- What does a headache on top of the head mean?
- Ask the doctor: Headache and stroke
- Is Your Headache a Sign of Something Serious?
- Stroke and migraine
- What is a stroke?
- Is there a risk of stroke during a migraine attack?
- What do the statistics show about migraine and stroke?
- Why should young women with migraine with aura be at an increased risk of stroke?
- What are the implications?
- What about older people with migraine?
- Symptoms of New Daily Persistent Headaches
- TENSION HEADACHE
What does a headache on top of the head mean?
The following types of headache may cause pain on the top of the head:
1. Tension headache
Share on PinterestA tension headache may cause pain on the top of the head.
Most people experience tension headaches at times.
They describe them as a pain that feels as if it is squeezing or adding weight to an area, such as the top of the head. People will also feel pain in their neck or shoulders in some cases.
The pain from tension headaches is often described as dull and does not throb or pulsate. Tension headaches are usually uncomfortable but not severe.
2. Chronic headaches
Chronic headaches may be persistent sources of pain. Symptoms may mimic tension headaches, and they often cause pain near the top of the head. Lifestyle factors, such as stress and lack of sleep, can influence chronic tension headaches.
3. Migraine headache
Migraines are less common than tension headaches but can be more severe. Many people say the pain feels as if it radiates from the top of the head, along one side, or down the back of the neck.
The pain is often described as severe and throbbing, and it may be felt along with other symptoms, including nausea and extreme sensitivity to light or sound.
4. Brain freeze
Exposure to cold temperatures may cause a cold-stimulus headache or brain freeze. This can happen when eating a large piece of ice cream or consuming very cold drinks.
This type of headache is a sharp, severe pain that hits the top of the head and lasts only a few seconds. It disappears once the cold temperature in the head has gone.
5. Cluster headaches
As the name suggests, cluster headaches occur in groups. They appear suddenly on one side of the head, often behind the eye, and they cause severe pain. Nasal congestion or a runny nose, and a watery eye may accompany the pain.
People with cluster headaches may not be able to rest or find relief when they are having an attack.
6. Sinus headaches
Sinuses can become inflamed through sickness or infection, which could cause a pain in the sides and top of the head. The symptoms usually disappear once the underlying issue or infection has been treated, and doctors may recommend specific medications to help with inflammation.
7. Sleep headaches
Poor sleeping posture can bring on sleep headaches, also called hypnic headaches. Issues in the spine may become more pronounced during sleep, which could cause a headache on the top of the head after waking. Adjustments in posture may help with symptoms.
8. Occipital neuralgia
Share on PinterestHeadaches that are severe or long-lasting should be investigated by a doctor, as they may be caused by an underlying condition.
Occipital neuralgia is pain that occurs when nerves that lead from the spine to the top of the head are irritated.
This can cause pain in the back or top of the head and may also make people feel as if they have a tight band on their head.
People with occipital neuralgia may also experience tingling or jolts of shocking pain. Doctors will look to treat any underlying issue causing this nerve damage.
9. Overuse headaches
Taking too much medication can cause an overuse or a rebound headache. Many over-the-counter (OTC) medications used to treat headaches can lead to overuse headaches.
People with frequent headaches should avoid adding to the discomfort by not using OTC medications too much.
10. Sleep deprivation headaches
Lack of sleep or physical exhaustion can trigger a headache, even when someone is not prone to headaches.
The pain is often described as a heaviness or dull ache combined with sluggishness. If a person gets more sleep, it may reduce symptoms.
11. Exercise headaches
In some people, a headache may be triggered by sudden intense exercise, such as running sprints or having sex.
In some circumstances, such as when embarking on physical exercise, a person may be able to avoid symptoms by warming up first.
Ask the doctor: Headache and stroke
Published: May, 2011
Q. I have heard that one symptom of a stroke is “the worst headache you can imagine.” I recently had a migraine that was so much more painful than previous ones that I worried it was a stroke. Is there any way to tell a migraine from a “stroke headache”?
