Does your headache keep returning?

How does the pain start and where do you feel it?

Headache is one of the most common physical symptoms. Think of your last episode and answer these questions:

• When did the headaches first appear?
• Did the pain come on gradually or suddenly?
• How often does it recur, and how long does it last?
• Where exactly do you feel the pain?
• What is it like: pressing, throbbing, sharp, burning or something else?
• How strong is it, and does it get in the way of everyday tasks?

If the pain came on suddenly and is unusually severe, or new problems with speech or movement have appeared, go straight to the first point of the section “Headache: urgent or routine?”.

What does a doctor ask about headaches?

Headaches can have different causes, including migraine, tension-type headache or another condition. Stress can affect the course but does not establish a diagnosis. A doctor will ask how it started, about other symptoms and how often you take painkillers.

If low mood and loss of interest in life persist along with headaches, a doctor may also assess for depression. A headache on its own does not yet mean that you have this disorder.

A working day with a headache

For Radoslava and Yaromyr the pain comes with tension in the neck and shoulders, while for Mykyta it has become more frequent and needs more and more painkillers – a separate reason to talk to a doctor. The section “A pain diary and care with painkillers” covers what to note and what to avoid.

If at least one of these stories resembles yours, think about what happened before your last headache. If none of them fits, go back to the questions in the section “How does the pain start and where do you feel it?”.

A family doctor for the pain, a psychiatrist for your mood

For new or persistent physical symptoms, start with a family doctor. Further investigations depend on your symptoms and examination, not a standard checklist. Mood or anxiety difficulties can also be discussed with a psychiatrist.

Before seeing a psychiatrist, look at the initial psychiatric consultation page: it describes what the conversation will cover. The specialists’ areas of work are collected on the clinic’s doctors page.

A pain diary and care with painkillers

If the pain is mild and similar to familiar episodes, rest, enough fluids, regular meals, sleep and easing tension in the neck and shoulders may help. Yaromyr in our example could change position during breaks and not hunch over his phone for long.

It is also useful to keep a headache diary for a while and note:

• when the pain starts, how long it lasts and how strong it is;
• sleep, meals, stress and caffeine;
• your menstrual cycle;
• the medicines you have taken.

This makes repeating patterns easier to see. If stress or anxiety regularly worsens the pain, relaxation techniques, physical activity and psychotherapy can be part of a combined approach, but they do not replace a medical diagnosis.

Do not take painkillers too often without consulting a doctor: with regular use of some of them, headaches can become more frequent.

Headaches often have companions

Headaches often come with other complaints. Compare what else is closer to your experience.

• Muscle tension. Your shoulders, neck or jaw are constantly tense, as with Radoslava in our example. See the page on muscle tension.
• Insomnia. Poor sleep and headaches make each other worse. Compare with the description of insomnia.
• Body pain. Not only your head hurts but also your back, joints or muscles. The page on body pain looks at what this is like.
• Psychosomatic pain. The pain gets noticeably worse when you are upset. See the page on psychosomatic pain.

These complaints often occur together, and one of them on its own decides nothing.

Headache: urgent or routine?

1. If the pain came on suddenly and is unusually severe, or new problems with speech or movement have appeared, you need urgent medical help: call 103 or 112 in Ukraine.
2. If a headache comes with repeated vomiting, vision problems, marked weakness, numbness, fever or other unusual symptoms, a medical examination is especially important.
3. If headaches have become regular, are getting worse, have changed their usual character or noticeably interfere with work, sleep and daily life, see a doctor.
4. If the pain is mild and similar to familiar episodes, start with the steps in the section “A pain diary and care with painkillers”.
5. If anxiety or low mood persist along with the pain, discuss this with a psychiatrist as well.