Skip to main content

Health condition · Clinically reviewed

Headaches, the types, the red flags and the treatments that actually work.

Almost everyone gets them, but the label hides a family of very different disorders. A structured approach beats a pill for every ache.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG150, BASH and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including CGRP monoclonal antibodies, gepants and specialist headache pathways.

Key facts

Headaches at a glance.

The essentials, in plain English - how common they are, the main types and how they are treated in the UK today.

  • How common

    Up to 90 per cent of adults experience a headache in any given year and headache disorders sit in the WHO top ten causes of disability.

  • Primary vs secondary

    Primary headaches (tension-type, migraine, cluster) are their own disease; secondary headaches are caused by something else and can be serious.

  • Tension-type

    The most common pattern - a band-like, bilateral, non-throbbing ache without aura, nausea or light sensitivity.

  • Migraine

    Unilateral, throbbing, often with aura, nausea, photophobia and phonophobia. See our dedicated migraine guide.

  • Medication overuse

    Regular use of painkillers or triptans on 10 to 15 days a month can flip an episodic headache into a daily one.

  • Red flags matter

    A thunderclap onset, new headache after 50, fever, focal signs or waking pain deserves urgent assessment.

Why this guide matters

One name, many disorders.

A tension-type headache and a cluster headache share a word and almost nothing else. The three points below shape every choice on this page.

  • Get the type right

    The right label - tension-type, migraine, cluster, MOH, secondary - unlocks a treatment plan that actually works.

  • Screen for red flags first

    Most headaches are benign but the small minority that are not need same-day imaging and specialist review. SNOOP10 makes that reliable.

  • Preventives change lives

    For frequent migraine or cluster, modern preventives - CGRP monoclonals, gepants, botulinum toxin - transform daily life.

How the diagnosis is made

From first attack to a clear plan.

The steps a UK GP or specialist headache clinician will normally follow, in the order laid down by NICE NG150.

  1. 01

    Assessing

    Structured history and diary

    Onset, pattern, triggers, associated features and family history. A two to four week headache diary sharpens the picture faster than any test.

  2. 02

    Assessing

    SNOOP10 red-flag screen

    Systemic, neurological, onset, older age, pattern change and ten more prompts that flag secondary causes needing urgent work-up.

  3. 03

    Assessing

    Medication and caffeine tally

    Counting analgesic, triptan, opioid and caffeine days per month uncovers medication overuse headache before it entrenches.

  4. 04

    Confirming

    Focused examination

    Blood pressure, fundoscopy, cranial nerves, neck, temporal arteries, TMJ and sinuses guide whether imaging is needed.

  5. 05

    Confirming

    Neuroimaging when indicated

    MRI (or CT for suspected bleed) is reserved for red flags, a clear change in pattern or focal signs, in line with NICE NG150.

  6. 06

    Planning

    Classification and plan

    Type of headache set against the ICHD-3 framework, then a plan combining lifestyle, acute and preventive treatment.

  7. 07

    Planning

    Specialist referral

    Diagnostic doubt, treatment failure, chronic migraine or cluster headache benefit from a commissioned headache service.

Typical timeline: a first visit to a settled plan in weeks, not months.

Types and patterns

What different headaches actually look like.

The main primary and secondary patterns clinicians recognise - and the red-flag features that mean it is time to escalate.

  • Tension-type pattern

    Bilateral, pressing or tightening band around the head, mild to moderate, not worsened by routine activity.

  • Migraine pattern

    Unilateral, throbbing, moderate to severe, with nausea, photophobia and phonophobia and often an aura beforehand.

  • Cluster pattern

    Strictly one-sided, stabbing peri-orbital pain in bouts with tearing, nasal blockage or a droopy eyelid on the same side.

  • Medication overuse

    A chronic daily headache that improves briefly with analgesia then returns - the classic rebound cycle.

  • Cervicogenic and TMJ

    Pain arising from the upper neck or jaw joint, reproduced on movement or palpation and often one-sided.

  • Hormonal triggers

    Menstrual migraine, contraceptive-related and perimenopausal headache follow the hormonal cycle in a recognisable way.

  • Post-concussion headache

    Persistent daily headache after a head injury, often mixed migraine and tension-type in character.

  • Red flag - thunderclap onset

    A severe headache peaking within seconds to a minute needs same-day assessment to exclude subarachnoid haemorrhage.

For the full ICHD-3 classification and less common syndromes - hypnic, exercise, cough, hemicrania continua and paroxysmal hemicrania - see our headache syndromes guide.

Treatment

How headaches are treated in the UK.

A stepped approach that matches treatment to type - lifestyle first, targeted acute relief next and modern preventives for frequent or disabling attacks.

  • Lifestyle foundations

    Sleep regularity, hydration, meals, stress management, measured caffeine and paced exercise reduce frequency across every primary headache type.

  • Tension-type acute care

    Paracetamol or an NSAID such as ibuprofen used sparingly, alongside heat, posture work and short courses of physiotherapy.

  • Tension-type prevention

    Low-dose amitriptyline at night, cognitive behavioural therapy and physiotherapy for episodes tipping into chronic patterns.

  • Migraine acute therapy

    Triptans, gepants and ditans taken early in the attack, with an anti-emetic where nausea is prominent. See our migraine guide.