A. The term “stroke” covers several distinct events that differ in location and cause. Some types of stroke can trigger a headache; others usually don’t. To understand the connection, it’s helpful to know a bit about the brain and pain. Brain tissue, and the blood vessels embedded in it, doesn’t register pain. But the membranes that surround the brain and the blood vessels that run through them do register pain.
To continue reading this article, you must login.
Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School.
- Research health conditions
- Check your symptoms
- Prepare for a doctor’s visit or test
- Find the best treatments and procedures for you
- Explore options for better nutrition and exercise
Learn more about the many benefits and features of joining Harvard Health Online “
Is Your Headache a Sign of Something Serious?
Billie, a resident of Asheville, N.C., had a history of allergies and sinus headaches. One morning she woke up with dizziness, headache, and facial pain. “I thought it was just my sinuses that hurt,” she says. “But it didn’t get any better, and it was different from a sinus headache. My face hurt so much I didn’t even want to brush my teeth. So my husband called the doctor and he told us to come in right away. Turns out I had giant cell arteritis . If I had waited, the doctor said I might have had a stroke.”
Billie’s story serves as a warning that sometimes a headache is more than just a headache. In fact, a headache can be an early warning sign of more complicated and serious health issues such as stroke, infection, or high blood pressure. And it isn’t just seniors who should be alert to this symptom — a recent large study published in the journal Stroke found that the rate of stroke in pregnant women and new mothers increased by about 54 percent over a 12-year period, largely due to high blood pressure during pregnancy.
Headache: When You Should Call Your Doctor
When should you see your doctor about a headache? According to the American Headache Society, it’s helpful to remember the word “SNOOP,” which stands for:
- Systemic symptoms. In addition to a headache, you feel symptoms in other parts of your body. This could be a fever, loss of appetite, or weight loss. It also stands for secondary risk factors, so if you have a headache in addition to HIV or cancer, call your doctor immediately.
- Neurologic symptoms. These symptoms include confusion, blurry vision, personality changes, weakness on one side of the body, numbness, or sharp facial pain.
- Onset. This means that the headache happens suddenly, with no warning. Sometimes these are called “thunderclap” headaches. This can occur when headaches are caused by bleeding in the brain.
- Older. If you are older than 50 and experience a new or progressive headache, call your doctor. You could have giant cell arteritis or a brain tumor.
- Progression. There is cause for concern if it is significantly different than your other headaches, if headaches are happening more often, or it is the worst headache you have ever had.
Other serious causes of headaches include:
- Stiff neck, fever, and rash. They might indicate meningitis or other infections.
- Elevated blood pressure. It can also cause headaches, and can occur if you have never been diagnosed with high blood pressure, or when you have been diagnosed and your blood pressure gets out of control.
Stroke and migraine
What is a stroke?
A stroke occurs when part of your brain is deprived of its blood supply. There are two main types of stroke, one of which is suggested to have a link with certain types of migraine.
Migraine affects three times the number of women than men. The incidence of stroke in men is twice that of women. Several studies have shown that the risk of ischaemic stroke was increased in women aged 35 to 45 years old who had migraine with or without aura and was exacerbated by oral contraceptive use, smoking and high blood pressure. Ischaemic means a reduced blood and oxygen supply sometimes due to a clot. The other type of stroke is a haemorrhagic stroke, which is where a damaged or weakened artery bleeds into nearby tissue. The link of migraine to this type of stroke is small.
Whilst several studies have shown a relative increased risk of stroke in young women with migraine compared to people without migraine, in absolute terms this risk remains extremely small since stroke is rare in young people.
Is there a risk of stroke during a migraine attack?
Understandably, some people are afraid that their migraine is a symptom of a stroke and others worry that they are more at risk of a stroke during a migraine attack. There is little evidence to suggest that a stroke is more likely to occur during a migraine attack than at another time. Migraine is common. In some people migraine and stroke appear together but the nature of the causal relationship, if any, is difficult to establish firmly. Migrainous infarction is the term given to an ischaemic stroke occurring during a migraine attack.
