Headaches
A headache is not simply pain. It is information.
Almost everyone gets headaches. Some are mild, some are disabling, some disappear after a glass of water and others put people in a dark room for a day. They can feel similar and they are not the same thing. There are around two hundred recognised headache disorders, and the useful question is not only how to stop this one. It is why your body is producing it at all.
Begin reading
Stressors accumulate
Poor sleep
Blood sugar swings
Hormonal change
Neck and jaw tension
Inflammation
Nutrient status
No single one of these has to be large. Together they are enough to cross the threshold, which is why a headache feels like it came from nowhere. It rarely does.
Most pages about headaches are lists of remedies, and most pages about migraine are lists of triggers. Both treat the headache as the problem. It usually is not. The headache is the alarm, and an alarm is worth listening to rather than only silencing. The interesting question is why the alarm has become so easy to set off.
The goal is not only to stop today’s headache. It is to understand why they keep returning.
This page covers why pain is a signal rather than a diagnosis, how the main headache types actually differ and why that matters, the honest division of labour between medication and everything else, the threshold model that explains why headaches seem to arrive from nowhere, what a migraine really is at the level of the nervous system, the role of the neck, hormones, thyroid, metabolism and inflammation, why patterns tell you more than triggers, and the warning signs that need urgent assessment today rather than a plan.
The division of labour
Medication is good at stopping the attack you are having. It is not designed to answer why you keep having them.
Both jobs matter. They are simply different jobs, and confusing them helps nobody.
Free guide
Find the Trigger
A structured way to record what your headaches are actually doing, timing, location, character, what came before, what came with it and what helped, plus how to read the pattern that emerges and which findings are worth taking to a clinician.
Find the Trigger
Finding the pattern behind attacks, and what lowers the threshold.
Start with what pain is for
Pain is a signal, not a diagnosis.
Pain is one of the oldest survival mechanisms we have. It takes your attention, it slows you down, and it tells you something deserves investigating. That is the whole job. It is not a disease in itself, and a headache is a symptom rather than a condition.
Sometimes the cause is embarrassingly simple. You have not had water, you skipped lunch, you slept badly, you spent nine hours at a laptop. Sometimes several systems are contributing at once, and no single one of them would have been enough on its own.
There is one further thing worth understanding early, because it changes how urgently this is worth taking seriously. Pain pathways learn. A signal that repeats often enough can become easier to produce over time, first in the nerves themselves and eventually in the brain’s own processing. Once that shift is well established it becomes considerably harder to undo, which is the strongest argument there is for addressing recurring headaches while they are still occasional.
Reducing the pain matters. Understanding what it is reporting is where the durable change happens.
What the signal does
And what happens if it repeats
What the signal does
What it is for
It takes your attention
It makes you slow down
It tells you something deserves looking into
What repetition does
A normal protective response at first
Nerves become easier to trigger
The brain begins amplifying the signal rather than damping it
Less provocation is needed each time
Once that shift is well established it is considerably harder to undo, which is the strongest argument for addressing recurring headaches while they are still occasional.
The first useful step
Not all headaches are the same.
Roughly nine in ten headaches are either tension type or migraine, and the rest are spread across a long list. Naming the type is not a bureaucratic exercise. Different patterns point at genuinely different physiology, and calling everything a migraine is one of the more common reasons people spend years on the wrong approach.
A neurological event, not a bad headache
Often one sided, throbbing, four to seventy two hours, and disabling enough to stop the day. Comes with nausea, and sensitivity to light, sound or smell. Around a fifth of people also get an aura beforehand.
The most common of all
Bilateral in about nine cases in ten, a tight band or pressure rather than a throb, mild to moderate, and usually survivable through a working day. Triggered by stress, poor sleep, dehydration, skipped meals and alcohol.
Referred from the neck muscles
A dull ache that can feel sharp, no throbbing, arriving after muscle overuse or a long stretch of repetitive posture. The pain is felt in the head but the problem is in the neck.
From the joints, not the muscles
Neck pain with headache, clearly worse with neck movement, and usually traceable to an injury involving the ligaments or joint capsules of the cervical spine. A different problem from muscular neck pain and it needs a different approach.
