A headache is when you have pain in your head, neck, or scalp. It may feel like throbbing, stabbing, or squeezing. People have a wider range in how often and how severe their headaches are. You might have a lot of headaches, while your partner gets them just once in a while.

Your headaches may just be a pain or come with other symptoms, like nausea and sensitivity to noise or light. They may come back over and over or last for weeks at a time.

There are a few instances in which a headache can be an emergency. A headache can come with a health emergency like a stroke, bleeding, clot, or blood vessel issue. If your headache is very bad and you have other symptoms that suggest an emergency, go to the emergency room right away.

In these emergencies, you may have a thunderclap headache. People describe it as "the worst headache of my life," rapidly reaching peak intensity. It's linked to bleeding in the brain.

When talking about severe headaches, we mean the chronic types. The ones that aren't typically life-threatening but can be very taxing. They're typically bad enough to disrupt your daily activities and quality of life.

Multiple health issues can cause headaches, and there are many common types of headaches.

Migraine

Migraines cause throbbing pain on one side of the head, and movement makes it worse. It can last days and cause nausea, vomiting, and sensitivity to light and sound. Common triggers include foods, caffeine withdrawal, and alcohol.

Tension headache

A tension headache feels like pressure or tightening around the head. It causes mild to moderate pain on both sides. Stress or muscle tension in the neck, face, and jaw can cause this headache.

Hypnic headache

A hypnic headache wakes you at night with mild to moderate throbbing pain. The pain comes on both sides and lasts up to 3 hours. These headaches are more common after age 50.

Trigeminal autonomic cephalgias

Trigeminal autonomic cephalgias are severe, one-sided pain. They cause not just a headache but come with symptoms like red, teary eyes, and runny nose. 

Includes:

• Cluster headache: Sudden, intense attacks in clusters, lasting up to 3 hours, often with visual changes and nausea
• Paroxysmal hemicrania: Short, severe attacks up to 40 times daily, around one side of the face or eye
• SUNCT: Short bursts of throbbing pain in the forehead or temple, peaking in seconds

Sinus headache

Sinus headaches cause pain in the front of the head and face. The pain is due to sinus congestion and gets worse when bending forward.

Cervicogenic headache

Cervicogenic headaches start in the neck after movement, like whiplash. They limit your range of motion.

Trigeminal neuralgia

Trigeminal neuralgia is a type of intense, stabbing facial pain. It's due to a blood vessel pressing on the trigeminal nerve.

Chronic daily headache

Chronic daily headaches cause constant, moderate pain for more than half the days in a month. They can feel like a migraine or a tension headache.

• Hemicrania continua: This type of headache involves continuous, one-sided pain that gets worse on and off. The pain waves come on with physical exertion or alcohol.
• New daily persistent headache: This starts suddenly in someone who hasn't had headaches before. It causes constant daily pain. It also causes sensitivity to light, nausea, and dizziness.

Primary stabbing headache

Primary stabbing headache causes an intense, piercing "ice pick" pain around the eye. Each spike of pain lasts seconds and comes on sporadically.

Primary exertional headache

Physical exertion triggers a primary exertional headache. These headaches can last minutes to days, sometimes with nausea.

Medication overuse headache

Frequent painkiller use causes medication overuse headaches. They can lead to recurrent headaches and worsening symptoms as the medicine wears off. Headaches can last weeks.

We treat severe headaches using proven treatments based on the type and cause of your symptoms.

Acute medicines include non-steroidal anti-inflammatories and triptans. These “rescue” medicines are taken when symptoms start to help relieve pain and help you return to daily activities. To avoid rebound headaches, use is usually limited to no more than 15 days per month.

Preventive medicines are taken daily to lower how often headaches happen and how severe they are. These may include calcitonin gene-related peptide (CGRP) inhibitors, which target specific migraine pathways and help reduce future attacks.

Treatment may also depend on the type of headache you have. For example, hypnic headaches may be treated with caffeine, indomethacin, or lithium.

Procedures

Some patients may benefit from procedures if medicines do not provide enough relief. These options may include:

• Botox injections: Injected into the muscles of the head and neck, Botox can block pain signals of chronic migraines.
• Ganglion and nerve blocks: These blocks stop the pain signal. They're helpful for migraines and cluster headaches.
• Ablative procedures: This damages the nerves that cause pain.
• Oxygen therapy: Breathing oxygen through a mask is helpful for cluster headaches.

We only use these procedures for patients who don't respond well to standard headache medicines.

Advanced Headache Care Clinic

Some patients with ongoing or hard-to-treat headaches may be referred to Carilion’s Advanced Headache Care Clinic. After evaluation by a neurology or physical medicine and rehabilitation specialist, eligible patients receive coordinated care from a team focused on managing complex headache conditions.