In this condition aura symptoms are prolonged, and ischaemic stroke is confirmed by being shown in a brain scan. However, research suggests that such a stroke would be independent of the migraine attack. It is also possible for a person to have a stroke but for this to have been mistaken for a migraine attack. The migraine aura can mimic transient ischaemic attacks (TIAs). Conversely, in stroke, headache similar to migraine may occur.
What do the statistics show about migraine and stroke?
Evidence supporting migraine as an independent risk factor for ischemic stroke comes from a review in 2009 that included 25 studies. The following observations were noted:
- In nine studies, relative risk (RR) for ischemic stroke among subjects with any type of migraine was 1.73 compared to those without migraine. The increased risk was largely driven by participants who had migraine with aura. In contrast, the increase in risk for those who had migraine without aura was not statistically significant.
- In studies with available data stratification, the risk of ischemic stroke was significantly increased for the following subgroups:
- Women with migraine but not men
- Subjects with migraine <45 years of age
- Smokers who had migraine with aura
- Women currently using oral contraceptives who had migraine with aura.
The relationship of migraine with hemorrhagic stroke is supported by a review of eight studies which found that the overall effect estimate of hemorrhagic stroke for subjects with any migraine was 1.48.
A review published in 1997 looked at some of the studies in terms of 100,000 women per year. It was suggested that in women under age 35:
- those who do not have migraine and do not take the pill (i.e. the background risk): 1.3 per 100,000 women per year are at risk of stroke
- those who have migraine without aura but don’t take the pill: 4 per 100,000 women per year at risk of stroke
- those who have migraine with aura but don’t take the pill: 8 per 100,000 women per year are at risk of stroke
- those who don’t have migraine and take the pill: 5 per 100,000 women per year at risk of stroke
- those who have migraine with aura and take the pill: 28 per 100,000 women per year at risk of stroke
- those who have migraine without aura and take the pill: 14 per 100,000 women per year are a risk of stroke
To put this into context, other studies have suggested that 8 per 100,000 women per year might die in a road accident and 167 per 100,000 women per year might die from a smoking related problem.
A study in America in 2004, called the Women’s Health Study, looked at 39,754 female health professionals. During the 9 years of the study there were 309 ischaemic strokes in the total population in the study, so there was a total incidence of 8 ischaemic strokes per 100,000 women (0.008%). This includes women with and without migraine aura, so it can be seen that although the relative risk is seemingly high, the actual risk is extremely small. This study confirmed previous studies suggesting that the association between migraine aura and stroke risk was greater in younger than in older women (in this case meaning women under age 55). The higher risk with aura will also include those who have other medical conditions that increase the risk of stroke and which can be associated with aura symptoms rather than true migraine aura. These conditions include some blood clotting disorders and heart conditions. The diagnosis of migraine and migraine aura was self-reported so is subject to bias (that is, there was not an objective person to make the diagnosis).
Why should young women with migraine with aura be at an increased risk of stroke?
The mechanism of the increased risk of ischaemic stroke in young women with migraine remains unknown. It does not seem to be due to an increase in conventional risk factors such as diabetes, high blood pressure and raised cholesterol levels. There are frequent reports of discoveries of differences between people with and without migraine, for example, the recent attention given to patent foramen ovale (PFO) or hole in the heart in patients with migraine with aura. However, these characteristics are not consistently found in people with migraine compared with people without migraine and they show no sex difference, so that they cannot explain why the increased risk of ischaemic stroke in migraine is statistically significant in young women. Some recent studies suggest that aura is associated with adverse cardiovascular risk profile and prothrombotic factors (tendency of blood to clot). Research is continuing to look into this area in the hope of discovering more about the complex relationship between migraine with aura and ischaemic stroke, and any underlying vascular differences between people with and without migraine.
