Headache on Top of Head: Causes, When to Worry, Treatment

Headache on Top of the Head — Causes, When to Worry and Treatment

What usually causes pain on the top of the head, the warning signs that need urgent care, and what helps. Explained by a Sydney neurologist.

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When a Headache on Top of the Head Needs Urgent Care

Most headaches on top of the head are not dangerous. A few patterns need care straight away, so they come first.

Call 000 — or go to an emergency department — if

a headache comes on suddenly and severely and reaches its worst within a minute (the worst headache of your life), even if it then eases
the headache comes with fever and a stiff neck, a rash that does not fade when pressed, confusion or unusual drowsiness
the headache comes with sudden loss of vision (even if brief), double vision, a new drooping eyelid or one pupil larger than the other, slurred speech, sudden severe dizziness or unsteadiness, or numbness or weakness of the face, an arm or a leg
the headache started after a head injury and is getting worse, comes with vomiting, drowsiness or confusion, or you take blood-thinning medicine
the headache comes with a seizure
a very high blood pressure reading (a top number of 180 or more, or a bottom number of 120 or more) comes with chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure: call 000 straight away
your blood pressure is still very high when you measure it again after 5 minutes of sitting quietly, and you have a headache
you are more than 20 weeks pregnant or had a baby in the last 6 weeks and have a severe headache, a headache that does not get better with simple pain relief, blurred vision or flashing lights, sudden swelling of the face, hands or feet, pain under the ribs or in the upper tummy, vomiting with a headache, or a reading of 160/110 or more: go to your maternity unit or an emergency department now; call 000 for a seizure, trouble breathing or chest pain
you have a spinal cord injury at mid-chest level or higher and get a sudden, pounding headache, often with sweating or flushing above the injury: sit upright with your legs down, loosen anything tight, check your bladder, catheter and bowel, and follow your own dysreflexia plan if you have one; call 000 if it does not settle within a few minutes or you cannot find the cause

A sudden, explosive headache, wherever it is felt, can mean bleeding around the brain (a subarachnoid haemorrhage). A very high reading with chest or back pain or shortness of breath can mean the heart or the main artery from the heart is under strain; with vomiting, problems with eyesight, confusion or a seizure, it can mean the pressure is affecting the brain (hypertensive encephalopathy). A very high reading with a headache needs checking in an emergency department, because only tests can show whether the pressure is harming the brain, heart, eyes or kidneys. In pregnancy or after a birth, a severe headache can be the first sign of pre-eclampsia, a condition of high blood pressure in pregnancy; after a spinal cord injury, a pounding headache can be autonomic dysreflexia, a sudden surge in blood pressure set off by something below the injury, such as a full bladder. In both, lower readings than 180/120 count: in pregnancy, 140/90 is high and 160/110 is severe; after a spinal cord injury, a rise in the top number of 20 to 40 or more above your usual reading matters, and 130/90 can already be high. Weakness, trouble speaking or a sudden loss of vision can mean a stroke. A new drooping eyelid or a change in the size of one pupil can mean pressure on a nerve from a bulging blood vessel (an aneurysm) or a tear in the wall of an artery in the neck (a dissection). Fever with a stiff neck can mean meningitis. A seizure with a headache needs urgent checks for a cause in the brain. All need urgent treatment. If you have migraine, your usual aura (shimmering or zigzag lines that spread slowly over several minutes and clear within an hour) does not need 000 on its own. A first attack, one that is different, or one that comes with a very high reading needs urgent care. In the same way, vomiting in your usual migraine attack does not need 000 on its own; with a very high reading, it does. Remember FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 000.