Often missed entirely
Referred from the muscles around the jaw hinge, and associated with grinding, clenching, dental work or a disc problem in the joint itself. Frequently attributed to stress alone when there is a mechanical component too.
Usually a mucus problem
Pressure and fullness across the forehead, cheeks or between the eyes depending on which sinuses are involved, alongside congestion. Genuine sinus headache is less common than the label suggests, and much of it responds to addressing mucus rather than the sinus.
Tracks the cycle
Can present as migraine or as a band like tension headache, and follows hormonal shifts around menstruation, ovulation and perimenopause. The timing correlation is the clue and it is only visible if someone is recording it. Hormone Health
Quietly common and reversible
Bilateral, dull and pulsing, at the base of the neck or the front of the head, not usually set off by light or sound. It typically resolves within two to six weeks of thyroid treatment, and it happens with subclinical thyroid problems too. Thyroid Health
After a head injury, even a mild one
Can appear anywhere and can imitate any other type, depending on which region was affected. Persistent headache after head injury is common, and notably so after injuries considered minor at the time.
Rare, and among the most severe pain known
Strictly one sided around one eye, searing or stabbing, fifteen minutes to three hours, with tearing, a blocked nostril or a drooping lid on the same side. Comes in bouts over weeks. This needs specialist care.
The trap that catches good patients
A dull constant headache present on fifteen or more days a month, often waking people from sleep, caused by frequent use of the very medication taken to relieve it. It usually settles once the overuse stops, which is easier to describe than to do.
Uncommon, and worth knowing about
Bilateral, at the back or top of the head, throbbing or pressing. Only one or two percent of people with high blood pressure get headaches from it, so this is rarer than assumed, and it becomes urgent when it arrives with chest pain, breathlessness or vision change.
Location plus behaviour
Where it hurts is a clue, and how it behaves is a bigger one.
No diagram diagnoses anybody, and this one is not meant to. It is meant to show that the common types tend to occupy different territory and behave in different ways, which is why a careful description of your own headache is worth more at a first appointment than almost anything else you could bring.
Where the common types present
Location plus behaviour narrows the list faster than any test does, which is why a careful description of your own headache is the most valuable thing you can bring to a first appointment.
One distinction inside that list is worth pulling out, because it changes the treatment entirely. A cervical myofascial headache comes from muscle, and it responds to release work, movement and addressing why those muscles are working so hard. A cervicogenic headache comes from the joints and ligaments of the neck, usually after an injury, and muscle work alone will not resolve it. They can feel almost identical to the person having them. The give away is that cervicogenic pain is clearly provoked by neck movement rather than by muscle overuse.
Two different jobs
Stopping today’s headache and preventing the next one are not the same task.
This needs saying plainly, because a lot of writing in this field is quietly dishonest about it. When someone is in the middle of a severe migraine, the priority is relief, and medication is genuinely good at that. Anti inflammatories, triptans and the newer drugs that block the signalling molecule behind migraine all have real mechanisms and real evidence. Nothing in a functional medicine approach competes with them during an attack.
What that approach is for is the other question. Not how do I stop this one, but why do these keep arriving, and what has changed in this person’s physiology to make them so much easier to produce than they used to be.
That distinction reorganises everything. Instead of chasing individual episodes you go after the load underneath them. It is slower, it is less satisfying in the moment, and over a year it is usually what changes the number of headaches someone has.
Medication stops the attack. Physiology decides how often you have one.
Who does what
Both, not either
Who does what, both rather than either
Stopping today’s attack
Anti inflammatories, usually first line
Triptans, second line
Drugs blocking CGRP, the newer option
Fast, evidence based and effective during an attack
Preventing the next one
Sleep, blood sugar stability and hydration
Thyroid and hormone status
Nutrient status and inflammatory load
Neck, jaw and posture
These are different jobs and both are needed. Nothing in the second column competes with medication during an attack, and nothing in the first column changes how often attacks happen.
The model that explains the most
Why headaches become easier to trigger.
