Know What’s Causing Your Headache

The best way to get rid of a headache quickly may depend on what’s causing it, or what type of headache it is. Some common and less common types and causes of headache include the following:

Tension-type headaches are the most common headaches. They tend to cause a dull, pressure-type pain on both sides of the head.
Migraine is also common, affecting nearly 40 million Americans. Migraine attacks tend to cause throbbing pain on one side of the head, often accompanied by nausea, vomiting, dizziness, tingling or numbness, visual disturbances, and sensitivity to light, touch, smell, or sound.
Consuming too much alcohol results in a hangover, or a headache that’s accompanied by thirst, fatigue, or nausea.
When a sinus infection is the cause of a headache, it typically occurs alongside nasal congestion, nasal discharge, decreased sense of smell, and a feeling of pain, pressure, or fullness in the sinuses. Many so-called sinus headaches are actually migraine attacks.
COVID-19 can cause headaches with migraine-like or, more commonly, tension-headache characteristics, research published November 11, 2021, in Current Pain and Headache Reports found. Headache can be the first symptom of a COVID-19 infection, and the pain can persist for days or weeks.
Cluster headaches, which are rare, cause severe pain, usually on one side of the head, that lasts from 15 minutes to three hours when untreated. They are accompanied by a runny nose and tears in the eye on the same side of the head as the headache. For most people, cluster headaches occur in a series, or in “clusters,” lasting weeks or months, separated by remission periods of months or years.
A brain aneurysm is a weak or thin spot in an artery in the brain that can bulge or rupture, causing bleeding in the brain. The pain caused by a brain aneurysm is often described as the “worst headache you’ve ever had,” and it may be accompanied by such symptoms as dilated pupils, blurred or double vision, pain above and behind an eye, weakness, numbness, or difficulty speaking. If you experience these symptoms, seek medical help immediately.

If headaches are disrupting your life and they don’t respond to the treatments you try, see your doctor for diagnosis and treatment.

Over-the-Counter Medication for Tension Headache Relief

Just about any over-the-counter (OTC) pain reliever, or analgesic, can offer relief for tension headaches, says Jack M. Rozental, MD, PhD, an associate professor of neurology and a headache specialist at Northwestern University’s Feinberg School of Medicine in Chicago.

Medication that contains only one drug, like Tylenol (acetaminophen), Advil (ibuprofen), Aleve (naproxen), or aspirin are effective headache treatments, he says, as are those that include a combination of aspirin, acetaminophen, and caffeine.

These pain relievers may also provide relief for hangovers and for headaches related to sinus infections or COVID-19. Some people who have migraine attacks also find them effective, particularly if taken at the first sign of an attack.

How quickly OTC pain relievers work depends in part on what formulation you take. For example, liquid medicines, orally disintegrating tablets, and chewable tablets will work faster than extended-release pills. How full your stomach is when you take these pain relievers matters, too, with a fuller stomach slowing absorption of the medication.

Your doctor or pharmacist can help you choose among the many OTC pain relievers on the market to make sure you’re using a product that’s safe for you and is likely to help.

Frequent use of OTC analgesics and caffeine-containing medications can lead to medication–overuse headache (see below), so judicious use is recommended.

Prescription Painkillers for Frequent Tension Headaches

For those people who have frequent or recurring tension headaches, doctors sometimes recommend prescription-strength doses of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.

Indocin (indomethacin), an NSAID that is available only by prescription, is "usually used for arthritis, but can also be very useful as a headache treatment," Dr. Rozental says. "Indomethacin's downside is that it is among the drugs most likely to cause gastric irritation as a side effect," including stomach ulcers and bleeding. It can also harm kidney function if taken at high doses or chronically.

Treatments for Quick Migraine Relief

Treating migraine symptoms right away can shorten the attack, which otherwise can last from hours to days.

The types of medications that can alleviate symptoms once a migraine attack has started are known as acute, or abortive, medications. These include OTC pain relievers such as aspirin and ibuprofen, prescription medications called triptans, and a new class of drugs called CGRP receptor antagonists.

Not everyone with migraine will respond to all of these drugs. You may need to try several before finding the drug or combination of drugs — and the doses — that work best for you.

Triptans There are currently seven triptan drugs available in the United States: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig).

All triptans are available in pill form; two, sumatriptan and zolmitriptan, come as a nasal spray; and one, sumatriptan, is sold in an injectable form.

Triptan injections start working in about 10 minutes, nasal sprays start working in 10 to 15 minutes, and most pills start working in 30 to 60 minutes, although the longer-acting triptans, frovatriptan and naratriptan, take one to three hours to start working.

