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What Causes a Headache on Top of Your Head?
Most headaches, including those at the top of the head (behind the forehead or beneath the scalp near the crown), resolve on their own. Still, some headaches are symptoms of underlying health problems, so it’s important to know the signs that you should seek further care.
Location is just one piece of information, and it may not be the most useful factor when it comes to making a diagnosis, says Elizabeth Loder, MD, vice chair of academic affairs in the department of neurology at Brigham and Women’s Hospital and a professor at Harvard Medical School in Boston. “We ask other questions to narrow the possibilities, including history of injury, migraine, tension-type headaches, or — rarely — a problem like a brain tumor or other abnormality.”
Some of the more common causes of head pain include migraine and tension headaches, Dr. Loder says. These are known as “primary” headaches, meaning they aren’t connected to other health issues. Secondary headaches, on the other hand, stem from other underlying problems, such as sinusitis.
Migraine
Many people have headaches caused by migraine on one side of the head. However, migraine can affect both sides of the head or the top, says Patricia Olson, MD, a neurologist and assistant professor at the Indiana University School of Medicine in Indianapolis. The cause of migraine is unknown, but it’s thought that people with the condition may have inherited or developed (perhaps due to a head injury) a nervous system that’s easily triggered, Loder explains.
“Some migraine triggers might be stress, caffeine withdrawal, dehydration, hormonal changes, sleep changes, and alcohol. All of those could contribute to a migraine attack,” Dr. Olson says.
Headaches caused by migraine usually cause moderate to severe pain, which may be made worse by physical activity and can last hours or days, Loder says. Other migraine symptoms include sensitivity to light or sound, as well as nausea or vomiting.
Tension-Type Headaches
Tension-type headaches are the most common headache type, says Sweta Sengupta, MD, assistant professor in the department of neurology at Duke University School of Medicine in Durham, North Carolina.
“Tension-type headaches are more mild to moderate in intensity. They’re typically described as ‘band-like’ and ‘tight,’” Dr. Sengupta explains.
Also known as stress headaches, these usually stem from muscle tension, eyestrain, sleep disorders, mood disorders, or neck and jaw problems.
Sinus Pressure
“Sinus pressure can be caused by environmental allergens, viruses, or bacteria that result in fluid in the sinuses that does not drain well,” says Rena Sukhdeo Singh, MD, neurologist and medical director of the Primary Stroke Center at the University of Maryland Shore Regional Health in Easton. “The accumulation of the fluid in the sinuses can lead to pressure in the head.”
Other symptoms of sinusitis include pressure-like pain behind the eyes, toothaches, face tenderness, coughing, and nasal stuffiness.
Medication Overuse
“Overuse of over-the-counter medications, like [acetaminophen, ibuprofen, and aspirin], can actually lead to rebound headaches or medication overuse headaches,” Dr. Singh says.
According to the Mayo Clinic, this phenomenon only seems to occur in people who use these types of medications to treat headache disorders, such as migraines. People without a history of headaches don’t usually have this problem.
Trigeminal Autonomic Cephalalgia (or ‘Cluster Headaches’)
With this category of headaches, of which cluster headaches are the most common type, pain molecules affect the trigeminal nerve system (a group of nerves in the head), says Singh.
The trigeminal nerve system sends signals to the brain from parts of the face — including behind the eyes — and vice versa.
Along with severe pain, cluster headaches can cause eye redness, tearing, and a runny, agitated nose, Singh says.
“Cluster headaches result in multiple headaches throughout the day that last between 15 minutes to three hours,” she adds.
Cervicogenic Headaches
“Cervicogenic headaches usually cause an aching pain or pressure that starts from the back and radiates upward to the crown,” says Minal Patel, DO, a neurologist with Atlantic Medical Group in Rockaway, New Jersey.
These headaches result from issues with the neck, says Chantel Strachan, MD, an assistant professor of medicine at Columbia University and internist at Columbia Primary Care in New York City. People with these headaches often have neck pain and stiffness as well.
“A common cause is cervical arthritis. However, secondary causes like a tumor or infection can play a role, depending on the clinical scenario,” Dr. Strachan explains. “Having neck pain and headache does not automatically mean you have cervicogenic headache.”
Although uncommon, pain on the top of the head can sometimes stem from more serious issues, including tumors or problems with the nerves or vasculature.
Occipital Neuralgia
Occipital neuralgia is a result of irritation or inflammation of the occipital nerves, located at the back of the head, Olson says.
“Occipital neuralgia can cause a shooting, stabbing, or burning pain that starts at the back of the head. The pain can spread toward the top of the head or even to the forehead or temples,” Olson says.