Think of your nervous system as having a threshold. When you are well it takes a real challenge to cross it. Over time a set of quieter factors can lower where that threshold sits, and once it is low enough an ordinary Tuesday is sufficient. This is the difference between what set off today’s headache and what made you the sort of person who gets them.
Two kinds of input
Amplifiers, already present
Neuroinflammation in the brain
Inflammation in the blood vessels
Mitochondria producing less energy than they should
Genetic susceptibility
Activators, the thing that happened on the day
A poor night, or several in a row
A missed meal or a blood sugar crash
A hormonal shift
Stress, or more often the let down after it
The more amplifiers are already present, the less an activator has to do. That is why the same glass of wine is fine one month and not the next, and why removing a single trigger so rarely fixes the pattern. Chasing triggers treats the last straw. The load is the real target.
This also explains a frustration that almost everyone with recurring headaches recognises. You keep a trigger diary, you find the culprit, you remove it, and for a while things improve. Then the headaches come back and the diary implicates something else. Nothing was wrong with the detective work. The trigger genuinely did contribute. It was simply the last item added to a load that was already close to the top, and while the load stays high there will always be another last item.
On trigger hunting
A trigger is the last thing added to a load that was already nearly full. While the load stays high, there will always be another last thing.
Which is why the diary keeps finding new culprits.
A neurological condition in its own right
Migraines are more than bad headaches.
Migraine is not a severe tension headache. It is a distinct neurological event involving the nervous system, the blood vessels of the head, immune signalling and the brain’s own processing, and the pain is only one part of it. It affects roughly six to eight percent of men and fifteen to twenty five percent of women, and it is consistently ranked among the most disabling chronic conditions there is.
The sequence is reasonably well understood. Nerve endings from the trigeminal system release a signalling molecule called CGRP. That widens the blood vessels in the lining around the brain, produces the throbbing quality people describe, and sets off an inflammatory response in the surrounding tissue. Meanwhile a slow wave of altered activity spreads across the cortex, which is what produces an aura in the twenty to twenty five percent of people who get one. The brain’s pain centres then amplify the signal rather than damping it.
That is why nausea, and sensitivity to light, sound and smell, are not side effects of a bad headache. They are part of the same event. So is the flat, foggy day before and the flat, foggy day after, which many people never think to mention because they do not connect it to the headache at all.
The pain is the loudest part of a migraine. It is not the whole of it.
Inside a migraine
The event, not just the pain
Inside a migraine
What actually happens
Trigeminal nerve endings fire
They release a signalling molecule called CGRP
Blood vessels in the lining around the brain widen
A slow wave of altered activity spreads across the cortex
The brain’s pain centres amplify the signal rather than damping it
Why it is more than pain
Nausea and vomiting
Sensitivity to light, sound and smell
Visual aura in roughly one person in five
A flat, foggy day on either side of the attack
The headache is the loudest part of the event and not the whole of it, which is why treating only the pain leaves so much of the experience unaddressed.
Why the neck, the thyroid and the gut all appear on a headache page
Where the threshold is actually set.
Not every headache begins inside the brain. Some come from the muscles and joints of the neck. Some follow hormonal shifts. Some become more frequent when thyroid function falls. Some are driven by dehydration, electrolyte balance, unstable blood sugar or nutrient status. The body works as one connected system, and a headache is usually a conversation between several parts of it rather than a fault in one.
These set the threshold between them
Sleep
Blood sugar
Hormones
Thyroid
Gut health
Inflammation
Nutrition
Hydration
Neck function
Environment
Lower any one of these far enough and the others have less room to absorb. This is why a headache page has to talk about the thyroid and the gut, and why the answer is rarely found by looking only at the head.
The thyroid deserves a specific mention because it is both common and correctable. Thyroid hormone influences how blood vessels behave, including their tone and the signalling molecules involved in migraine, and headaches associated with low thyroid function typically resolve within two to six weeks of treatment. Autoimmune thyroid disease appears to be notably common among people with migraine, and subclinical thyroid problems, meaning the ones where TSH is raised but everything else looks fine, produce headaches too. If you have recurring headaches and have never had a full thyroid panel rather than TSH alone, that is a reasonable thing to ask for. Thyroid Health covers what a full panel means.
