The majority of headaches — even bad headaches — are not due to any serious underlying health problem. Doctors sometimes call these 'primary headaches', meaning there is no secondary (other) cause.
Most headaches aren’t serious and can be easily treated with over-the-counter pain relief medicines, or lifestyle changes, such as eating regular meals or getting more sleep.
However it is important to know which pain relief medicines will help, and how and when to them.
Read on to learn more about medication overuse headache, signs and symptoms that may point to a more serious cause for your headache, and when to consult a doctor or seek immediate help for a proper diagnosis and treatment.
About tension-type headache
Tension-type headache is the most common type of headache worldwide, and affects many people from time to time. Most of the headaches we think of as ‘normal’ or ‘ordinary’ headaches are probably tension-type headaches.
Key symptoms of tension headaches are:
a mild or moderate head pain that can affect the whole head, or a part of the head such as the sides or the front.
a steady pain (not usually throbbing) that feels like a dull tightness or band of pressure
pain that can be brief or can last for several days
There is no nausea and vomiting, which happens in migraine headache.
Tension-type headaches do not usually get worse with physical activity such as walking or climbing stairs.
Did you know?
These headaches were called 'tension' headaches because they were thought to be due to increased tension in the scalp muscles. It’s now known that muscle contraction is not necessarily the cause of the pain, although there can be increased muscle tenderness.
Stress and mental tension are the most common factors that cause tension-type headache.
Non-medicine treatments for tension-type headache
The following non-medicine treatments may help some people, and are unlikely to cause any harm:
cognitive behaviour therapy (CBT) a psychological therapy designed to teach people to identify and challenge stress generating thoughts
physiotherapy, including improvement of posture, massage, neck exercises, ultrasound and home exercise programs
relaxation training, to help relieve the tension that may be causing headaches, and some types of massage.
Exercise has been shown to be valuable for managing tension-type headache, and is effective for both short- and long-term pain.
Medicine for treating tension-type headache
These over-the-counter pain relievers are the main treatment for occasional tension-type headaches:
aspirin (Disprin, Aspro Clear) 600 mg to 900 mg, repeat in 4 hours if required.
non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, eg Nurofen (Nurofen, Advil) 200 mg to 400 mg, repeat in 6 hours if required.
paracetamol (brands include Panadol, Panamax) 500mg to 1000 mg, every 4 hours, up to a maximum dose of 4000 mg daily.
Medicines containing a combination of paracetamol and ibuprofen are available from your pharmacy and have evidence supporting their short-term use for treating headaches. If you are thinking about taking one of these combination medicine brand, speak with your pharmacist or healthcare professional first, to confirm they are suitable for you.
Paracetamol and ibuprofen are common active ingredients found in a number of medicines. Taking more than the recommended daily amount can lead to serious side effects.
Paracetamol and caffeine tablets (Panadol Extra) for headaches that don’t respond to NSAIDs or ordinary paracetamol. Regular use of this combination is not recommended, however, as paracetamol and caffeine tablets may increase the risk of medication overuse headache.
Paracetamol is the recommended treatment for people:
aged over 65 years
with heart problems
with a history of stomach problems (eg ulcers, heartburn and indigestion).
The NSAIDs ketoprofen (Orudis), diclofenac and naproxen (both available in multiple brands) have similar side effects to ibuprofen and aspirin and may not be any more effective at relieving pain. Ketoprofen (Orudis) must be prescribed by your doctor, but diclofenac and naproxen may be purchased from your pharmacy after consulting the pharmacist on duty.
These medicines may not completely relieve the pain of tension-type headache but should reduce it to a manageable level. Don’t take more than the recommended dose of these medicines. Taking more than directed won’t help your pain but may increase the risk of side effects.
Keeping a headache diary can help identify triggers for tension-type headaches. Avoiding triggers probably won’t eliminate your headaches completely but may reduce their frequency.
People with depression and anxiety seem to be at increased risk of tension-type headache. Treatment for these conditions may also help alleviate headaches.
Medicines to prevent tension-type headache
If you suffer from frequent tension-type headaches — more than twice a week on a regular basis — and especially if you are getting headaches almost every day (chronic tension-type headache), your doctor may recommend a preventive treatment.
Antidepressant drugs, such as amitriptyline (Endep), nortriptyline or dothiepin can help with frequent tension-type headache. These medicines can help stop you getting headaches as often, and help you recover faster when you do have one.
The dose of antidepressant needed to prevent tension-type headache is usually much lower than doses used for depression. Your doctor will probably suggest you continue treatment for around 6 months, after which you may not need to take them any more. If your headaches come back, you can start to take them again.
