a headache

Synonyms in a broader sense

Headache, migraines

Medical: cephalgia

English: headache


Overall, headaches are one of the most common symptoms. Causes of such pain can be very different.

Nevertheless, one still has to say that the exact processes that trigger the individual forms of headache in many cases, he suspects, can be proven.

Occurrence in the population


About 30% of Germans (that's almost 25 million) have at least occasional headaches. Almost 12% of them are children (mostly of school age) and over 20% of them suffer from migraines.

Read more on the topic: Headache in child

Worldwide, headache patients alone use almost 13,000 tons of aspirin (acetylsalicylic acid). These vast amounts of pain relievers that patients consume are, in most cases, over the counter. On the one hand, this harbors the risk of developing drug dependency / addiction on the other hand, but also of massive organ damage.
It is known that almost 10% of today's dialysis patients have massively damaged their kidneys with regular use of painkillers.

Read more on the topic: Drug addiction


The Classification he follows according to the International Headache Society (international headache league). An experienced doctor will usually be able to make the correct classification after a specific questioning.

A basic distinction is made between headache without external influences (primary headache) and headache caused by external influences.

Primary headache

Primary headache:

  1. Tension headache
    • episodic (the pain comes and goes)
    • chronic (constant pain)
  2. migraine
    • without aura
    • with aura
  3. Cluster headache and chronic paroxysmal hemicrania
  4. Various headaches without damage to the head or its organs

Secondary headache

Secondary headache

  • Headache after brain injury (trauma)
  • Headache with vascular diseases
  • Headache in other brain disorders
  • Headache with substance abuse or withdrawal
  • Headache from infections that do not affect the brain
  • Headache with metabolic disorders
  • Headache from pain in nerves (facial neuralgia e.g. Trigeminal neuralgia)
  • Headache from diseases of the skull, the eyes, of the nose, of the Ears, of the Sinuses, teeth or mouth
  • Very often, especially in people over the age of 40, the headache caused by high blood pressure is conditioned.

Headache by localization

Headache in the forehead area

Headaches are particularly common in the forehead area.
The pain can be unilateral or bilateral. Migraineurs also typically experience their headache in the forehead area. The headache is usually one-sided, pulsating and strong.

Read more on this topic: Pain over the eye

In addition, many migraineurs suffer from nausea (possibly with vomiting), Photophobia and a kind of flickering in front of the eyes. This phenomenon is also known as the aura and heralds the coming migraine headache for many patients.
However, headaches in the forehead area do not always necessarily indicate a migraine.

If the headache extends from the forehead to the temples, the origin may be in the temporomandibular joint. The jaw joint and the masticatory muscles are overexcited and damaged by unconscious, stress-related teeth grinding. Relaxation techniques and wearing a grinding splint can help.

Typical tension headaches can also manifest in the forehead area. The pain is then often bilateral, permanent and pulling. Stress, too little sleep and general inner tension make these headaches more likely.
Problems with the eyes also often lead to headaches in the forehead area. If a person suffers from a visual defect that has not been corrected by glasses or contact lenses, the eyes must constantly strain to correct the blurred image on the retina. In the long run, this overloads the eyes and the affected person's vision becomes increasingly blurred.
The brain no longer receives clear visual information. Headaches can result.
If you have frequent headaches, you should therefore also consider an ophthalmological evaluation.

The frontal sinuses - air-filled cavities in the bone - also run in the forehead area. Respiratory infections can spread to the sinuses and frontal sinuses, where they cause an inflammatory reaction.
This is often very painful and the affected patients feel a feeling of pressure in the forehead area, which increases in particular when the head is tilted downwards, for example when tying shoes.

Excessive alcohol consumption the day before is also a possible cause of headache in the forehead area. This phenomenon is also known colloquially as "hangover" and usually improves on its own in the course of the following day.

Of course, the pain can also set in with direct trauma, such as a blow or fall to the head. In the event of very strong violence or temporary loss of consciousness of the patient, a hospital should always be visited afterwards in order to clarify serious injuries (cerebral haemorrhage, skull fractures).
Malignant diseases or nerve damage are less common causes of pain in the forehead area.

Read more on the topic: Headache in the forehead area

Headache in the back of the head

Back of the headache can have different causes.

Very often they are triggered by tension in the muscles in the neck and shoulder region (please refer: tense neck). The neck muscles pull from the lower area of ​​the back of the head towards the shoulders, so that tension can lead to cramps in this entire area.
Neck tension are favored by bad postures, which nowadays often result from predominantly sedentary activities at the workplace and a general lack of exercise.