The load underneath
What actually lowers the threshold.
One caveat belongs at the top of this list rather than buried in it. Where nutrients appear below, they are preventive rather than rescue. They are taken consistently for weeks to months to reduce how often headaches happen, and they do nothing whatsoever during an attack. Anyone selling a supplement as something to reach for mid migraine is describing a product rather than a mechanism.
Both too little and too irregular
Short sleep is a well established activator, and so is the change itself, which is why the weekend lie in has a reputation. Consistency of timing tends to matter as much as total hours.
The drop, more than the spike
A glucose crash is a direct trigger for both migraine and tension type headaches, and insulin resistance quietly raises inflammatory tone in the background. Regular meals with fibre, fat and protein do more here than any supplement. Blood Sugar and Metabolic Health
Unfashionable and genuinely relevant
Sodium, potassium, magnesium, calcium and chloride carry the charge that muscle contraction and nerve signalling depend on. Imbalance shows up as headache, cramping, fog and drowsiness, and it is easily produced by heat, illness, hard training or common medications.
The best supported single nutrient here
Across several thousand people, inadequate dietary magnesium was associated with meaningfully higher odds of migraine, and the highest intake group with lower odds. In one controlled trial, magnesium performed comparably to a standard preventive drug.
Low far more often than expected
In one study of a hundred and twenty people with myofascial pain, not a single person reached the ideal range and around eight in ten were insufficient or frankly deficient. Levels also run lower in people with migraine, and correcting them reduces frequency.
Better evidence than most people realise
Pooled across forty controlled trials and more than six thousand people, preventive EPA and DHA reduced frequency and severity and were not inferior to approved pharmaceutical preventives. Weeks to months, not days.
Aimed at the energy problem
Brain imaging shows an energy deficit in people with migraine, and both of these support the machinery that produces it. Each has trial evidence for reducing frequency and duration when taken consistently over months.
Worth checking rather than assuming
Low iron can worsen migraine and correcting a genuine deficiency reduces frequency and intensity. Raised homocysteine is also associated with migraine, and lowering it with folate and B vitamins has reduced frequency and severity. Nutrient Deficiencies
Mechanical, and frequently ignored
Muscle overuse, clenching and grinding, old neck injuries and long static postures all feed headache directly. Movement matters here for a physical reason: motion stretches fascia and releases its grip on the vessels and nerves running through it.
Three distinct patterns, not one
The drop before a period, the fluctuating spikes of perimenopause, and in men a relative shortage of testosterone, which is more common in migraine and cluster headache than in men without them and is almost never tested. Hormone Health
A real association, not a fashionable one
Migraine travels with several digestive conditions more often than chance allows, including irritable bowel syndrome, coeliac disease and Helicobacter infection. Intestinal inflammation feeds the same signalling that drives migraine. Gut Health
The amplifier behind the amplifiers
Inflammation in blood vessels and in the brain’s own immune cells is what turns an occasional headache into a frequent one. After a head injury this can persist, leaving the system reacting hard to small provocations. Neuroinflammation
The most valuable thing you can bring
Patterns tell you more than any single headache does.
One headache is almost useless as evidence. Ten of them, recorded properly, will usually tell you what kind you have, what is driving them, and whether they are getting better or worse. These are the questions worth answering, and they are considerably easier to answer at the time than from memory three months later.
The questions that reveal a pattern
One headache tells you very little. Ten recorded properly tell you most of what a first appointment needs to know, and they are far easier to record at the time than to reconstruct from memory.
There is one pattern in particular worth watching for, because it is the one people miss in themselves. If headaches are present on fifteen or more days a month, and you are regularly reaching for something to treat them, the medication may have become part of the problem. Frequent use of painkillers, triptans or combination products can produce a dull, constant headache in its own right, often waking people in the early hours. It resolves once the overuse stops, which is a straightforward sentence describing a genuinely difficult few weeks. It should be done with your prescriber rather than alone.
Order before breadth
How an evaluation is sequenced.