CGRP receptor antagonists Sometimes referred to as “gepants,” two CGRP receptor antagonists, rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy) are available for acute treatment of migraine. Both are oral tablets that start reducing pain in about one hour. These drugs may be alternatives for people who can’t take triptans or don’t get relief from them.

Lasmiditan (Reyvow) Lasmiditan is also available as an oral tablet and can alleviate migraine pain in as little as an hour. Because lasmiditan works differently from triptans, it may also be an alternative for people who can’t take triptans or don’t get relief from them.

Dihydroergotamine (DHE) Intravenous DHE is commonly used in emergency departments to relieve intractable migraine. For home use, it’s available as a nasal spray, Migranal and Trudhesa, and an injection, D.H.E. 45, and is most effective when taken soon after the onset of migraine symptoms for attacks that typically last longer than 24 hours, according to the Mayo Clinic.

While Migranal and Trudhesa contain the same drug, Trudhesa delivers the drug higher in the nasal cavity, an area rich in blood vessels, meaning it should start working faster.

Ergotamine Combinations of ergotamine and caffeine — Cafergot, sold as a tablet, and Migergot, a rectal suppository — are less effective than triptans at resolving migraine pain but may be appropriate for some people. They can relieve pain within 30 minutes, according to MedlinePlus.

Neurostimulation devices A nondrug option for migraine treatment is a neurostimulation, or neuromodulation, device, which delivers electric or magnetic pulses to nerves that are directly or indirectly involved in pain processing. Several devices targeting different nerves are available, and all can be used for acute treatment of migraine. All are most effective when used as early as possible after the start of symptoms.

Anti-nausea drugs The drugs used to treat headache caused by migraine may also relieve other symptoms, including nausea. But if your migraine therapies are not relieving nausea and vomiting, speak to your doctor about prescription anti-nausea drugs.

Acute Treatment for Cluster Headaches

Given the severity and also the relative brevity of cluster headaches, acute treatments need to work quickly to relieve pain and suffering. According to the neurologist and headache expert Peter J. Goadsby, MBBS, MD, PhD, writing for the American Headache Society, effective acute treatments for cluster headaches include:

Inhaled oxygen
Injected or nasal triptans
Injected dihydroergotamine
Topical lidocaine nasal drops or nasal spray

According to the patient advocacy group Clusterbusters, high-flow 100 percent oxygen will abort a cluster headache attack within 15 minutes for most people.

Another option for treating cluster headache is the drug galcanezumab (Emgality), which in 2019 became the only drug specifically approved for this type of headache. It’s also approved for the prevention of migraine attacks. Emgality belongs to a class of drugs known as calcitonin gene-related peptide (CGRP) antibodies.

When used to treat cluster headaches, Emgality is self-administered using three 100 milligram (mg) prefilled syringes, which are taken one after the other at the start of a cluster period and then every month until the end of the cluster period.

The nerve stimulation device GammaCore Sapphire is also FDA-approved to treat cluster headache. The device is held against the front of the neck to stimulate the vagus nerve during an attack.

Home Remedies to Ease a Headache or Migraine Attack

Many headache symptoms can be at least partially alleviated without medication. Here are some tips for homemade headache and migraine relief.

Apply an ice pack to your head and neck. Cold compresses on the head and neck are a common home remedy to ease the pain of a migraine attack. Some people also find it helpful for tension headaches. To avoid skin injury, wrap the ice or cold pack in a cloth and apply it for no more than 15 to 20 minutes at a time.

Apply heat to the head, neck, or hands and feet. Applying heat may help relieve a tension headache or dull the pain of a migraine attack, according to the Mayo Clinic. Use a heating pad set on low, a hot-water bottle, a warm compress, or a hot towel. A hot bath or shower may also be helpful, or simply run warm water over your hands and feet.

Have a big glass of water. Dehydration can trigger a migraine attack or lead to a nonmigraine headache, says the National Headache Foundation. Replacing the liquids your body needs may help to relieve the pain.

Practice a relaxation technique. Meditate, breathe deeply, and try to visualize a peaceful image. "Various relaxation techniques can significantly help patients who suffer from 'muscle contraction' headaches," says Rozental.

Give yourself a massage. Massage eases muscle tension, and sometimes helps to reduce headache pain, according to the Mayo Clinic. Gently massage your temples, scalp, neck, and shoulders with your fingertips, or gently stretch your neck.

Try acupressure. You may be able to reduce migraine and headache pain by massaging the pressure point located in the “V” between the thumb and forefinger. Use the thumb of one hand to massage the other hand with a circular motion for 15 to 20 seconds, then switch hands.

