How to Get Rid of a Headache: What Works

What to do right now

Most headaches are not serious and settle with simple steps:¹

• Drink a glass or two of water. Not drinking enough is a common trigger
• Rest in a dark, quiet room, and sleep if you can
• Put a cold or warm cloth on your forehead or the back of your neck
• Loosen your neck and shoulders with gentle stretches or massage
• Eat something if you have skipped a meal
• Take simple pain relief from a pharmacy if you need it, following the directions on the pack

Does the evidence back these up?

Water

In a Dutch trial, 102 people with recurrent headaches were asked either to drink an extra 1.5 litres of water a day or to carry on as usual. Those who drank more scored better on a headache quality-of-life scale, and 47 per cent said they were much improved, compared with 25 per cent of the others. The number of headache days didn’t change.² It costs nothing to try.

Cold

In a small crossover trial, people with migraine wore a wrap holding ice packs against the front of the neck at the start of an attack. After 30 minutes their pain had fallen by about a third. In the comparison condition, it rose by about a third.³

Caffeine

Caffeine cuts both ways.

• It can help. A Cochrane review of 20 studies found that adding about 100 mg of caffeine, roughly a strong cup of coffee, to a standard pain reliever helped an extra 5 to 10 in every 100 people get good relief⁴
• Missing it causes headaches. In a trial where regular coffee drinkers were switched to a placebo without knowing, half developed a moderate or severe headache⁵
• Too much may make headaches more frequent. In a population study, people with headaches on most days were more likely to have been heavy caffeine users beforehand⁶

The practical message is to keep your intake moderate and steady from day to day, weekends included.

What kind of headache is it?

About half of all adults have an active headache disorder, so you are in large company.⁷

• Tension-type headache. The most common kind. A pressing or tightening feeling on both sides of the head, mild to moderate, and not made worse by ordinary activity.⁸ See tension headache
• Migraine. Affects about one in seven people.⁷ Usually throbbing, often one-sided, with nausea or sensitivity to light and sound, and worse with movement. See migraine relief and migraine vs headache
• Other types. See sinus headache, cluster headache and waking up with a headache

Don’t overdo the pain relief

Taking pain medicines for headaches too often can itself cause more headaches. This is called medication overuse headache, and it feels like a tension-type headache or a migraine.¹ It affects between 1 and 2 per cent of the population.⁹

The international definition is a headache on 15 or more days a month in someone who has been taking headache medicines on 10 to 15 or more days a month, depending on the type, for over three months.¹⁰ A sensible rule of thumb is to keep to two or three days a week at most. If you need more than that, see your doctor.

How to prevent headaches

• Keep a regular routine. Too much or too little sleep, skipped meals and not drinking enough water are all triggers¹
• Keep a headache diary for a few weeks. It helps you and your doctor spot patterns¹
• Exercise. A meta-analysis found that regular aerobic exercise reduced the number of migraine days¹¹
• Learn to relax your muscles. Biofeedback, which teaches you to notice and release tension, had medium-to-large effects on headache frequency in a review of trials, and the benefit lasted for more than a year¹²
• See a physiotherapist for frequent tension-type headaches. A network meta-analysis found that hands-on treatment combined with exercise was the most effective approach for reducing how often they occur¹³
• Check your posture and your eyes. Neck and shoulder tension and uncorrected eyesight problems are common contributors¹⁴
• Deal with stress. See stress

When a headache is an emergency

Call triple zero (000) or go to an emergency department if you have:¹

• A sudden, severe headache, sometimes described as the worst of your life
• A headache with fever and vomiting, or a stiff neck
• A headache with confusion, a change in personality or changes in your vision

When to see a doctor

See your doctor soon if you have a headache that:^1,15

• Gets steadily worse over several weeks
• Started after a head injury
• Wakes you from sleep, or is worse when you lie down
• Comes on when you cough, sneeze or strain
• Is new and you are over 65, pregnant, or have cancer or a weakened immune system
• Is different from your usual headaches

Also see your doctor if headaches are frequent, are stopping you from doing normal things, or have you reaching for pain relief often.¹ See constant headaches.

References

1. healthdirect. Headaches.
2. Spigt M, Weerkamp N, Troost J, et al. A randomized trial on the effects of regular water intake in patients with recurrent headaches. Fam Pract. 2012;29(4):370-5.
3. Sprouse-Blum AS, Gabriel AK, Brown JP, et al. Randomized controlled trial: targeted neck cooling in the treatment of the migraine patient. Hawaii J Med Public Health. 2013;72(7):237-41.
4. Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database Syst Rev. 2014;2014(12):CD009281.
5. Silverman K, Evans SM, Strain EC, et al. Withdrawal syndrome after the double-blind cessation of caffeine consumption. N Engl J Med. 1992;327(16):1109-14.
6. Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache: a population-based study. Neurology. 2004;63(11):2022-7.
7. Stovner LJ, Hagen K, Linde M, et al. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022;23(1):34.
8. Ashina S, Mitsikostas DD, Lee MJ, et al. Tension-type headache. Nat Rev Dis Primers. 2021;7(1):24.
9. Diener HC, Dodick D, Evers S, et al. Pathophysiology, prevention, and treatment of medication overuse headache. Lancet Neurol. 2019;18(9):891-902.
10. . Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
11. Lemmens J, De Pauw J, Van Soom T, et al. The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. J Headache Pain. 2019;20(1):16.
12. Nestoriuc Y, Martin A, Rief W, et al. Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2008;33(3):125-40.
13. Jung A, Eschke RC, Struss J, et al. Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache. A systematic review and network meta-analysis. Cephalalgia. 2022;42(9):944-965.
14. Better Health Channel (Victorian Government). Headache.
15. Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019;92(3):134-144.