What are the implications?
Whatever the underlying mechanism, the practical implications of the increased ischaemic stroke risk in young women with migraine with aura are relatively clear: when the low absolute risk and its increase by cigarette smoking are taken into account, the first recommendation is not to smoke.
The Faculty of Family Planning and the Family Planning Association guidelines confirm that best practice is to contraindicate the combined contraceptive pill for use by women who have migraine with aura, which is also in line with World Health Organisation recommendations. The risk for women with migraine without aura is lower and other risk factors like smoking are far more likely to increase stroke risk than migraine. However, in practice, given the very low absolute risk of stroke in young women, there is no systematic contraindication to oral contraceptive use but rather a firm recommendation for no smoking and for the use of low oestrogen or progestogen only pills particularly for women with migraine with aura. It is important however that women with migraine who are taking the pill do not decide to suddenly stop taking it without discussing this with their doctor.
Being ‘at risk’ of stroke does not mean dying from a stroke. Around 25% of people who have stroke recover, and another 50% will have a disability after a stroke.
What about older people with migraine?
Migraine is considered to be insignificant as a risk factor for stroke after the age of 50 years. This is because the usual risk factors for ischaemic stroke are high blood pressure, obesity, raised blood cholesterol levels, smoking and older age. These factors tend to combine with each other and, with advancing age, the risk of stroke due to migraine becomes insignificant in comparison with the other risk factors.
Migraine with aura stands out as a stroke risk of young women because it affects people before the usual and more significant age-related factors apply. In addition migraine tends to improve in later life.
- The Stroke Association website
Symptoms of New Daily Persistent Headaches
The pain of NDPH becomes steady within 24 hours of its start. It may feel similar to a tension or migraine headache.
You may have pain on both sides of your head. At the same time, you may be sensitive to light or sound.
Most headaches are throbbing in nature. But they can come on as a stabbing, aching, tightening, or burning pain.”
There are other serious causes of head pain that can lead to a sudden headache. Your doctor may order imaging tests such as an MRI or a CT scan to rule out conditions that may need immediate treatment. These include:
A change in pressure or volume of fluid in your spine. This can sometimes be due to procedures such as a lumbar puncture, or “spinal tap.”
Meningitis. An infection that causes swelling of the membrane that covers the brain and spinal cord.
Head injury. A blow to the head can trigger a sudden, severe, and persistent headache. It can also cause an area of bleeding on the brain, known as subdural and epidural hematoma, that can trigger head pain.
Blood clots. Cerebral venous sinus thrombosis is a condition where blood clots form near the brain, causing chronic head pain and other dangerous complications.
Dural sinus thrombosis (DST), also known as cerebral venous thrombosis, describes thrombosis of cortical and deep cerebral veins as well as that of the dural sinuses. DST is relatively rare (the cause of 1% of acute strokes) and has a nonspecific clinical presentation; thus, it is frequently a delayed or missed diagnosis. A high level of clinical suspicion and proper imaging techniques are critical for prompt diagnosis and treatment. The site of thrombosis is variable, with the superior sagittal sinus most commonly involved, followed by the transverse, sigmoid, and cavernous sinuses (1).
DST results from a multistep process. Virchow’s triad of venous thrombosis includes endothelial injury, venous stasis, and hypercoagulability; any or all of these may be present (2). DST usually begins with a partially occlusive thrombus within the dural sinus that progresses to obstruct the involved dural sinus and then extends to bridging cortical veins. Increased venous pressure results, with breakdown of the blood-brain barrier, vasogenic edema, and then hemorrhage. Up to 50% of cases of DST progress to venous infarction. Venous infarctions are frequently bilateral, parasagittal, and hemorrhagic. Petechial perivascular hemorrhages may also be seen with cortical venous infarcts. If thrombosis and occlusion of the straight sinus occurs, bilateral thalamic infarcts may result.
