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Almost 5% of adults suffer from chronic headaches, or headache disorders. Whether you fall into this minority and have headaches everyday or only deal with the occasional headache, you may wonder what the root cause of your discomfort is (and what you can do to prevent another splitting headache).
In this research article, we'll discuss causes of a headache on top of head along with ways you can treat the throbbing pain. If you're wondering, "Why does my head hurt?" you'll hopefully have an answer shortly.
Common Headache Symptoms
If only life came with a headache chart to let us know the exact cause of our discomfort, how to treat it, and whether we need to head to the doctor. But unfortunately, we're stuck searching for these answers on our own.
Finding the answers all comes down to pinpointing your symptoms. Here are some of the most common symptoms of a persistent headache.
- Sharp pain in temple
- Sharp pain behind eye
- Neck tension
- Pain on top of head
- Pressure in back of head
- Sensitivity to loud noises or bright lights
- Inability to carry on daily activities
While this list should resonate with most headache sufferers, there are some unique symptoms some experience. We'll cover those in more depth as we explore top of head headache causes.
We've divided these causes into five categories as follows.
- Low risk: Easily managed with over-the-counter (OTC) medications or by avoiding the known stimulus.
- Low-medium risk: Usually managed as an outpatient by your doctor with prescription medication.
- Medium risk: May require an ED visit or hospitalization. Prescription medication usually needed.
- Medium-high risk: Hospitalization or urgent intervention needed, usually not life-threatening if appropriately treated.
- High risk: Serious and potentially lethal complications possible; emergent intervention needed; Intensive Care Unit (ICU) care often needed.
Does Headache Location Matter?
Does the location of your headache help determine the cause? The first thing to look for when you say, "My head hurts" is the headache location. Take a look at our brief headache location chart to see how head muscles play a part in your discomfort and what different locations mean.
- Headache on top of head: You may feel as if there is a heavy weight sitting on top of your head. This is typically causes by body tension. You may also feel the tension in your neck, shoulders, and back of the head.
- Headache behind left eye: When you're experiencing pressure behind left eye and not the right, or unilateral, the most common diagnosis is a migraine. Tension headaches usually affect both sides equally. This is the main difference between headache and migraine.
- Headache behind right eye: Just as it is with the left eye, a possible cause of a unilateral right sided headache behind the eye is a migraine. A tension headache is also a possible cause, especially if you're feeling discomfort in your neck and forehead as well.
- Temple headache: If you're experiencing a dull and squeezing pain in both of your temples, a tension headache is most likely to blame. But there are serious causes to worry about as well, like meningitis. Track your symptoms carefully if the headache occurs frequently.
- Pain at base of skull: The suboccipital muscles are located at the base of your skull. If you're experiencing pain there, they are usually the cause. Even though the pain feels scary because of its location, this is typically considered a standard tension headache.
Putting together your list of symptoms and headache locations will get you a step closer to finding out why your head hurts. Just remember that every headache is unique, and they don't always follow the rules. If you suffer from chronic headaches, keep a headache journal to spot similarities and track the differences between your headaches for an accurate diagnosis.
When to See a Doctor
While the majority of top of head headache occurrences aren't an immediate threat to your wellbeing, there are times when you should seek medical attention. If any of the following symptoms should arise, closely monitor your condition and either head to the emergency room or speak with a medical professional.
- High fever
- Stiff neck
- Vision problems
- Slurred speech
- Weakness or numbness
- Loss of consciousness
- Headache for 3 days or more that shows little to no improvement
- You suffer from a headache everyday
- Headaches that cause severe pain, leaving you unable to manage small tasks
Ready to discover the cause of your headache top of head symptoms? Let's start breaking down headache causes and get you on the road to treatment.
Low Risk Causes
Migraine - mild or moderate
Migraines can cause debilitating pain that forces the sufferer to retreat from their lives on a regular basis. A headache on right side of head or left is one of the tell-tale signs of a migraine. Mild migraine attacks are defined as those that occur less than eight days out of a month. However, those days can still be debilitating. The exact causes of migraines are not known though there are several triggers linked to the pain, like foods, hormonal changes, and sensory stimuli. Treatment mainly focuses on preventative measures in mild cases.
Sinus headache symptoms include a stuffy nose, pain and pressure in your forehead or top of your head, and the fast onset of a headache when bending over. Many confuse a sinus headache with a migraine because many of the symptoms of similar. The main differences are that migraine suffers often experience a nausea and a headache simultaneously, along with sensitivity to loud noises and bright lights. At-home treatments include regular exercise to relieve tension and avoiding triggers. Pain medication can be used as needed.
