Types of headaches by location: where it hurts and what it can mean

Both sides, a band or pressure: tension-type

The International Classification of Headache Disorders (ICHD-3) describes infrequent tension-type headache as typically bilateral, pressing or tightening rather than pulsating, mild to moderate, lasting minutes to days, and not worsened by routine activity. The NHS describes it the same way: pain on both sides of the head, face or neck, like something pressing or tightening around the head, where the affected area may feel tender.

The NHS calls tension headaches very common. The NHS says you can usually treat it yourself with painkillers and relaxation, and to see a GP if you have headaches several times a week or they are severe.

One side, throbbing: migraine

ICHD-3 describes migraine without aura as attacks of 4 to 72 hours, typically one-sided, pulsating, moderate or severe, worse with routine activity and with nausea or sensitivity to light and sound. The NHS says the headache is often on one side and worse when you move around.

Location varies. ICHD-3 notes migraine headache is usually frontotemporal and that, in children, it is more often on both sides than in adults. Some people have it on both sides or in the face, so one-sided pain is common but is not a rule.

Around or behind one eye, and the temple: cluster

ICHD-3 describes cluster headache as severe, strictly one-sided pain around the eye, above it, in the temple or a combination, lasting 15 to 180 minutes, with a red or watering eye, a blocked or runny nose, sweating, a smaller pupil or a drooping eyelid on the same side. The pain usually returns on the same side during a cluster period, and people often cannot lie still.

The NHS says cluster headaches are rare and can share symptoms with migraine. It advises seeing a GP if you think you might have them, or if ordinary painkillers do not help. A drooping eyelid or a smaller pupil in one eye for the first time needs emergency care.

Front of the head and face: sinus or something else

Pain across the forehead and cheeks is often called a sinus headache. ICHD-3 says pain from nose and sinus problems is usually felt in the front of the head or face, but notes migraine and tension-type headache can be mistaken for it because they hurt in similar places. It looks for other signs of sinus infection, such as purulent nasal discharge, before attributing a headache to the sinuses.

So a headache across the forehead does not prove a sinus cause. If it comes with a cold or a blocked nose, that can fit, and ICHD-3 adds that migraine can be triggered or worsened by sinus problems.

Back of the head and neck

Pain at the back of the head or neck can come from tension-type headache or from the neck itself. ICHD-3 describes cervicogenic headache as headache caused by a disorder of the cervical spine, usually with neck pain, and says features that tend to separate it include side-locked pain, pain provoked by head movement or pressure on neck muscles, and pain that spreads from back to front. It adds that these features are not unique to it.

In its migraine entry, ICHD-3 also notes that occipital headache in children is rare and calls for diagnostic caution. The NHS lists a head injury in the last 3 months with a headache as a reason to get emergency care.

What location cannot tell you, and when to get care

Types overlap. The same person can have tension-type headaches and migraine, and any type can hurt in more than one place. Location is one clue beside how long it lasts, what it feels like and what comes with it. Only a clinician who examines you can say what type it is.

The NHS says most headaches are not serious, but to call 999 or go to A&E if a headache started suddenly and is extremely painful, comes with numbness or weakness, trouble speaking, balancing or remembering, a head injury in the last 3 months, a rash that does not fade under a glass, or a very high temperature, stiff neck or bright lights hurting. It advises urgent advice for headaches with vision problems, headaches triggered or worsened by coughing, sneezing, bending or exercise, or with vomiting.

A diary helps your doctor. The NHS says keeping a headache diary might help you work out what triggers your headaches. Write the place, the side, how it feels, how long it lasted, what came with it and what you took.