We do not start by assuming every headache has the same cause, and we do not start with a large panel of tests. We start by understanding the person and the pattern, screen properly for the features that need urgent attention, then work outward from the foundation. Each step should answer the question that decides the next one.
The order we work in
Nothing here replaces neurology and nothing here is a reason to delay it. The aim is to find what is raising the load, and then to lower it.
The foundation answers more than people expect, and it is inexpensive. Iron, vitamin D, thyroid and glucose alone account for a meaningful share of recurring headaches, and all four are on a standard wide panel. Comprehensive Blood Chemistry covers what that includes and why it is read as a whole rather than value by value. Beyond it, Hormone Testing matters where the pattern follows a cycle, Micronutrient Testing where diet is restricted or absorption is in question, and Functional Medicine Testing explains how the specialised options fit together and when they earn their cost.
The sequence
How I approach recurring headaches.
This describes a clinical process carried out with a person rather than a protocol to run on yourself. It works alongside neurology, dentistry and manual therapy rather than in place of any of them, and it assumes that acute treatment stays exactly where it is while the preventive work happens.
The number to watch is headache days per month. Everything else is a story about that number.
Do not wait on these
Some headaches are not a long game.
Most headaches are not emergencies. A small number are, and the features that distinguish them are worth knowing by heart. These need assessment today rather than a plan, and the correct response to any of them is medical care rather than more reading.
A sudden severe headache reaching full intensity within about a minute
The worst headache of your life, or one entirely unlike your usual
Headache with weakness, numbness, confusion or difficulty speaking
Headache with fever, or with a stiff neck
New visual loss, double vision, or a drooping eyelid
Headache following a head injury, particularly if it is worsening
A headache that gets steadily worse over days or weeks
A first headache of this kind after the age of fifty
Headache with a seizure or loss of consciousness
Headache that consistently wakes you, or is worst on waking
Headache clearly worse on coughing, straining or bending forward
Headache with unexplained weight loss, or alongside cancer or reduced immunity
Two deserve naming directly. A headache that goes from nothing to maximum in under a minute is a medical emergency and warrants emergency services rather than an appointment, because one of the things it can indicate is bleeding around the brain. And if you are someone who gets headaches regularly, the signal is not severity but difference. A headache that breaks your established pattern deserves attention precisely because you are the person best placed to notice it.
Free guide
Find the pattern before you chase the trigger
Find the Trigger gives you a structured way to record timing, location, character, what preceded each headache and what helped, then read what emerges. It also lists the findings worth taking to a clinician and the ones that need same day attention.
Own your biology
Your headache is information.
Sometimes it reports stress. Sometimes hormones. Sometimes a neck that has been holding a position for nine hours. Sometimes inflammation. Occasionally something that needs attention today. Learning to read which of those you are dealing with is one of the more useful things you can do with your own biology, and nobody is better placed to do it than the person having the headaches.
Treating the pain matters and you should keep doing it. Understanding why it keeps coming back is where the change that lasts tends to come from. That work is slower and less dramatic: sleep, meals, water, movement, the things measured on a blood panel, the neck, the cycle. It is also the only part of this that changes the number.
Signal from disease The headache is the alarm, not the fault.
Load from trigger The trigger is the last straw. The load is the target.
Prevention from relief Medication stops the attack. Physiology sets the frequency.
Pattern from episode Ten headaches recorded beat one remembered.
Bring the pattern, not just the pain.
No pressure, and nothing to buy. Bring how many headache days you have had in the last month, how many days you took something for them, what the pain is like and where it sits, what comes with it, any recent blood work, everything you take including over the counter medication, and anything that has changed in the last year.
Common questions
Questions about headaches and migraine.
Short, plain answers to what people ask most.
How do I know whether I get migraines or just bad headaches?
Why does my trigger diary keep finding new triggers?
Can functional medicine stop a migraine attack?
I take painkillers a few times a week. Is that a problem?
Does magnesium actually work for migraine?
My headaches changed when my periods did. Is that connected?
Could my neck be causing this?
Should I be worried about what migraines are doing to my brain?
When should I seek emergency care rather than book an appointment?