Primary cough headache
A primary cough headache is caused by excessive straining, either from coughing as the name suggests or from other actions like blowing your nose, laughing excessively, or crying hysterically. If you're experiencing a dull pain after excessive straining, the best treatment is an over the counter pain medication as a primary cough headache typically resolves on its own.
Cold stimulus headache ("ice-cream headache" or "brain-freeze headache")
Have you ever taken a giant bite of ice cream on a hot, summer day only to be suddenly hit with a sharp pain in your forehead? This forehead headache type is known as a cold stimulus headache. It usually lasts less than a minute and don't require medical attention. The cause of this type of headache isn't known but theories suggest that the cold temperature alters blood flow and results in brief discomfort.
A tension headache is the most common type of headache. The discomfort is described as a feeling of a tight band being wrapped around the forehead. Its causes aren't clearly understood but symptoms include a sharp pain in back of head, tenderness around the shoulders, and eye pressure pain. In most cases, tension-type headaches resolve on their own and can be treated with over the counter pain medication. If you're experiencing this type of headache more than 15 days in a month, you should seek medical care to discuss advanced preventative measures.
Migraine - moderate
When migraines begin to worsen, concern begins to set in. As the days of suffering within a month increase, the risks increase along with them. Complications can arise such as abdominal problems from excessive NSAID pain reliever use. One serious but rare complication is serotonin system, caused by consistent use of migraine medication. If your migraines are causing sharp pains in head that are worsening, speak to your doctor about a different treatment regimen.
Trigeminal neuralgia (may need surgical therapy if refractory to medical therapy)
The trigeminal nerve carries sensations to your brain from your face. It the nerve is affected, severe pain can strike during normal activities, like brushing your teeth or scratching an itch on your cheek. This is classified as trigeminal neuralgia, a chronic pain condition. The pain can last for just a few seconds or for several minutes and can intensify over time. There are prescription medications available to lessen the amount of episodes patients experience but if they don't respond favorably to these medications, there are surgical options to consider, such as microvascular decompression.
If you experience an injury to your head or neck, you can expect a post-traumatic headache to set in sooner than later, though sometimes the discomfort doesn't begin for a week after the incident. Symptoms include head pain, neck pain, dizziness, loss of appetite, nausea, and insomnia. Medications like those used for migraines, blood pressure pills, and anti-seizure medications are all possible treatments. Non-drug treatments involve biofeedback and physical therapy.
Medication overuse headache
If you experience a lot of morning headaches, it's time to evaluate how much medication you daily take. Whether you take NSAIDS, Triptans, or opioids on a regular basis and in high dosages, you're at risk for a medication overuse headache. Caffeine is also a root cause when discontinued even for a day or more, which is why they're sometimes referred to as caffeine withdrawal headaches. The seriousness of the headache depends on the level of medication used. For example, a caffeine withdrawal headache wouldn't be as serious as one caused by an opioid addiction. Treatment always starts by weaning off the medication causing the discomfort and if a prescribed medication, under medical supervision.
A cervicogenic headache will always start as pain in back of head at base of skull. It is almost always caused by neck stress, such as a damaged disk or an injury. Eventually, the pain will spread, possibly to the top of the head, and in severe cases, cause blurred vision, dizziness, and mobility difficulties. If diagnosed with a cervicogenic headache, treatment could include spinal manipulation, nerve blocks, or in extreme cases, spinal surgery to relieve compression.
A sudden change in pressure behind left eye or the right can cause angle-closure glaucoma. Sometimes this is caused by cold medications or antihistamines. Other times its caused by cataracts or eye inflammation. It's more common in women and those with a family history of the condition. Symptoms include an eye headache, nausea, and blurry vision. Treatment involves removing excess pressure from the eye with the use of medication and then treating the cause behind the pressure, which varies from patient to patient.
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Medium Risk Causes
Migraine- moderate to severe
When migraines begin to affect you on an almost daily basis, they're considered severe. At this point, you have no choice but to explore all distinct types of treatment. You could explore clinical trials or consider alternative medicine like acupuncture or cognitive behavioral therapy. While you wait to speak with your doctor, keep a headache diary, do your best to reduce stress, and put together a sleep routine that provides you with enough sleep every night.