See your GP the same day if

it is a new headache and you are over 50, especially with a tender scalp, pain in the jaw when you chew, or feeling generally unwell
the headache is getting steadily worse over days or weeks, or is worst on waking or when lying down, with vomiting or blurred vision
the headache is brought on by coughing, sneezing, laughing or straining, or comes with a whooshing sound in the ears in time with your heartbeat
the headache is worse when you sit or stand up and eases when you lie down
a rash of small blisters appears on one side of the scalp or forehead, often after 2 or 3 days of burning or tingling pain there
your blood pressure is still very high (a top number of 180 or more, or a bottom number of 120 or more) when you measure it again, even if the headache has gone and you feel well
you have a fever with the headache
you have cancer or a weakened immune system
you are pregnant or have had a baby in the last 6 weeks, or a reading taken from 20 weeks of pregnancy to 6 weeks after the birth is 140/90 or more: contact your midwife, maternity unit or GP the same day; with blurred vision or sudden swelling of the face, hands or feet, contact your maternity unit or go to hospital now

A very high reading without symptoms is rarely an emergency, but it needs a doctor that day to start or adjust treatment. If you cannot see your GP that day, go to an emergency department. If the headache started after a lumbar puncture, a spinal anaesthetic or an epidural, contact the hospital that did it. If something matches both lists, follow the 000 list.

Where most people sit

These patterns are uncommon. Most headaches on top of the head are tension-type headache or migraine: common conditions that do not damage the brain and can be treated. If you are worried about a brain tumour: in a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have one, and tumours usually cause other symptoms too, such as weakness, seizures, a change in personality, or a headache that gets steadily worse over weeks.

Why Does the Top of My Head Hurt?

Pain on top of the head can feel as if it comes from deep inside, as though pressure were building up in the brain. Usually it does not. The brain itself cannot feel pain: it has no pain sensors of its own. So what is actually hurting when the top of your head aches?

The pain comes from the structures around the brain: its coverings and their blood vessels, and the scalp, muscles and nerves outside the skull. Two sets of nerves carry the signals. The forehead, the front of the scalp and most of the coverings of the brain are supplied by the trigeminal nerve, the main nerve of the face. The back of the scalp, as far forward as the top of the head, is supplied by the occipital nerves, which come from the top of the neck. The top of the head is where the two meet.

Both sets of nerves feed into the same relay station, in the brainstem and the top of the spinal cord, which doctors call the trigeminocervical complex. It is a little like two rivers flowing into one lake: once the water has mixed, you cannot tell which river it came from. So tense muscles in the forehead or the neck, a migraine, and a tight hat or ponytail can all show up in the same place: on top of the head.

Where most people sit

A headache on top of the head is felt through the scalp and the nerves around the brain, not in the brain tissue itself. Most are tension-type headache or migraine. They can be painful and they can keep coming back, but they do not damage the brain, and most improve once the cause is clear.

The Common Causes of a Headache on Top of the Head

Each of these has a typical pattern. No single feature proves one, but together they point to it.

Tension-type headache. The most common headache of all: in different studies, between 30% and 78% of people have had one. It feels as if something is pressing on your head or tightening around it, like a weight or a tight band, usually on both sides. It is mild to moderate, does not throb, and you can usually carry on with your day. Stress, tiredness, poor sleep and long hours at a desk make it more likely, and the muscles of the scalp and neck are often tender. Read more about tension headache.
Migraine. Migraine is most often felt around the eyes, the temples or the forehead, but it can sit on top of the head: in a US study of nearly 1,300 people with migraine, about 1 in 4 felt pain there. It is usually throbbing, moderate to severe and worse with activity, lasts 4 to 72 hours, and comes with nausea or a dislike of light and noise. Stress, missed meals and poor sleep are among its most common triggers. Some people see flashing lights or zigzag lines before the headache: see migraine aura.
Medication-overuse headache. Pain relief taken on too many days a month can itself keep headaches going, and can turn occasional headaches into near-daily ones. See medication overuse headache.
Pressure or pull on the scalp. A tight hat, helmet, headband or swimming goggles can cause a headache where they press, which settles within an hour of taking them off. A tight ponytail, bun or braids can do the same where they pull: in one survey, 50 of 93 women had had a headache from wearing a ponytail, sometimes spreading forward to the top of the head, and loosening the hair eased it, usually within an hour.
Short, sharp stabs ("ice pick" pains). Brief stabs of pain that last a second or two (80% last 3 seconds or less), usually one or a few a day, which can strike anywhere on the head, including the top, and often move from place to place. Doctors call them primary stabbing headache. They are common: in a Norwegian study of 1,838 adults, about 1 in 3 had had them. They are more common in people with migraine. On their own they are harmless, but if the stabs are always in exactly the same spot, see your GP, because a cause at that spot needs to be ruled out. (In people with migraine, stabs often sit where the migraine usually does; your GP can judge this.) Read more about ice pick headache.
Occipital neuralgia. Irritation of the occipital nerves, which supply the back of the scalp as far forward as the top of the head. It causes severe, sharp, shooting, stabbing, burning or electric-shock-like pains that run from the base of the skull up over the back of the head, often to the top, and last from a few seconds to minutes; a duller ache can linger between them. It is usually on one side but can affect both. Unlike ice pick pains, which jump from spot to spot, these follow the path of the nerve. The scalp can feel numb, tingly or sore, so brushing your hair or resting your head on a pillow can hurt, and the nerve is often tender where it leaves the base of the skull. An injection of local anaesthetic around the nerve (an occipital nerve block) can ease the pain. A new pain like this should be checked by your GP, because a cause in the neck or in the nerve itself needs to be ruled out. A burning pain followed by a rash of small blisters is shingles: see your GP the same day. See also headache at the back of the head.