If the head is held in one position for many hours a day, for example when working at the computer for a long time, this can cause neck tension and pain in the back of the head. Another cause of back head pain is that Grinding teeth (Bruxism), which many people do in their sleep without realizing it.
It also causes neck and occiput headaches as well as morning pain in the masticatory muscles.

Several nerves run in the neck area, which can be irritated for various reasons, for example through Tension, Inflammation, Conditions of wear or Infections.
When the nerves are irritated, stabbing, attack-like pain occurs, which can radiate from the neck to other areas of the head. This clinical picture is also called Occipital neuralgia designated.

There are more serious causes of back head pain Circulatory disorders of the brain, for example as part of a Stroke. The pain is often massive and occurs very suddenly. It often accompanies it nausea, Vomit and Neck stiffness - if there is bleeding in the area between the meninges (Subarachnoid hemorrhage).

Last but not least, behind permanent pain in the back of the head there can also be a malignant disease, for example a Brain tumor or metastases from another tumor that has appeared in the body.
In the case of persistent and / or severe symptoms that do not show any tendency to improve, a doctor should be consulted to clarify the serious causes of the pain.

Symptoms and Therapy

Headache pills

Tension headache

With this type of pain, both halves of the head are affected. the pain moves from the back of the head towards the forehead. Mostly it is described as oppressive. Patients often feel as if their skull is in a clamp. It is not uncommon for a permanent (chronic) course to occur.

It occurs at all ages and is not infrequently accompanied by dizziness in the head and vomiting. Headaches with nausea are also common.

Read more on the topic: Dizziness and headache

Women are typically more affected than men. The chances of complete healing and freedom from pain are generally poor with drug therapy alone. With regular use, e.g. in endurance sports, one can achieve quite good and long pain-free episodes.

The focus must be on a good relationship between doctor and patient. Special attention must be paid to addressing the patient's fears about a serious, life-threatening illness. Tension headaches are excruciating, but not life-threatening.

In terms of medication, therapy with a (tricyclic) antidepressant (e.g. Amitriptyline, Doneurin, Imipramine) is started if there are more than 9 days of pain per month. You should always use painkillers sparingly and not more than e.g. Take 500mg aspirin per day.

It has also been shown that progressive muscle relaxation can be very helpful.


In addition, 10 recommendations for behavior from the German Migraine League are listed here.
More about headaches from our partner

This article might also interest you: Headache after exercise

10 golden rules for migraines

10 golden rules for migraine sufferers
recommended by the Migraine League e.V. Germany

  1. Frequent use of pain relievers should be avoided. Attempts should also be made to reduce the actual amount of medication.
  2. Attempts should be made to identify possible triggers for a migraine attack. Such triggers can be extremely different. To think about is e.g. work stress, a weather change, etc.
  3. Certain foods that are known to trigger and worsen migraines should also be avoided.
    These include: A lot of animal fat, caffeine, nicotine, but also sweets and citrus fruits.
  4. Relaxation methods (autogenic training, PMR = progressive muscle relaxation or yoga) should be used on a regular basis, as should sporting activities (endurance sports) and other hobbies that involve physical exertion.
  5. It is imperative to avoid excessive light and noise. Unfortunately, this also includes long sunbathing
  6. Sometimes your own expectations and demands have to be checked. If your own standards are too high, it can give you a "headache".
  7. Attempts should be made to reduce psychological stress and stress factors. Excessive worries and neglecting your own claims can also make the disease worse.
  8. Situations in which experience has shown that the emotion "boils up" should be avoided. Here you should pay particular attention to different media (television, radio, etc.)
  9. One should try to learn to understand the language of the body. Pain is a signal that has a message behind it. Deciphering these will help.
  10. There are many people who suffer from this disorder. Patients with migraines can be helped.

Headache and nausea

Headaches that are accompanied by nausea are very common Migraine headache.
Nausea and vomiting, photophobia, visual disturbances and sensitivity to noise are typical symptoms of a migraine. The symptoms can often be managed well with appropriate pain medication and - if severe - anti-nausea drugs (please refer: Migraine Therapy).
However, nausea can also occur with headaches, which have a much more dangerous cause. A classic example is the so-called Subarachnoid hemorrhage. This leads to a rupture of an artery at the base of the skull, which results in profuse bleeding.
The pressure in the skull increases sharply and suddenly massive headaches, neck stiffness (Meningism) and nausea with gushing vomiting.
In addition, the patient often quickly loses consciousness. Severe or persistent headaches that have not yet been clarified by a doctor and that may be accompanied by other symptoms such as nausea should definitely be clarified by a doctor.

Cluster headache

Synonyms Bing-Horton headache, erythroposopalgia, histamine headache

The cluster headache is quite similar to the headache that occurs with migraines. It is one-sided and can be seen on the front of the skull or behind the eyes. The pain attacks are generally very violent, stabbing and run at time intervals. The pain may change sides between the intervals.