A cluster headache is a severely painful type of headache. If you're experiencing intense headaches at night, you may be experiencing cluster headaches. The attacks can last for weeks to months and are then followed by remission periods. Symptoms include a painful eye ache, typically around one eye, along with redness in the affected eye, sweating, pale skin, and a drooping eyelid. If you're just starting to experience cluster headaches, seek a medical diagnosis to rule out other conditions. Common treatments are Octreotide, an injectable synthetic brain hormone, local anesthetics, and inhaling 100% oxygen.
Hypertension, also known as high blood pressure, is a common diagnosis in the United States, affecting about 30% of all adults. Hypertensive individuals are at a higher risk for heart disease and strokes. There is little medical evidence that supports a link between hypertension and headaches with the exception of the less common but life-threatening situation of hypertensive emergencies. In fact, some researchers believe high blood pressure can prevent certain types of headaches. A low blood pressure headache would be more common than one linked to hypertension. But should your doctor believe a hypertension diagnosis is playing a role in your headaches, you should strive for better control your high blood pressure.
Spontaneous intracranial hypotension- mild or moderate severity
Spontaneous intracranial hypotension is the name given to a condition in which the fluid pressure inside the skull becomes lower than normal. This is not due to a trauma but instead a spontaneous spinal fluid leak. Symptoms include a severe headache that increases throughout the day along with facial numbness and vertigo. In the case of mild or moderate severity, bed rest and hydration are often enough to reverse the condition.
When the optic nerve is damaged, inflammation quickly sets in. This is diagnosed as optic neuritis. It may be linked to multiple sclerosis but can also occur in those with infections or immune diseases. One of the first symptoms is a stabbing pain in eye followed by some degrees of vision loss and affected color perception. Optic neuritis usually improves with time as the inflammation decreases. But for some, steroid medications can help. Normal vision is typically regained within 12 months.
Giant cell (temporal) arteritis
Giant cell arteritis can cause severe temple pain. It causes inflammation in the lining of your arteries, most commonly in the head. If you're experiencing pain in temples along with scalp tenderness, jaw pain, fever, and vision problems, see your doctor immediately. Blindness and stroke are just two possible complications. Treatment requires immediately prescribed high doses of corticosteroids.
Post lumbar puncture headache
If you've recently received a lumbar puncture for diagnosis or for spinal anesthesia, be on the lookout for a post lumbar puncture headache. They occur in 10 - 30% of those who undergo the procedure and can infrequenty lead to seizures and other serious complications. If you're experiencing a frontal headache that radiates to the neck and shoulders along with back pain and nausea, a post lumbar puncture headache is a likely diagnosis. Contact your physician or provider who performed the lumbar puncture. Resting in a comfortable position and pain medication are the first courses of treatment. If relief is not achieved additional procedures such as an epidural blood patch may be necessary.
Idiopathic intracranial hypertension
Idiopathic intracranial hypertension is the occurrence of elevated fluid and pressure within the skull. Its cause is unknown. Signs of the condition include an intense and unbearable headache along with nausea and vomiting. Because of the severity of the headache, immediate medical attention is necessary. In some cases, a lumbar puncture is the safest and fastest way of relieving the pressure and eradication the pain.
Spontaneous intracranial hypotension- severe or long-standing
Unlike idiopathic intracranial hypertension, spontaneous intracranial hypotension has several understood causes. The most common is a spontaneous spinal fluid leak. Other causes include diabetic comas or leaking cerebrospinal fluid through the nose or ears. Symptoms include a severe headache, nausea, vertigo, and tinnitus. The best course of treatment is the use of lumbar epidural blood patches. In severe cases, surgical repair may be necessary.
Pheochromocytomas are tumors. They grow in the adrenal gland and can cause an overproduction of adrenaline, leading to severely elevated blood pressure. Symptoms include severe headaches, anxiety, nausea, and heat intolerance. Because of the potential risks, medical attention should be sought immediately. If diagnosed with pheochromocytomas, surgical removal is necessary.
High Risk Causes
Cervical venous thrombosis
Cervical venous thrombosis is a life-threatening blood clot that develops around the neck. The condition starts innocently enough, with a dull but deep pain within the affected area. The pain remains constant for several days. If not diagnosed or left untreated, death can occur. While there is sometimes no understandable cause for a clot, repetitive sports injuries have been linked to the condition. The clot will need to be dissolved and preventive measures may be discussed.