The pain, which can also spread to the neck, may be on one or both sides of the head, she says. People with occipital neuralgia may also feel tenderness in the affected area.
Cranial Arteritis
Strachan explains that cranial arteritis is inflammation in a blood vessel, which can cause pain. Temporal arteritis, or giant cell arteritis, is one subtype.
“Classically, giant cell arteritis presents as a throbbing, long-duration pain in one or both temples,” Strachan says. “Sometimes there is associated jaw pain or jaw fatigue.”
Cranial arteritis requires immediate diagnosis and treatment, since it can damage other blood vessels, potentially leading to blindness, Strachan says. Symptoms that are a sign you should seek urgent medical attention include jaw pain, a persistent headache, scalp pain, fever, fatigue, vision loss, and unintended weight loss.
“With treatment, the symptoms usually resolve,” she says. “However, it can take a couple of years to taper off the steroids without relapse.”
Abnormal Spinal Fluid Pressure
High or low spinal fluid pressure may cause pain on the top of the head by producing pressure or traction on pain-sensitive structures in the head, Loder says.
“In addition to headache, people with elevated spinal fluid pressure may experience noise in the ears and notice that the headache is worse when lying flat and better when they sit or stand,” she says. “With low spinal fluid pressure, the headache may improve with lying down and worsen with standing.”
Signs you should seek urgent medical care include blurred vision, vomiting, seizures, sleepiness, weakness, feeling less alert than usual, and other behavioral changes.
Bleeding in the Brain
In rare cases, bleeding in the brain may cause pain on the top of the head, Singh says.
“Bleeding into the brain can be caused by a ruptured blood vessel (hemorrhagic stroke), ruptured aneurysm, extremely high blood pressure, or trauma,” she explains.
This can cause a sudden, severe “thunderclap” headache, as blood irritates the tissue surrounding the brain — for example, the meninges, Olson explains.
“It’s what many would describe as the worst headache of their life,” Olson says.
These are medical emergencies that require immediate attention. Head to the hospital if you experience a severe, sudden headache along with dizziness, difficulty speaking clearly, sleepiness, confusion, or sudden weakness, tingling, or paralysis on one side of your body.
Brain Tumors
Brain tumors are another unlikely, though possible, cause of head pain, Singh says.
“Brain tumors can push on the brain tissue and cause pain in the head. A brain tumor can also increase the pressure in a person’s head, which leads to pain,” she explains.
Headaches caused by tumors usually come with other red-flag symptoms, such as seizures, nausea and vomiting, numbness, paralysis, slurred speech, personality changes, or eye swelling.
Often, at-home remedies are enough to treat mild to moderate headaches, Dr. Patel says.
She recommends the following:
- Over-the-counter pain medications
- Cold compresses
- Applying pressure to the affected area
- Massaging the scalp
- Drinking fluids
- Resting in a quiet, dark room
Patel adds that healthy habits can also help prevent future attacks.
“Certain positive lifestyle changes can make the nerves less sensitive and make it harder for headaches to occur — including regular exercise, adequate hydration, sleeping well, and managing stress,” she says.
Most headaches don’t require medical intervention, but MedlinePlus (a service of the National Library of Medicine) advises scheduling an appointment if you get headaches that:
- Disrupt your sleep
- Last more than a few days
- Are worse in the morning
- Have changed in pattern or intensity
- Are recurring and have no known cause
Patel also recommends seeking medical advice if you’re using over-the-counter medications to manage headache pain more than twice a week, those medications are ineffective, or you’re experiencing other bothersome symptoms.
In some cases, headaches can signal a medical emergency, such as bleeding in the brain, a brain tumor, abnormal spinal fluid pressure, or temporal arteritis. The National Institute of Neurological Disorders and Stroke recommends seeking urgent care if you experience the following:
- Sudden, severe headache and stiff neck
- Severe headache accompanied by fever, nausea, or vomiting (unrelated to another illness)
- The first or worst headache you’ve ever experienced that includes confusion, weakness, double vision, or loss of consciousness
- Severe headache accompanied by confusion, weakness, double vision, or altered consciousness
- Headache that progressively intensifies or changes
- Headache after head trauma
- Recurring headaches in children
- Headache along with a loss of sensation or weakness in any body part
- Headache along with convulsions or shortness of breath
- A new, persistent headache if you’re over age 50
- A new headache if you have a history of cancer or HIV/AIDS
- Head pain can have many causes, but most are nothing dangerous.
- For the more common types of top-of-head headaches (such as those caused by migraine or tension), you can treat the pain at home with a cold compress, over-the-counter medication, and rest.
- However, it is essential that you seek medical advice if your headache is persistent, severe, or interfering with your life.
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