From the Guidelines
The most common causes of headaches include tension-type headaches, migraines, and sinus headaches, with migraines affecting approximately 16% of people in the United States, according to a 2025 study published in the Annals of Internal Medicine 1.
Common Causes of Headaches
- Tension headaches: typically result from muscle contractions in the head and neck due to stress, poor posture, or eye strain, causing mild to moderate pain that feels like a tight band around the head.
- Migraines: often triggered by hormonal changes, certain foods, stress, or environmental factors, producing moderate to severe throbbing pain usually on one side of the head, sometimes with nausea and sensitivity to light and sound.
- Sinus headaches: occur when sinuses become inflamed due to infection or allergies, creating pressure and pain in the forehead, cheeks, and bridge of the nose.
Other Common Causes
- Dehydration
- Lack of sleep
- Alcohol consumption (especially red wine)
- Caffeine withdrawal
- Certain medications
Treatment and Prevention
- For tension headaches, over-the-counter pain relievers like acetaminophen (500-1000mg every 4-6 hours) or ibuprofen (400-600mg every 6-8 hours) often help.
- Migraines may require specific medications such as triptans (like sumatriptan 50-100mg) prescribed by a doctor.
- Maintaining regular sleep patterns, staying hydrated, managing stress through relaxation techniques, and identifying personal triggers can help prevent recurring headaches.
Recent Guidelines
A 2024 study published in the Annals of Internal Medicine found that aspirin-acetaminophen-caffeine was effective in treating acute migraine, with a number needed to treat of 9 for pain freedom at 2 hours and 4 for pain relief at 2 hours 1.
Recommendations
The American College of Physicians recommends initiating monotherapy for episodic migraine prevention in nonpregnant adults in the outpatient setting, with considerations for frequency, severity, duration, and functional disability 1.
From the Research
Common Causes of Headache
The most common causes of headache can be categorized into primary and secondary headache disorders.
- Primary headache disorders are defined as headaches that are unrelated to an underlying medical condition and are categorized into 4 groups:
- Migraine
- Tension-type headache
- Trigeminal autonomic cephalalgias
- Other primary headache disorders 2
- Secondary headache disorders are defined as headaches due to an underlying medical condition and are classified according to whether they are due to vascular, neoplastic, infectious, or intracranial pressure/volume causes 2
Prevalence of Primary Headache Disorders
Studies evaluating prevalence in more than 100 000 people reported that:
- Tension-type headache affected 38% of the population
- Migraine affected 12% and was the most disabling 2
- Migraine is the second leading cause of years lived with disability worldwide 2
Evaluation and Management
Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder 2, 3.
- A complete history is essential to identify the most likely headache type, indications of serious secondary headaches, and significant comorbidities 3
- A headache diary can document headache frequency, symptoms, initiating and exacerbating conditions, and treatment response over time 3
- Neurologic assessment and physical examination focused on the head and neck are indicated in all patients 3