Although numerous systemic diseases and conditions predispose to DST (>100 have been described), approximately 25% to 40% of cases occur with no identifiable cause (1, 2). Common predisposing conditions include dehydration, trauma, pregnancy, oral contraceptive use (present in the current case), coagulopathies (protein C and S deficiency and factor V Leiden deficiency most commonly), and association with arteriovenous malformations or arteriovenous fistulas. Local infection (sinusitis, otitis, meningitis) remains a common cause of DST through direct spread of infection and alterations in the coagulation pathway. Because of more effective antibiotics, infection has decreased as a cause in past years. Local or invading tumors, particularly meningiomas, can also be associated with DST. Hematologic illnesses, particularly leukemia and sickle cell disease, have been reported to cause DST (1). Systemic diseases such as vasculitis, thyrotoxicosis, or inflammatory bowel disease are also reported but are less commonly associated with DST. All age groups and both sexes can be affected; however, the disorder is more common in young women and aging adults.
Although the clinical presentation of DST is variable, headache is the most common symptom and is believed to be secondary to increased intracranial pressure. Nausea, vomiting, visual changes, focal neurologic deficits, and seizures are other symptoms associated with DST. When cavernous sinus thrombosis is present, eye pain, ophthalmoplegia, pupillary changes, and retinal hemorrhages may occur. Intraparenchymal hemorrhage and infarcts are more serious presenting clinical findings. If DST is secondary to central nervous system, ear, nose, or throat infections, alterations in mental status and fever are commonly reported. The clinical presentation may vary from asymptomatic to coma or profound neurologic deficit.
Although computed tomography (CT) is usually the first diagnostic imaging examination performed in patients with suspected DST, MR imaging is the preferred modality for diagnosis of the disorder. MR venography is especially useful. With MR techniques, the clot can be directly visualized, the extent more accurately characterized, and associated cerebral ischemia or hemorrhage more completely evaluated. MR signal characteristics vary with the age of the thrombus, with the acute clot appearing isointense when compared with normal brain on T1-weighted images and hypointense on T2-weighted images. In the subacute stage, the signal is hyperintense compared with that of normal brain parenchyma on both types of imaging sequences. Associated cerebral edema will typically be hyper-intense on FLAIR and T2-weighted images. When DST has progressed to venous infarction, contrast enhancement of the infarcted parenchyma can be seen secondary to blood-brain barrier breakdown, which may mimic an enhancing mass. The differential diagnosis includes giant arachnoid granulations (mimicking a filling defect in the sinus) and a congenitally hypo-plastic transverse sinus. Although conventional cerebral angiography was the standard in diagnosing DST in years past, it is now indicated only when MR imaging is nondiagnostic or when intervention is desired.
Management of DST involves 1) a diagnostic workup to determine any underlying conditions or causes, such as infection or a mass, 2) aggressive treatment of the cause, and 3) supportive care for associated symptoms. In cases of septic thrombus that is associated with central nervous system, ear, nose, or throat infections, antibiotic therapy is the mainstay of treatment. Treatment with antithrombotics such as heparin is controversial (3, 4).
More recently, interventional neuroradiologic techniques have been used to deliver thrombolytic agents directly to the clot. Reported series are small, but the results are promising. Most authors describe the following basic endovascular treatment technique. Cerebral venography is performed to determine the extent of venoocclusive disease. Afterward, a microcatheter is maneuvered into the dural sinus system and, ideally, is placed across the clot. Unlike systemic delivery, this method allows the thrombolytic agent to be infused directly into the clot. The micro-catheter is then left in place for continuous infusion of the thrombolytic agent. After approximately 18 to 24 hours, the patient is reexamined with venography to determine if the sinus is patent or if repeat direct thrombolysis is needed (2). Initial results of endovascular treatment have been encouraging, with little morbidity reported in stable candidates.
