Reports, 25(6). https://doi.org/10.1007/s11916-021-00958-z   

Moy, G., & Gupta, V. (2022, October 4). Menstrual-Related headache. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557451/   

Rist, P. M., Buring, J. E., & Kurth, T. (2014). Dietary patterns according to headache and migraine status: A cross-sectional study. Cephalalgia, 35(9), 767–775. https://doi.org/10.1177/0333102414560634   

Rossi, M. F., Tumminello, A., Marconi, M., Gualano, M. R., Santoro, P. E., Malorni, W., & Moscato, U. (2022). Sex and gender differences in migraines: a narrative review. Neurological Sciences, 43(9), 5729–5734. https://doi.org/10.1007/s10072-022-06178-6