Tension-Type Headache, Migraine, Stabbing Pains, Nerve Pain or Pressure?

These features help tell the five apart.

Swipe the table sideways to compare all five →

Feature	Tension-type headache	Migraine	Stabbing ("ice pick") pains	Occipital neuralgia	Pressure from a hat or hairstyle
Where it hurts	Both sides; like something pressing on the head or tightening around it	Most often around the eyes, temples or forehead, often on one side; on top in about 1 in 4 people with migraine	Anywhere on the head, including the top; often moves from spot to spot	From the base of the skull up over the back of the head, often to the top; usually one side	Where the hat, band or hair presses or pulls; it can spread
Feels like	Pressing or tightening, mild to moderate	Throbbing, moderate to severe, worse with activity	A sudden, sharp stab	Severe, sharp, shooting, stabbing, burning or electric-shock-like	Pain that is worst at that spot
How long	30 minutes to 7 days	4 to 72 hours	A fraction of a second to a few seconds; usually one or a few a day	A few seconds to minutes, in repeated attacks; a duller ache can linger between them	Starts within an hour of the pressure; settles within an hour of removing it
Brought on by	Stress, tiredness, poor sleep, long hours at a desk	Stress, missed meals, poor sleep, hormonal changes, weather changes, alcohol	Usually nothing: they come out of the blue	Touching the scalp, brushing the hair, resting the head on a pillow, or pressure at the base of the skull	A tight hat, helmet, headband, goggles, ponytail, bun or braids
Other symptoms	Usually none; no more than mild nausea	Nausea, a dislike of light and noise; sometimes aura	Usually none; more common in people with migraine	A numb, tingly or sore scalp; tender at the base of the skull	None

Headaches every day? A headache on 15 or more days a month is often called chronic daily headache. The usual causes are frequent tension-type headache, migraine that has become chronic, and taking pain relief on too many days, which can itself keep headaches going; often more than one is present. Waking with a headache most mornings can also come from sleep apnoea, where breathing stops and starts during sleep, especially if you snore. And if you have caffeine every day, stopping or delaying it can bring on a headache within a day that settles within a week. Daily headaches are common, and treatable once the causes are sorted out. A daily headache that is new and getting steadily worse needs your GP the same day.

Where most people sit

The table is a guide, not a diagnosis. The features overlap, and many people have more than one kind of headache: stabbing pains and tension-type headache are both common in people with migraine. All five are treatable or easily avoided, and sorting them out is the main job of the consultation.

The Less Common Causes Doctors Look For

A few other conditions can cause pain on top of the head. Each is uncommon, and each usually has a pattern that gives it away.