A tension headache is head pain that results from muscle tightening (contraction) in the neck and head. The muscle contraction leads to a slight decrease in blood flow to the surrounding areas and an irritation of pain fibers in the skin, muscles, and blood vessel walls.
WHAT CAUSES IT?
The causes are unknown. Anxiety, depression, and emotional conflicts are often associated with tension headaches. Headaches may also result from muscle strain associated with injury to the neck muscles. An abnormality in the bones at the back of the neck (cervical vertebrae) or in the area where the mouth opens and closes (temporomandibular joint) may also put tension on the surrounding muscles and lead to a tension headache. On occasion, a child who has been incorrectly fitted with glasses may suffer from a tension headache due to eye muscle strain.
WHAT ARE ITS COMMON SYMPTOMS?
More than 90 percent of tension headaches are on both sides of the head. The headache is often described as a pressure or band-like sensation around the head. The dull, steady pain builds gradually and is often intense at the end of the day. In some individuals, the headache continues day and night. Even after sleep, the headache may still be present.
IS IT CONTAGIOUS?
HOW LONG WILL IT LAST?
Tension headaches may last a few hours, several days, weeks, or even months.
HOW IS IT TREATED?
Treatment for this problem consists of two important parts: (1) what you can do, and (2) what your health care provider can do.
- Some people get relief by applying heat to the area of the head or neck where the pain is most severe. Apply heat in the form of a dry towel warmed in the oven, or use a heating pad on a low setting for brief time periods. Other people gain relief by applying an ice bag wrapped in a towel to the painful area.
- A gentle fingertip massage over the area just in front of and above the ears (temporal area) may reduce the pain.
- Lying down and relaxing may also help to decrease the pain. Many people find concentrating on a soothing thought or image while taking slow, deep breaths helps them relax.
- Record on a calendar the date of the headache, the time it started and ended, the amount of medication you took. Remember to brink this record with you on follow-up visits to your health care provider. It will help in your treatment.
WHAT CAN YOUR HEALTH CARE PROVIDER DO?
If the cause of the tension headache is a cervical vertebrae or temporomandibular joint problem, medical correction of the condition will be necessary. Incorrectly fitted eyeglasses must be refitted if they are the cause of tension headaches. A neck injury that is contributing to a tension headache can be helped with supportive collar, which allows the muscles in the neck to rest and relax.
Medications are needed for some individuals. Your health care provider may prescribe one or more of the following medications.
- Analgesics — These medicines reduce the pain of a tension headache.
- Muscle relaxants — These medications aid in relaxation by causing sedation and decreasing anxiety. They have little or no direct effect on relaxing the muscles of the head and neck that contribute to the headache. Some of these medications can become addictive.
CAN YOU PREVENT IT?
Because tension headaches recur in some individuals for years and because continual use of medication can lead to serious side effects, prevention is a key aspect in the management of tension headaches.
Tension headaches are often a response to stress, anxiety, and emotional conflict in a person’s life. It is important to find ways to reduce these conflicts. Regular exercise (e.g., walking, biking, swimming) and relaxation techniques (e.g., yoga, meditation) may help you. Exercise and relaxation not only reduce stress but also decrease the severity of head pain. A trained counselor can help provide assistance to identify the stresses in your life and make suggestions to resolve the problems.
It is a myth that tension headaches are inherited. However, people tend to imitate the stress reduction and responses of those around them. They may develop a tension headache as a result of ineffective stress management.
It is important to return for your follow-up care as advised.
Call your local community center, YMCA, YWCA, or adult education program for information about classes in yoga, meditation, aerobic dance, or other exercise classes. A community mental health center can assist in an evaluation for stress and make a referral to a counselor for you.
Notify your health care provider if you have any of the following:
- Changes in vision
- Difficulty speaking
- Numbness or tingling in your arms or legs
- Marked change in severity of your headache
- Sudden onset of a fever with a headache
- Difficulty walking
- Questions concerning the symptoms you are experiencing
Information provided by University of Illinois Health Resource Center