You may not notice an effect from antidepressants immediately, as these medicines can take several weeks to exert their full effect.
Antidepressants can cause side-effects including dry mouth, dizziness, drowsiness, blurred vision, constipation and weight gain. Side effects are less likely if you start on a low dose and increase this gradually over a few weeks under your doctor’s instruction.
Medicines to avoid in tension-type headache
Morphine-related pain relievers such as codeine and dihydrocodeine are not recommended for the treatment of tension-type headache.
Other medicines called triptans (eg, Relpax, Naramig, Maxalt, Imigran, Sumatab, Zomig) are a mainstay in the treatment of migraine, but they are not effective in the treatment of simple tension-type headache.
In Australia, before 1 February 2018, some people took over the counter medicines containing paracetamol, aspirin or ibuprofen in combination with low doses of codeine (eg, Codapane, Panadeine Extra, Codis, Dispirin Forte, Rafen Plus, Nurofen Plus, Aspalgin Soluble), or medicines containing paracetamol and codeine in combination with doxylamine, an antihistamine with sedative effects (eg, Panalgesic, Mersyndol).
From 1 February 2018, all codeine-containing medicines became prescription medicines.
Cluster headache is a rare type of headache, affecting only about 1 person in every 1000. They are known as cluster headaches because people get from 1 to 8 headaches each day, for weeks or months at a time, before they stop. The pain associated with cluster headaches is very severe – many times worse than migraine headache pain. The pain is so severe that people who get them can’t lie down and have to pace the floor instead.
Key symptoms of cluster headache:
extreme pain on one side of the head
pain usually around the eye, in the temple or jaw
attacks may occur at the same time each day (known as ‘alarm clock’ headaches)
headaches are repeated (occur in ‘clusters’) up to 8 times a day, for weeks or months
headaches can last from 15 minutes for up to 3 hours.
Treatment for cluster headache
Cluster headaches do not respond to treatment with normal pain relievers. Sumatriptan (Imigran) by injection or intranasally can relieve the pain of cluster headaches in most people. Lignocaine delivered intranasally may also be effective, and pure oxygen may also be useful for some people. There are also medicines you can take to help prevent cluster headaches, but management is complex and usually best managed by a specialist (neurologist).
As alcohol is a known trigger, alcohol should be avoided during cluster periods.
If you believe you may be suffering from cluster headaches, talk to your doctor.
Medication overuse headache
If you suffer from regular migraine or tension-type headaches, you can find yourself in a vicious cycle. If you try to treat these headaches with medicines on every occasion, you can develop a condition known as medication overuse headache.
Medication overuse headache is a form of chronic headache, brought on by the daily, or near daily, use of pain-relief medicine for a prolonged period. Headaches develop or get worse as the medicines become ineffective from overuse.
When pain relievers are combined with either codeine or caffeine, both of which have addictive properties, the risk of medication overuse headache increases. Pain relievers containing codeine or caffeine should not be consumed on more than 10 days each month, or, in the case of codeine, preferably avoided altogether.
Medication overuse headache rarely develops in people who don’t have a history of headache and who regularly take pain relievers for other conditions, such as arthritis.
If you experience regular — almost daily — headaches that no longer respond to your usual pain relievers, talk to your doctor about the possibility of medication overuse headache. He or she may ask you to complete a headache diary to help with the diagnosis.
Treatment for medication overuse headache
Management of medication overuse headache is difficult and may require specialist referral. For treatment to be successful, it’s necessary to completely withdraw from the ‘offending’ pain reliever. This is usually followed by a period of worsening symptoms that may last up to 10 days, depending on the drug. Other medicines can be prescribed to manage pain during this period.
Headaches – when to see a doctor
Even severe headaches usually don’t need to be seen by a doctor. However, there are some signs and symptoms that indicate further testing may be needed to make sure a headache is not serious.
Call your doctor or seek emergency help if you have a headache:
that becomes worse and is accompanied by a high temperature (fever) and neck stiffness
that starts extremely suddenly and rapidly becomes very painful (within minutes)
that started following coughing, sneezing, or straining
following a head injury (within 3 months)
accompanied by unexplained sickness vomiting
that gets worse if you sit or stand
accompanied by confusion, your memory is affected, or there is a change in behaviour
that is accompanied by problems with speech and balance
with changes to your vision, or with red or painful eyes.
You should also seek help if the headaches are:
in a child aged under 5 years
new onset, or have changed, in a person aged over 50 years
in a person with compromised immunity (such as HIV) or is on immune-suppressing medicines
in a person with a history of a type of cancer that can spread through the body.