Raised pressure inside the head. A headache that is worse lying down or first thing in the morning, sometimes with vomiting or blurred vision, and that gets steadily worse, can mean pressure is building up, for example from a blockage of the fluid pathways or, rarely, a tumour. Raised pressure of the fluid around the brain without a tumour (idiopathic intracranial hypertension) can also cause a whooshing sound in the ears in time with the heartbeat, and is most common in women of child-bearing age. All need prompt assessment, because some can affect sight.
Low pressure of the fluid around the brain (low cerebrospinal fluid pressure). A headache that comes on soon after you sit or stand up and eases when you lie down. It most often follows a lumbar puncture, a spinal anaesthetic or, occasionally, an epidural, and rarely happens without any procedure.
Giant cell arteritis, an inflammation of the arteries of the scalp. A new headache after 50, often at the temples, with a tender scalp (brushing the hair can hurt), pain in the jaw when chewing and feeling unwell. It is treated urgently to protect the eyesight.
Shingles. Burning or tingling pain on one side of the scalp or forehead, followed after 2 or 3 days by a rash of small blisters there. Treatment works best when it is started early, so see your GP the same day.
Inflammation deep in the sinuses (sphenoid sinusitis). The sphenoid sinus sits deep behind the nose, in the middle of the skull. Inflammation there is uncommon and easily overlooked, and its pain can be felt behind the eyes, across the forehead, at the back of the head or on top. A scan is usually needed to find it, and it is treated by an ear, nose and throat (ENT) specialist; treatment usually eases the headache. With fever, double vision, a drooping eyelid or any change in vision, it needs urgent care: see the warning signs above.
Coin-shaped headache (nummular headache). A constant or recurring pain in one small, sharply outlined, round patch of scalp, 1 to 6 cm across, most often on the top or upper side of the head. The skin there can feel numb, tingly or sore, and it often lasts for months. Doctors check the scalp and the skull at that spot first, to rule out other causes.
A headache that wakes you from sleep (hypnic headache, sometimes called "alarm clock" headache). Attacks that come only during sleep and wake you, lasting 15 minutes to 4 hours, on at least 10 nights a month for more than 3 months, usually starting after 50. It is rare and not dangerous in itself, but it is diagnosed only after other causes of night-time headache have been ruled out: sleep apnoea, high blood pressure at night, low blood sugar, pain-relief overuse and conditions inside the head.
Very high blood pressure. Long-standing high blood pressure rarely causes headache. A sudden, very high rise (a top number of 180 or more, or a bottom number of 120 or more) can: if the reading is still that high after 5 minutes of sitting quietly and you have a headache, go to an emergency department or call 000; call 000 straight away if you also have chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure. In pregnancy, after a birth and after a spinal cord injury, lower readings count: see the lists at the top, and headache with high blood pressure.

A headache set off within a second or two of coughing, sneezing, laughing or straining is a different condition (cough headache). It peaks almost at once and usually fades over seconds to minutes. About 4 in 10 cough headaches have an underlying cause, most often a Chiari malformation, where the lowest part of the brain sits lower than usual and crowds the top of the spinal canal. So a cough headache is always worth having checked, usually with an MRI scan. Headaches that come on with hard exercise or during sex are assessed with the same care: see headache after exercise.

Where most people sit

These causes are uncommon, and they usually announce themselves: a headache that changes with posture, comes with coughing or a rash, wakes you night after night, worsens week by week, sits in one fixed spot, or starts after 50. A careful history and examination usually tell the doctor whether any of them is possible, and the right test, when one is needed (a scan, blood tests or an eye check), usually settles the question.

How Is the Cause Found?

Most of the time the cause is found from your story and an examination. Tests are for when the pattern raises a question.

