Headache: common types, assessment and when to see a doctor

Headache is divided into primary headache, which arises without a demonstrable underlying disease, and secondary headache, which is caused by a specific disease [1]. The great majority have the first type.

NHI states that eight out of ten have had a headache in the past year, and that about 5 percent have headache weekly or more often. In fewer than 1 percent of those who see a GP for headache is there a disease that explains the symptoms [1]. Common causes are tiredness and stress, and headache can also accompany fever [2].

Tension-type headache is the most common type of headache. The pain is described as pressing, often like a tight band across the forehead and around the head, and it is not throbbing. It is usually absent in the morning and increases during the day, and it is not made worse by physical activity [3].

About one in four in Western countries experience episodes. A connection with increased tension in the head and neck muscles is assumed, but it is uncertain whether the tension is a cause or a result. Psychological stress is a common trigger [3]. Chronic tension-type headache means headache on more than 15 days a month for at least three months [3].

Migraine causes attacks of one-sided, throbbing headache lasting from 4 to 72 hours, often with nausea, vomiting and sensitivity to light and sound. The headache can change side from attack to attack, and neck pain is common [5].

About 15 percent of adult Norwegian women and 6 percent of men have migraine. In 15 to 30 percent the attacks come with aura, for example flashes of light or zigzag lines in the visual field, usually lasting less than an hour. Possible triggers are certain foods, stress, lack of sleep and menstruation [5].

Cervicogenic headache is a one-sided headache in which the pain is assumed to originate from structures in the neck. It usually starts in the neck and spreads forward towards the forehead. The pain is often related to head position or neck movements, and neck mobility may be reduced [4].

NHI states that 0.2 to 4 percent in population studies may be affected, and that the condition is more common in women than in men. The diagnosis is made mainly by examination in which the history is central, and blood tests and imaging give little clarification [4].

The assessment starts with the history: the type, location, character and duration of the headache, accompanying symptoms and what relieves it. After that the head, eyes, vision, sinuses, jaw joints, teeth, neck muscles and blood pressure are examined, among other things [1].

CT or MRI is rarely necessary in tension-type headache, unless the examination raises suspicion of another type of headache [3]. A headache diary can help to document the attacks [3][4].

In tension-type headache it is important to have it explained that the condition is not caused by serious disease. Relaxation techniques, regular physical activity and enough sleep are central measures, and physical activity does not make the headache worse [3]. Overuse of painkillers can itself cause headache, so use should be limited [3].

The evidence for manual therapy is weak. For tension-type headache, NHI writes that manipulation of the neck is widely used, but that documentation of effect is lacking [3]. For cervicogenic headache, NHI mentions one large study in which manipulation, exercises or a combination gave less headache than no physical treatment, while another study found no effect of manipulation [4]. In cervicogenic headache a gentle start with light stretching, training in relaxation and regular physical activity is recommended [4].

Acute headache of a different type or intensity than you have had before requires medical assessment [1]. You should also get medical help if the headache:

• comes suddenly and is very severe
• is accompanied by fever, a stiff neck, rash, confusion, seizures, double vision, dizziness, marked weakness, loss of balance, numbness or difficulty speaking
• gets worse after a head injury, a fall or a blow to the head
• is a new type of pain and you are over 55 [2]

Sudden loss of vision together with pain in the temple or scalp, and a red and painful eye with reduced vision, are other signs that should be assessed by a doctor [1].

If the headache has no signs of acute illness, a chiropractor can go through the history and examine the mobility and function of the neck, and together with you consider what may be relevant next. You can read more about tension-type headache and neck-related headache.

What is the most common type of headache?

Tension-type headache is the most common type of headache. The pain is often described as a tight band around the head [3].

What is the difference between migraine and tension-type headache?

Migraine typically causes one-sided, throbbing headache with nausea and sensitivity to light and sound [5]. Tension-type headache is pressing rather than throbbing, and it is usually not made worse by physical activity. Sensitivity to light and sound is less common [3].

Can a headache come from the neck?

Yes. In cervicogenic headache the pain is assumed to originate from structures in the neck, and it is often related to head position or neck movements [4].

Do I need an MRI for headache?

Usually not. In tension-type headache CT or MRI is rarely necessary unless the examination raises suspicion of another type of headache [3]. In cervicogenic headache imaging gives little clarification [4].

When is a headache dangerous?

Headache that comes suddenly and is very severe, or that is accompanied by fever, a stiff neck, confusion, seizures, paralysis or difficulty speaking, should be assessed by a doctor immediately [1][2].

The page about headache and dizziness describes what an examination can involve. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Akutt hodepine (headache guide). NHI.no, based on Legehandboka. Last updated 31 May 2022. Link

2. Hodepine (headache). NHI.no, first aid. Last updated 1 April 2022. Link

3. Spenningshodepine (tension-type headache). NHI.no, based on Legehandboka. Last updated 12 March 2024. Link and link

4. Cervikogen hodepine (cervicogenic headache). NHI.no, based on Legehandboka. Last updated 9 June 2022. Link

5. Migrene (migraine). NHI.no, based on Legehandboka. Last updated 9 April 2024. Link