Finding the right treatment for a persistent headache

Common explanations include migraine, tension-type headache, medication overuse, eye strain, sinus problems, dehydration and sleep disruption. A headache can also arise from conditions that need urgent treatment, so a new, changing or continuing pattern deserves clinical assessment.

A clinician will ask when the pain began, where it is felt, what it feels like, how often it occurs and whether nausea, light sensitivity, fever, weakness or vision changes accompany it. They may examine the eyes, nerves, strength, balance, blood pressure, head and neck.

Brain tumours, glioblastoma and brain metastases can present with headache, but headache alone does not establish any of these diagnoses. Imaging is selected when the history, examination or known medical conditions suggest it could help; it is not required for every headache.

Book a medical review if the headache persists, recurs frequently or differs from your usual pattern. Keep a diary of timing, severity, associated symptoms, sleep, meals, caffeine, menstrual timing where relevant, and every pain medicine taken. This can reveal triggers and medication overuse.

Maintain regular fluids, food and sleep where possible. Use non-prescription pain relief only as labelled and check suitability with a pharmacist if you have other conditions or medicines. Repeated use can itself sustain some headaches, so do not keep increasing the amount without clinical guidance.

Call emergency services for a headache that reaches extreme intensity suddenly, follows a significant head injury, or occurs with a seizure, fainting, confusion, new weakness, facial droop, trouble speaking, loss of vision, severe imbalance or a stiff neck with fever.

Seek same-day clinical advice for a new headache during cancer treatment, with a weakened immune system, during pregnancy or after birth, or when vomiting, personality change, worsening morning pain or increasing drowsiness accompanies it. Urgency comes from these warning features, not from guessing which diagnosis is most common.

Ask what headache type fits the pattern, whether any medicine may be contributing, which warning changes should prompt urgent help, and what treatment can prevent recurrence. If imaging is not advised, ask which examination findings make it unnecessary now and when that decision should be reconsidered.