Headache

Call 999 or go to A&E if:

• you injured your head badly – for example, from a fall or accident
• the headache came on suddenly and is extremely painful (Thunderclap headache)
• You have an extremely painful headache and:
  • sudden problems speaking or remembering things
  • loss of vision
  • you’re feeling drowsy or confused
  • you have a very high temperature, feel hot and shivery, and have a stiff neck or a rash
  • the white part of your eye is red

See your GP or call 111 if you have any of the following symptoms:

• You have been getting frequent headaches, especially if they wake you from sleep or are associated with nausea or vomiting
• You have developed problems with speech, balance or memory or noticed changes in behaviour or personality
• Your headache is associated with scalp tenderness, blurred vision or pain in your jaw on eating
• You have or have had a type of cancer that can spread through the body or if you have an illness causing immune suppression such as HIV
• Your headaches have changed significantly in character, or you have developed headaches for the first time aged over 50

Working out the underlying cause of any headaches through discussion with your doctor is often the best way to solve them.

It is often helpful if you can complete a headache diary and bring this along to your appointment. You can find a link to a headache diary here: Headache diary

Common triggers for headaches include:

• Stress
• Lack of sleep
• Dehydration
• Too much alcohol
• Skipping meals
• Having a cold or flu
• Hormone changes in women
• Taking frequent doses of painkillers

Migraine, tension headache and medication-overuse headache are all very common. Most of the population will experience one or more of these.

Click here for more information on types of headache.

Most headaches, whilst unpleasant, are harmless and respond to simple measures.

The NHS.uk site has a helpful list of dos and don’ts which can be found here.

Aspirin is a good choice of painkiller. The usual dose is 300-900mg, up to 4 times a day.

Ibuprofen 400-600mg is a suitable alternative, again up to 4 times a day.

Paracetamol 1000mg up to 4 times a day is appropriate if you are unable to take either aspirin or ibuprofen.

For migraine headaches, it may be helpful to take an anti-emetic such as Metoclopramide to cope with nausea and vomiting.

Suitable over-the-counter options would be Paramax 500mg/5mg which contains Paracetamol and Metoclopramide or Migraleve Pink tablets, which contain Paracetamol, Codeine and Buclizine. Please follow the manufacturer’s dosage instructions.

Triptans are a group of drugs specifically for migraine headaches and may be suggested if over-the-counter medicines have not been effective. They can be prescribed by your doctor. They generally work best when taken near the onset of a migraine headache.

Please be aware of the risk of medication overuse headache with any of these painkillers and avoid taking too frequently. It is possible to develop a persistent (chronic) and continuous headache through taking simple painkilling medicines which you took to get rid of your headache. Your doctor can support you through the process of stopping painkillers if this is the case.

For further information on medication used to treat different types of headache, please refer to The Migraine Trust – Treatment Options.

If headaches are continuous or recurring frequently, it is often worth trying a preventive treatment. Please discuss this with your GP. Keeping a headache diary can be very helpful for you to track your progress and to monitor your response to treatment: The Migraine Trust Headache Diary.

In most cases, your doctor will be able to rule out serious problems such as a stroke or a brain tumour simply by finding out about the type of headaches you are experiencing and looking for other associated symptoms and signs. They may also suggest a trial of treatment. A scan may be considered if uncertainty remains. If they have a strong suspicion of a brain tumour, they will arrange an urgent scan and specialist referral.

Generally, this would be between you and your GP, but your GP may request specialist advice if they are uncertain of the diagnosis, or if you are not responding to medication as expected. This would entail a letter to a Consultant Neurologist or a GP with a specialist interest in headaches for advice, and would not necessarily lead to a face to face outpatient appointment, unless it was felt you would benefit from specialist treatment unavailable in primary care such as injections.