Drink a caffeinated beverage. In small amounts, caffeine can decrease migraine-related pain in the early stages of an attack or enhance the pain-reducing effects of OTC medication, according to the Mayo Clinic. But don’t overdo it: Too much caffeine too frequently can lead to withdrawal headaches if you later cut back quickly. Caffeine can also contribute to medication-overuse headaches (see below).

Dab on some peppermint oil. Rub some peppermint oil into your temples or forehead to see if this natural remedy helps reduce your head pain, suggests Migraine.com. Because peppermint oil can cause skin irritation, you may wish to mix a drop of peppermint oil into a teaspoon or two of a neutral oil such as jojoba or avocado oil to dilute it first.

Close your eyes and rest. This is an effective treatment for headaches associated with migraine, and it can help ease a tension headache as well. Sit or lie down in a quiet, dark room with your eyes closed and just relax for a bit. "Patients with migraine instinctively seek out a dark, quiet environment in which they can go to sleep for at least a few hours,” Rozental says. “Sleep frequently diminishes or eliminates the pain."

Self-Care Tips to Prevent Headaches and Migraine Attacks

You may be able to prevent some headaches and migraine attacks by avoiding the triggers that set them off. Here are some wellness tips that may help.

Get enough sleep. Lack of sleep can lead to a headache or trigger a migraine attack, and a chronic lack of sleep — caused by sleep apnea, for example — can also cause headaches. If you snore or suspect you have sleep apnea, see your healthcare provider for help. Whether or not you snore, try to go to bed and get up at the same time every day to avoid triggering a migraine attack.

Maintain healthy eating habits. What you put into your body and when can have a big impact on your headaches. Rozental observes that regular meals are important, especially for people who get headaches from low blood sugar. "Do not skip meals, particularly breakfast,” he says. It’s also important to eat a healthy diet rich in fruits, vegetables, and whole grains, according to the Mayo Clinic.

Manage your stress. Stress can act as a trigger for both tension headaches and migraine attacks, so find ways to manage your stress level, whether through a meditation practice, working with a psychotherapist, exercising regularly, or a combination of approaches.

Avoid cigarettes. Smoking tobacco can trigger migraine attacks and nonmigraine headaches in both the person who smokes and in those exposed to secondhand smoke, according to a study from the Spanish Foundation for Science and Technology.

Limit your alcohol intake. Too much alcohol can lead to a hangover in anyone. For some people with migraine, any type of alcohol is a trigger for a migraine attack, and for others, only certain types of alcoholic drinks trigger attacks. Learn some tips for drinking safely from MigraineAgain.

Keep a food journal. Write down everything you eat and drink for a period of time to determine whether a certain food or beverage may be triggering your migraine attacks.

Exercise regularly. Exercise releases chemicals in your body that block pain signals to the brain and can help prevent tension headaches and migraine attacks, according to Mayo Clinic. But start slowly; overdoing it with vigorous exercise can trigger some types of headaches.

Maintain a healthy weight. In younger people, up to about age 50, obesity raises the risk of migraine. And in people with episodic migraine, it raises the risk of chronic migraine.

Consider taking supplements. Supplements like riboflavin (vitamin B2), coenzyme Q10, and magnesium (if your level is low) may help prevent migraine attacks, according to the U.S. National Library of Medicine. Butterbur is an herbal remedy that some people take to prevent migraine attacks, but some experts caution against it because of possible liver toxicity. Always talk to your healthcare provider before taking any supplement.

How to Treat Medication-Overuse Headaches

Frequent use of any acute headache medication, including OTC drugs, can cause what are known as rebound, or medication-overuse, headaches, says Rozental. By definition, a medication-overuse headache occurs on 15 or more days of the month as a consequence of regular overuse of acute or symptomatic headache medication.

The only way to stop medication-overuse headaches is to stop using the drug or drugs that are causing them. However, this process can be uncomfortable and cause worsening of the headache, among other symptoms, according to the Migraine Trust. If you think you may have medication-overuse headache, speak to your doctor or a neurologist trained in chronic headache management.

Am I at Risk for Chronic Daily Headache?

Anyone who has recurrent acute headaches and who uses short-acting medication or techniques to treat them is at risk of developing chronic daily headache, which is characterized by headache symptoms 15 or more days of the month over three months.

The two most common types of chronic daily headache are chronic migraine and chronic tension-type headache, although people diagnosed with chronic migraine often also have symptoms of chronic tension-type headache, and vice versa.

Individuals with chronic daily headache often also have a diagnosis of medication-overuse headache.

If your head pain or other symptoms cause you to frequently take short-acting medication, talk to your doctor about being referred to a headache specialist, who should be able to identify medical treatments as well as lifestyle or behavioral changes that can prevent your symptoms while also reducing your reliance on acute medications.

Additional reporting by Ingrid Strauch.