  • Migraine prevention

    Propranolol, topiramate or candesartan first, then CGRP monoclonal antibodies and, in chronic migraine, botulinum toxin.

  • Cluster headache

    High-flow oxygen and subcutaneous sumatriptan for attacks; verapamil, galcanezumab and gammaCore for prevention through specialist services.

  • Medication overuse withdrawal

    A planned withdrawal of the offending analgesic or triptan, with bridging treatment and specialist support to break the cycle.

  • Secondary headache pathways

    Treatment is directed at the underlying cause - giant cell arteritis, IIH, sleep apnoea, glaucoma or blood-pressure control as appropriate.

Complex or refractory patients are managed through specialist commissioned centres (Queen Square, King's College Hospital and Great Ormond Street for paediatric care), often alongside CGRP monoclonal antibodies, botulinum toxin and multidisciplinary support from the Migraine Trust, National Migraine Centre and OUCH UK.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or neurologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Headaches in over 12s: diagnosis and management (NG150).

  • British Association for the Study of Headache (BASH). National headache management guideline for adults.

  • International Headache Society. ICHD-3 classification of headache disorders.

  • NICE. Migraine - prophylaxis in adults, technology appraisals on CGRP monoclonal antibodies and gepants.

Red flags · SNOOP10

When a headache needs urgent attention.

Most headaches are benign. These are the situations that are not - and where same-day assessment or specialist review is required.

  • Thunderclap headache

    Severe pain peaking within seconds needs same-day imaging and lumbar puncture to exclude subarachnoid haemorrhage.

  • New headache after 50

    Especially with scalp tenderness, jaw claudication or visual loss - urgent assessment for giant cell arteritis is essential.

  • Focal neurology or reduced consciousness

    Weakness, speech disturbance, ataxia, seizure or drowsiness with a headache is a same-day hospital assessment.

  • Fever, neck stiffness or rash

    Suspect meningitis or encephalitis - do not delay for imaging if the picture is clear, treat and refer immediately.

  • Worse on waking, coughing or straining

    Postural or Valsalva-driven headache raises suspicion of raised intracranial pressure, a mass or a CSF disorder.

  • Papilloedema on fundoscopy

    Swollen optic discs indicate raised intracranial pressure - urgent imaging and ophthalmology review are required.

  • Immunocompromise or cancer history

    A new or changing headache in these groups lowers the threshold for imaging and specialist review considerably.

  • Pregnancy and postpartum

    A new headache in the third trimester or first six weeks post-delivery needs urgent assessment for pre-eclampsia and venous sinus thrombosis.

  • Progressive daily headache

    A steadily worsening pattern over weeks, particularly if it does not fit a primary picture, deserves imaging.

For a full walk-through of the SNOOP10 mnemonic and exertional patterns see our exercise headache guide. Specific secondary causes are covered in dedicated guides for giant cell arteritis and idiopathic intracranial hypertension.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - a headache diary, steady rhythm, a sensible painkiller calendar and knowing when to escalate.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits - kept up for months - do more than a heroic week that does not last.

  1. 01 Diary

    Keep a headache diary

    Two to four weeks of frequency, severity, triggers and medication use tells you more than any single consultation can.

  2. 02 Rhythm

    Sleep, meals and hydration

    The most modifiable triggers are the least glamorous - regular sleep, meals and fluids reduce attacks in most people.

  3. 03 Limit

    Watch the painkiller calendar

    Ten or more days of triptans or combination analgesia a month can create the very headache you are treating.

  4. 04 Escalate

    Ask about specialist options

    CGRP therapies, botulinum toxin, occipital nerve blocks and specialist commissioned services exist for a reason - use them.

Frequently asked

Everything we get asked about headaches.

Quick answers on types, red flags, painkiller use and modern preventives.

  • What is the difference between a primary and secondary headache?

    A primary headache - tension-type, migraine or cluster - is the disease itself, with no other cause on investigation. A secondary headache is a symptom of something else, such as a bleed, infection, giant cell arteritis, raised pressure, sinus disease or a medication effect, and treatment targets that cause.

  • When is a headache an emergency?

    A sudden thunderclap headache, one with fever and neck stiffness, focal neurological signs, reduced consciousness, seizure, a first severe headache after 50 or a headache that steadily worsens over days to weeks all warrant urgent same-day assessment.

  • How do I know if it is tension-type or migraine?

    Tension-type headache is usually bilateral, pressing and mild to moderate, without nausea or aura, and does not worsen with routine activity. Migraine is more often one-sided, throbbing and moderate to severe, worsened by activity, and comes with nausea, light and sound sensitivity, sometimes with an aura beforehand.

  • Can painkillers make headaches worse?

    Yes. Regular use of simple analgesia on 15 or more days a month, or triptans or combination or opioid analgesia on 10 or more days a month, can drive medication overuse headache. Treatment involves a planned withdrawal supported by a clinician, usually with bridging therapy.

  • What are CGRP monoclonal antibodies?

    CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab and eptinezumab) are injectable preventives that block a key migraine pathway. NICE has approved specific agents for episodic and chronic migraine in patients who have not responded to at least three oral preventives.

  • Do I need an MRI scan?

    Most primary headaches do not need imaging. NICE NG150 reserves neuroimaging for red flags, a clear change in an established pattern, focal signs or when a specialist judges it necessary. A structured history and examination pick up the vast majority of secondary causes.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.