Persistent headache on top of the head: what should you know?

Pressure or aching over the top of the head may come from tension in the scalp, neck, or jaw, migraine, poor sleep, dehydration, an infection, or irritation of nerves in the scalp. Tenderness when brushing the hair can add useful information for a clinician. The crown location does not identify a brain tumour. A brain tumour can present with headache, but diagnosis requires consideration of the complete pattern and may involve neurological assessment or imaging. Learn about [Brain Tumour](/conditions/brain-tumour/) and [Glioblastoma](/conditions/glioblastoma/) as general background.

Describe whether the pain feels like pressure, throbbing, burning, or tenderness, and whether it spreads to the neck or face. Record sleep, meals, fluids, posture, stress, screen use, recent illness, and medicines. Gentle rest, hydration, regular meals, and reducing neck strain may help some headaches. Seek a medical review if the pain persists, repeatedly returns, is worsening, or is unlike your usual headaches. Do not rely on repeated pain medicine without professional guidance.

Get emergency help for sudden severe pain, confusion, fainting, seizure, new weakness or numbness, difficulty speaking, vision loss, repeated vomiting, fever with a stiff neck, or a headache after injury. If you have cancer or are receiving treatment, report a new persistent headache and any neurological change promptly. Cancer can spread to the brain, called [Brain Metastases](/conditions/brain-metastases/), and this possibility is assessed through symptoms and examination rather than headache location alone.

Ask: Could scalp, neck, jaw, migraine, or nerve symptoms explain the pain? Does the tenderness need examination? Do I need neurological assessment or imaging? Which changes require emergency care?