Most headaches are benign tension or migraine headaches. A small number signal dangerous conditions including meningitis, hypertensive crisis, or brain bleeding. Knowing the difference is life-saving.
Assess the onset. Ask: Did this come on suddenly and reach maximum intensity within seconds or minutes — like a thunderclap? This is a medical emergency. Or did it build gradually over hours? Gradual onset is usually less dangerous.
TENSION HEADACHE — dull, pressing pain on both sides of the head, like a tight band, worsens with stress and improves with rest. Most common type. Usually responds to paracetamol.
MIGRAINE — severe throbbing pain, usually one-sided, with nausea, vomiting, and sensitivity to light and sound. May be preceded by visual disturbances. Debilitating but not dangerous.
HYPERTENSIVE HEADACHE — throbbing pain at the back of the head, often in the morning, in someone known to have high blood pressure. Measure blood pressure if possible.
MENINGITIS HEADACHE — severe headache with fever, stiff neck, sensitivity to light, and a rash that does not fade when pressed with a glass. This is a medical emergency.
For tension headache: paracetamol or ibuprofen, rest in a dark quiet room, drink water, gentle neck stretches.
For migraine: paracetamol or ibuprofen taken early, rest in a completely dark and quiet room, cold compress on the forehead or back of neck, sleep if possible.
Keep the person hydrated. Dehydration is one of the most common headache triggers.
Note all associated symptoms and their timing — this is critical information for the doctor.
Thunderclap headache — worst headache of life, reaching maximum intensity within seconds — possible brain bleed.
Headache with fever and stiff neck — possible meningitis.
Headache with a rash that does not fade when pressed — meningococcal disease.
Headache with confusion, slurred speech, or weakness of one side of the body — possible stroke.
Headache in a pregnant woman with visual changes and swelling — possible eclampsia.
Progressively worsening headache over days with no relief.
Headache following a head injury.
A thunderclap headache — sudden maximum intensity pain — is a medical emergency until proven otherwise.
Do not give aspirin to children under 16.
Do not take pain medication more than 3 days per week for headaches — overuse causes rebound headaches that are harder to treat.
Do not ignore a headache that is different from any previous headache the person has had.
✓ What Helps
· Paracetamol 1000mg for tension headache
· Ibuprofen 400mg with food for migraine — most effective taken at onset
· Oral rehydration or water for dehydration headache
✗ What To Avoid
· Aspirin in children under 16
· Codeine or strong opioids without medical prescription
· Taking pain medication daily — causes rebound headaches
→ Ask The Pharmacist For
· Sumatriptan — specific migraine medication available on prescription
· Blood pressure check for persistent morning headaches
· Urgent referral for thunderclap headache or headache with neurological symptoms
🏥 Get Professional Help
Go to hospital immediately for any thunderclap headache, headache with fever and neck stiffness, headache with confusion or weakness, or headache in pregnancy with visual changes. These are medical emergencies.