Your story. Where the pain is and whether it moves, what it feels like, how long it lasts, what brings it on (stress, short sleep, a hat or hairstyle, coughing, lying down), how often you take pain relief, how much caffeine you have, how you sleep and whether you snore, and any other symptoms.
The examination. A full neurological examination, including the back of the eyes and your blood pressure, and a check of the scalp, the arteries at the temples, the neck, and the occipital nerves at the base of the skull.
A scan, when it will change what happens next. An MRI scan is the usual test when the pattern points away from the common causes, for example a headache that is worse lying down, stabs that are always in the same spot, or a fixed patch of pain. Most people with tension-type headache or migraine do not need one. A CT scan shows the sinuses when sphenoid sinusitis is possible.
A nerve block, when occipital neuralgia is likely. If an injection of local anaesthetic around the nerve eases the pain for a while, that supports the diagnosis, and it can also be part of the treatment.
Blood tests, when they fit. For example, tests for inflammation when giant cell arteritis is possible.
A sleep study, when sleep apnoea is likely. Snoring, morning headaches and sleepiness during the day are reasons to ask your GP about one.

A few weeks of a headache diary (when the pain came, where it was, what you were doing, what you took) often makes the pattern clear.

How to Get Rid of a Headache on Top of the Head

The right treatment depends on the cause, which is why the diagnosis comes first. These help most people.

For the headache today. Rest, a drink of water, something to eat if you have missed a meal, loosening anything tight on your head, and simple pain relief from the pharmacy can ease a tension-type headache.
Keep pain relief to two or three days a week at most. Taking it on too many days (15 or more days a month for simple pain relievers, 10 or more for some others) can itself keep headaches going: see medication overuse headache.
Loosen what presses or pulls. A looser hat, helmet strap or goggles, and a looser ponytail, bun or braids, usually stop that kind of headache.
Sleep, meals, water and stress. Regular sleep, regular meals, enough water, regular exercise and ways to manage stress, such as relaxation training or psychological therapy, reduce how often headaches come. In a trial in people with recurrent headaches, drinking more water helped them feel better, though it did not reduce the number of headache days.
Keep caffeine steady. If you have caffeine every day, stopping suddenly can bring on a headache within a day that lasts up to a week. If you want to cut down, do it gradually.
Snoring, or waking with headaches? Ask your GP about sleep apnoea: when it is treated, the headaches it causes settle.
Stabbing pains rarely need treatment. If they are frequent, your doctor can advise.
For occipital neuralgia. An occipital nerve block can ease the pain, and preventive medicines that calm nerve pain can help.
Medicine, when headaches are frequent. Preventive medicines can reduce how often headaches occur. Your doctor can advise whether they suit you.
Treat the migraine, if migraine is present. Migraine treatment and prevention help the headache wherever it is felt.

Where most people sit

Most people improve once the cause is clear and the treatment matches it, often with simple changes to sleep, caffeine, hairstyles and how pain relief is used. For those who need more, there are preventive treatments that help many people.

When to See a Neurologist About Headaches on Top of the Head

Headaches on top of the head keep coming back, or are becoming more frequent
Headaches on most days, or you are taking pain relief on many days a month
You are not sure whether it is tension-type headache, migraine or something else
Stabbing pains that are frequent, or always in the same spot
Pain fixed in one small patch of the scalp
Headaches that wake you from sleep
A new headache after 50 (see your GP the same day first)
You want a clear diagnosis and a plan

A consultation involves a detailed history, a neurological examination and a plan: working out which headache, or headaches, you have, arranging scans when the result will change what happens next, and coordinating with your GP and, when needed, a sleep or ENT specialist. Dr Ron Granot trained at Prince of Wales Hospital, Sydney, and sees patients in Bondi Junction. For the wider picture, read our migraine overview.

Frequently Asked Questions

What causes a headache on top of the head? +

Most often tension-type headache, which feels like pressure or tightening on both sides of the head, or migraine, which usually throbs and comes with nausea or a dislike of light and noise. Pressure from a tight hat or ponytail, brief ice pick stabs, irritation of the nerves at the back of the scalp (occipital neuralgia), and taking pain relief on too many days are other common causes. Less often it comes from a sinus deep behind the nose, or from a condition doctors look for when the pattern is unusual. A sudden, severe headache is different: call 000.

Why do I get a headache on top of my head every day? +

The usual reasons are frequent tension-type headache, migraine that has become chronic, and taking pain relief on too many days, which can itself keep headaches going; often more than one is present. Poor sleep, sleep apnoea and caffeine wearing off can add to it. Daily headaches are treatable once the causes are sorted out. A daily headache that is new and getting steadily worse needs your GP the same day.

