What Does Your Headache Mean? A Guide to Signs and Treatment

Headaches are so common that many people just accept them as a routine part of life. A stressful week, a poor night’s sleep, dehydration or too much screen time can all leave your head throbbing. But for some people, headaches become frequent, disruptive or even debilitating.

Neurologist Kristen Steslow, MD, says the first step in understanding headaches is knowing where the pain actually comes from.

“The brain itself can’t feel pain,” Dr. Steslow explained. “So, all headache pain is created by pain-sensitive nerves.”

Those nerves are located in the face and scalp, in the muscles of the neck and shoulders, in the blood vessels of the head and in the meninges, which are the tissues that coat the brain. When those nerves become activated, they send pain signals. The way they are activated helps determine what type of headache a person is experiencing.


What’s Behind a Headache?

“Headache is a kind of umbrella term,” said Dr. Steslow. “Under that umbrella are different primary headache disorders, including migraines and tension headaches. There are also secondary headaches, which are caused by another medical condition.”

In tension headaches, pain-sensitive nerves are often triggered by muscle tightness in the neck and shoulders. Stress is a common contributor as well. The result is typically a steady, pressure-like discomfort.

Migraines, however, involve a more complex process inside the brain. They include changes in electrical activity that lead to the release of signaling molecules, including CGRPs, or calcitonin gene-related peptides. That signaling can cause blood vessels in the brain to tighten and widen, activating pain-sensitive nerves in the blood vessels and meninges.

Migraines can occur spontaneously, but they can also be triggered by a range of factors, including:

  • Alcohol
  • Barometric pressure changes
  • Bright lights
  • Chocolate
  • Hormonal changes
  • Poor sleep
  • Processed foods
  • Stress
  • Strong smells


Migraine vs. Tension Headache: How to Tell the Difference

Because headaches are diagnosed based on what they feel like, minor details can matter. “The way we treat primary headaches is by their phenomenology,” Dr. Steslow said. Phenomenology is the study of headaches and what it’s like to live with them. “Finding out what kind of headache we’re dealing with often results from a person telling you what it feels like from the inside.”

Migraines have a cluster of important features. “Unilateral throbbing is a core feature of migraine,” Dr. Steslow said. During a migraine, the pain is often on one side of the head, although it can switch sides. It typically lasts between 4 and 72 hours if untreated. Movement often makes a migraine worse, and it is frequently accompanied by nausea and sensitivity to light and sound.

During a tension-type headache, on the other hand, the sensation “feels more like pressure,” according to Dr. Steslow. It often feels like a band or halo around the head. The pain tends to be duller and more spread out. While there may be mild light or sound sensitivity, it typically does not include both, and nausea is uncommon.

Sorting out these patterns helps guide treatment. Some medications work well for migraines but not for tension-type headaches. This is why neurologists often ask detailed questions and may recommend keeping a headache diary to track symptoms and frequency.


Why Migraines Can Become So Disruptive

Migraines are extraordinarily common. They affect more than 10% of people worldwide, according to the American Brain Foundation. Migraines are one of the leading causes of neurologic disability.

For many people, migraines are episodic. This means that they, occur occasionally and respond to over-the-counter medications. Other people, however, develop chronic migraines. These are defined as severe headaches occurring more than half of the days in a month.

“As you can imagine, spending more than half the month with a headache would be pretty miserable,” said Dr. Steslow. “This is why people experiencing these types of headaches are encouraged to seek treatment.”

Migraine patterns can change over time. Illness, major stressors and other life changes can push episodic migraines into a chronic pattern.

One surprisingly common contributor is medication overuse. “Medication overuse is a really common way for a headache to become chronic,” Dr. Steslow explained. “When the brain is exposed to pain medication more than two or three times a week, it can cause more headaches. This is sometimes called medication overuse headache.”

Other factors that can increase headache frequency include:

  • Caffeine overuse
  • Illness
  • Medication overuse
  • Obesity
  • Stress
  • Tobacco use

Recognizing these patterns early can help prevent headaches from becoming more frequent and harder to control.


When a Headache Is Something More Serious

Most headaches are primary headaches, meaning they are not caused by another condition. Still, certain warning signs should prompt medical evaluation.

“If you’re debilitated by headaches, you should see a doctor,” Dr. Steslow said. “The same is true if you are taking headache medication frequently.”

There are also red flags that may suggest a secondary cause. Headaches accompanied by fever, chills or night sweats raise concern for infection or inflammation. Headaches with neurologic symptoms, such as weakness, facial drooping, numbness or confusion, require urgent care.

“If your headache comes on suddenly and gets really severe really quickly, we want to see you,” said Dr. Steslow, as a sudden severe headache can signal a bleeding blood vessel or another serious health condition.

Age is another factor when assessing headaches as signs of other conditions. If someone over 50 develops a new headache disorder, doctors are more likely to investigate with imaging, typically an MRI, to rule out underlying causes.

Positional headaches also warrant attention. If a headache worsens dramatically when you’re lying down or standing up, it may indicate abnormal pressure in the fluid surrounding the brain.


How Headaches Are Treated: A Layered Approach

“Treating headaches tends to be a combination of medication and modifying your lifestyle,” said Dr. Steslow.

Lifestyle factors can be particularly significant for reducing headaches. Poor sleep, skipped meals, dehydration and lack of physical activity can all increase headache frequency. Addressing sleep hygiene, regular meals, hydration and stress management can reduce headache burden.

Non-medication therapies can also help. “Physical therapy for the neck and shoulders can be really helpful,” Dr. Steslow said, particularly when muscle tension contributes to pain. Stretching, yoga and massage may provide additional relief.

For some patients, procedures can be a helpful treatment component. Trigger point injections can relieve tight muscle knots in the neck and shoulders. Nerve blocks can temporarily numb irritated nerves and sometimes help break a severe headache cycle. Botox injections, administered every three months, are also an established treatment for chronic migraines.

Traditional preventive medications for headaches and migraines include certain blood pressure medications, antidepressants and anti-seizure medications. If those are not effective or tolerated, doctors may move to migraine-specific therapies that target CGRP.

“Blocking CGRP, which is a pain signaling molecule, can stop a migraine,” Dr. Steslow said.

CGRP-targeting medications are often given as monthly injections. Over time, they can reduce both the frequency and severity of migraines. In headache medicine, success is typically defined as about a 50% reduction in headache days or intensity.

In severe cases, a combination of therapies may be needed.


Does Headache Location Mean Something?

People often wonder whether pain on the left side versus the right side means something specific. In many cases, the side of the headache alone does not indicate a serious problem.

However, certain patterns are more telling. A band-like pressure around the head is typical of tension-type headache. Shooting, burning pain from the base of the skull up the back of the head may suggest occipital neuralgia, a condition caused by nerve damage. Brief, shock-like facial pain triggered by chewing or brushing teeth may indicate trigeminal neuralgia, which can be caused by blood vessels affecting your nerves.

So, while it’s important to monitor your headaches, especially if they’re becoming frequent, the location might not be as important as the sensation.


When to Seek Specialty Care

If headaches interfere with work, school or family life, or if over-the-counter medications are no longer effective, it may be time to see a specialist.

Neurologists often ask detailed questions and may recommend tracking headaches in a diary to identify patterns and triggers. At National Jewish Health, headache care is integrated into the neurology program, where physicians with additional training in headache medicine can offer more specialized evaluation and treatment.

For people living with frequent or severe headaches, Dr. Steslow emphasizes that effective options exist.

“There are better ways to live than going through bottles of pain medication over and over again,” she said. And understanding the type of headache you have is the first step toward finding relief.