Cervical artery dissection
A tear in any of the large arteries in your neck is known as a cervical artery dissection. This may follow minor trauma, chiropractic neck manipulation and physical activities such as vigorous exercise Should you experience one, you can expect to develop a severe headache, pain in the neck, sight problems, a painful and drooping eyelid, and vertigo. Treatment will depend on the tear's severity. For some, an injectable medicine is used to break up any clots. But if severe, surgical repair will be necessary. This is a medical emergency as a life-threatening stroke can result from the dissection.
Brain tumor (expansive intracranial process)
A brain tumor headache can be quite severe, and the pain typically worsens with activity. Seizures are also a common symptom along with changes in vision or smell, fatigue, memory problems, and personality changes. Diagnosis usually requires imaging with CT or MRI scans. Treatment will depend on the grade of the tumor determined following a biopsy along with the patient's age and the tumor's location. Treatment could involve surgery, chemotherapy, and/or radiation.
Pituitary apoplexy is rare but very serious. The pituitary gland is located at the base of the brain and produces several hormones. A pituitary apoplexy is diagnosed when blood flow is blocked to the gland or there is bleeding into it. Symptoms include a sudden and severe headache, double vision, low blood pressure, and personality changes. Surgery is often required if vision is affected. If not, hormones can be administered to treat the condition.
Traumatic brain injury – moderate or severe
After a head injury, up to 90% of patients will experience a headache. Most are tension related and not considered dangerous. However, other types of headaches can ensue, such as rebound headaches and cervicogenic headaches. Headaches after a traumatic brain injury can become an issue if they continue to get worse and cause vomiting, arm or leg weakness, and insomnia. Treatment will depend on the individual case. Mild headaches can be treated with over the counter medications while chronic headaches due to a brain injury may require the prescription of blood pressure medication or Botox injections.
A headache can be a sign of a stroke, or a condition in which blood flow to the brain is temporarily interrupted. A stroke is a medical emergency and requires immediate care. Headaches associated with strokes typically appear in one of two headache locations. If the stroke occurs in the carotid artery, the forehead will begin to ache. But if the stroke occurs in the back of the brain, the back of the head will hurt. If you experience a headache like nothing you've ever felt in your life and feel weakness in your face, arm, or leg, have an inability to speak or have double vision, call 911 immediately.
Chronic subdural hematoma
Severe head injuries can cause blood to collect outside of the brain. This is known as a subdural hematoma. There are various levels of severity when it comes to subdural hematomas. If chronic, veins can tear, making the condition more severe. Symptoms include a headache, sudden change in behavior after a head injury, dizziness, vomiting, and lethargy. With small acute subdural hematomas, the best treatment is observation. But for a chronic diagnosis, brain surgery is often required to reduce pressure on the brain.
A brain aneurysm is a bulge in a blood vessel in the brain. It can leak or rupture and cause bleeding in the brain or a subarachnoid hemorrhage. This is a life-threatening situation and requires immediate medical attention. Symptoms include a sudden and extreme headache, a stiff neck, vomiting, seizure, and loss of consciousness in the event of a ruptured aneurysm. An unruptured aneurysm will cause milder symptoms, such as numbness on one side of the face and unilateral right or left eye pain. Surgery is often required along with lifestyle changes to prevent the rupture of a brain aneurysm.
Bleeding from ruptured aneurysm in the space between the brain and surrounding membrane is called a subarachnoid hemorrhage (SAH). If untreated, the condition can lead to permanent brain damage or death. SAH is actually a form of stroke. Symptoms include a severe headache along with nausea and loss of consciousness. A CT scan is often used to diagnose the hemorrhage and treatment will focus on stabilizing your condition. Surgery or less invasive endovascular treatments may be needed to repair the aneursym.
Carbon monoxide poisoning
Carbon monoxide exposure if high enough in concentration or long enough in time of exposure will lead to replacing the oxygen carried in the blood. Serious tissue damage and death can occur. The gas is colorless and odorless so knowing the symptoms is crucial if you believe you've been exposed. These include a dull headache and nausea, blurred vision, dizziness, confusion, and loss of consciousness. If you believe you are suffering from carbon monoxide poisoning, get into fresh air immediately and call emergency medical help.
A couple of the best ways to prevent top of head pain is to find your trigger points, avoid them, and focus on making stress relief part of your daily routine. Whether you suffer from mild headache symptoms or debilitating pain, don't accept your fate without speaking to a doctor and reviewing your treatment options. There is hope beyond the headache.
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