Why does the top of my head hurt when I lie down or wake up? +

Common reasons are short or poor sleep, and pain relief or caffeine wearing off overnight. Morning headaches are also more common with sleep apnoea, where breathing stops and starts during sleep, especially if you snore. Rarely, headaches that wake you from sleep on many nights are hypnic headache, which usually starts after 50 and is not dangerous in itself, but it is diagnosed only once other causes have been ruled out, so a new headache that wakes you should be checked by your GP, the same day if you are over 50. A headache that is worst on waking or when lying down, with vomiting or blurred vision, or that keeps getting worse over days or weeks, needs your GP the same day, because it can mean raised pressure inside the head.

What is the sharp, stabbing pain on top of my head? +

Usually primary stabbing headache, also called ice pick pains: brief stabs lasting a second or two, usually one or a few a day, that can strike anywhere on the head and often move from spot to spot. In a large Norwegian study, about 1 in 3 adults had had them, and they are more common in people with migraine. On their own they are harmless and rarely need treatment. Stabs that are always in exactly the same spot should be checked by your GP. Sharp, shooting, burning or electric-shock-like pains that run from the base of the skull up over the back of the head, often to the top, with a numb, tingly or sore scalp, are more likely occipital neuralgia, an irritation of the occipital nerves; see your GP, because a cause in the neck needs to be ruled out, and an occipital nerve block can ease the pain.

Can dehydration or lack of sleep cause a headache on top of the head? +

Both can bring on a headache. In one survey, about 1 in 10 people had headaches when they went without water, and drinking eased them, often within half an hour. Short or broken sleep and missed meals are among the most common triggers of migraine, and tiredness and poor sleep make tension-type headache more likely. Regular sleep, regular meals and enough water are worth trying, though in a trial in people with recurrent headaches, drinking more water helped them feel better without reducing the number of headache days.

How do I get rid of a headache on top of my head? +

It depends on the cause. For a tension-type headache, rest, a drink of water, something to eat if you have missed a meal, loosening a tight hat or ponytail, and simple pain relief help. To prevent headaches, sleep regularly, eat regular meals, keep caffeine steady, exercise and manage stress. Keep pain relief to two or three days a week at most, because using it more often can keep headaches going. If headaches are frequent, preventive medicines can help.

When should I worry about a headache on top of my head? +

Call 000 if it comes on suddenly and reaches its worst within a minute; if it comes with fever and a stiff neck, confusion, weakness, loss of vision, double vision, a new drooping eyelid, slurred speech, sudden unsteadiness or a seizure; or if it started after a head injury and is getting worse, or after any head injury if you take blood-thinning medicine. See your GP the same day if it is new after 50, keeps getting worse, is worst on waking or when lying down with vomiting or blurred vision, is brought on by coughing or straining, or is worse when you sit up and eases when you lie down.

Could a headache on top of my head be a brain tumour? +

Very unlikely. In a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have a brain tumour. Tumours usually cause other symptoms as well, such as weakness, seizures, a change in personality, or a headache that gets steadily worse over weeks, with vomiting. A headache with any of those needs prompt assessment.

Important: This page is general health information for adults living in Australia and is not a substitute for individual medical advice. If you have a sudden, severe headache that peaks within a minute, a headache with a stiff neck and fever, or a headache with weakness, sudden loss of vision, double vision, slurred speech or sudden unsteadiness, call 000. Diagnosis and treatment decisions are made on an individual basis with your treating doctor.

Headaches on Top of Your Head?

Book a consultation with Dr Ron Granot — neurologist with a special interest in headache, Bondi Junction. Ask your GP for a referral, then get in touch.

Book a Consultation

Call Us02 9388 0615

LocationSuite 301, Bondi Junction

Emailreception@eastneurology.com.au

Last reviewed: 17 October 2026 by Dr Ron Granot, FRACP — Consultant Neurologist, East Neurology, Bondi Junction.