On the side on which the headache shows up, there is a watery eye, a runny nose and reddening of the facial skin.

The eyelid on the affected side may also droop.
A pain interval can last between 20 minutes and 3 hours and occur up to 10 times a day.
There is an increase in attacks in spring and autumn.
In cluster headache patients, symptoms can often be triggered by alcohol.

In the acute attack it is best to give an aerosol spray (active ingredient: ergotamine) from the doctor. 3 strokes should be sufficient.
Oxygen administration for up to 10 minutes is also helpful in the acute phase.
To prevent further attacks, e.g. cortisone shock therapy (active ingredient: prednisone)

Lithium can also be helpful in preventive therapy.
Further sensible attempts at therapy for the acute attack are

  • Lidocaine instillations
  • Triptans (especially subcutaneous sumatriptin injections)

Even if in some cases a response rate of only 25% is described, every patient b.B. to open up such an opportunity once.

Headache in other neurological disorders

  1. Dilatations (aneurysms) of the arteries and veins in the head can put increased pressure on cranial nerves and lead to pain or even to failure of certain brain functions.
  2. Bleeding below the spider skin (meninges / subarachnoid hemorrhage). If a pathological vasodilatation suddenly bursts, a feeling of "exploding pain" can occur, which is often associated with nausea, vomiting and clouding of consciousness.
  3. Bleeding under the "hard" meninges (subdural bleeding) can also lead to severe headaches. It is important to pay attention to elderly people who occasionally fall and are not otherwise typical headache patients.
  4. A typical cause of headache can also be an inflammation of the temporal artery (arteritis temporalis). The type of pain is felt to be "pulsating".
  5. Pain from tumors or other masses. There is no room in the head for anything other than the natural organs. Therefore, with every growth in the head (due to cyst, tumor, abscess or the like), massive pressure very quickly arises on the skull and also on the brain. Pressure typically results in pain. The severity and location of the pain depend on where the tumor is growing.
  6. All types of pain are theoretically conceivable here:
    Pain in the whole head area, only very selective pain, pain only in light, pain when coughing, etc.
  7. Pain after injury to the head or its organs (trauma)
    Overall, this type of pain is very common. Almost all head injuries result in at least one so-called "slight head trauma", a concussion. Such a concussion can lead to episodic pain and difficulty concentrating months after the event.
  8. Pain caused by the cervical spine
    In almost all people who have reached the age of 40, you will find signs of wear and tear, among other things. on the cervical spine. It should be noted here that the x-ray findings often do not show too great changes, although the pain is felt to be very pronounced. (See also therapy back pain and back pain and psyche).
  9. Headaches can also occur with herniated discs in the cervical spine. However, these are usually accompanied by other clear symptoms.
  10. Pain caused by metabolic diseases
    Oxygen deficiency, e.g. Occurs in the so-called sleep apnea syndrome or lung diseases, can also lead to headaches.
    It is also known that low blood sugar levels (hypoglycaemia) also lead to pain.
  11. In about 1/3 of all patients, severe headaches can occur after the removal of cerebrospinal fluid (CSF puncture) = CSF loss syndrome

Homeopathy and headache

Headaches can also be treated homeopathically.
Please also note our topic:

  • Homeopathy headache
  • Home remedies for headaches

Headache in pregnancy

Pregnancy headaches are a common problem.
Many women suffer from these symptoms again and again, especially at the beginning of pregnancy. This is possibly due to the hormonal changes in the body, which first has to adjust to the new requirements.

Stress during pregnancy, lack of sleep, insufficient fluid intake and an unbalanced diet can all contribute to the development of headaches during pregnancy. If a woman regularly consumed coffee before pregnancy and now suddenly completely refrains from it during pregnancy, this change can also be accompanied by headaches.

In some cases, however, there is also a serious illness behind the symptoms - preeclampsia (pregnancy poisoning). It is a disease of pregnant women caused by:

  • High blood pressure in pregnancy
  • Water retention during pregnancy
  • increased protein excretion in the urine
  • Dizziness during pregnancy
  • Headache in pregnancy
  • Nausea in pregnancy
  • Vomiting during pregnancy
  • and impaired vision.

As a serious complication, preeclampsia can develop into eclampsia, which can lead to seizures, headaches, high blood pressure, confusion, and liver and kidney failure.
Headaches during pregnancy should therefore be taken seriously and discussed with a gynecologist. Since most cases are harmless in nature, there is usually nothing to worry about. Most women suffer from headaches much less often from the third month of pregnancy than at the beginning of pregnancy.

Read more on the topic: Headache in pregnancy