A headache on the top of the head is usually caused by lack of sleep, quickly drinking a cold beverage, a direct blow to the head or a cold. It can occur with symptoms like fever, coughing and nausea.

Although this symptom is not always a sign of a health condition, it can be serious if it occurs with other symptoms, like a seizure or vision loss. Headaches with these symptoms can occur with tumors and serious injuries, which require immediate medical attention.

If the pain at the top of the head occurs frequently or emerges with other symptoms, you are advised to see a doctor for assessment and possible treatment.

What causes of pain at the top of the head?

The main causes of headaches felt at the top of the head include:

1. Direct trauma and injuries

A headache at the top of the head caused by a direct blow or mild injuries generally do not cause other symptoms. Nonetheless, some patients may also present with mild swelling, difficulty concentrating and insomnia in the following days. These symptoms usually resolve on their own within a few days.

What to do: Pain at the top of the headache in this situations tends to improve after a few days. If pain persists for over a week, you should see a family doctor or neurologist for assessment.

If you additionally have symptoms like vomiting, seizures, or loss of consciousness after the trauma, you should seek immediate medical attentions, as these can be signs of a more serious head injury.

2. Respiratory infections

Respiratory infections, like a flu or COVID-19, typically cause symptoms like coughing fever and congestion, however it can also cause a headache at the top of the head which worsens when leaning the head forward. Check out which other symptoms can occur with a viral infection.

What to do: If you suspect you have an infection like the flu or COVID-19, you are advised to see a doctor to confirm a diagnosis. The doctor will recommend the most appropriate treatment, which may involve analgesics and other flu medicine. You can also try these tips for a speedier recovery from your infection.

3. Sinusitis

Pain at the top of the head caused by sinusitis usually affects the front of the head and is associated with a pressure or tightness sensation. Other symptoms, like yellow nasal discharge, fever and stuffy nose, can also occur. Although this condition presents similarly to a cold, symptoms are often more severe and worsen over time. Read about other symptoms associated with sinusitis.

What to do: Nasal irrigation can help to relieve symptoms temporarily, however it is important to confirm a diagnosis with a doctor. Treatment may involve the use of antibiotics or nasal decongestants. Learn about home remedies for sinus infection that you can use as a complement to your medical therapy.

4. Tension headaches

Tension headaches can be felt at the top of the head, and usually are usually described as a tight or pressure type of pain. They usually do not cause other symptoms, and tend to emerge with anxiety or stress. In more severe cases, tension headaches can last for up to 7 days.

What to do: Relaxation techniques can help to relieve pain from anxiety of stress. However, frequent tension headaches should be evaluated by a family doctor or neurologist.

If confirmed, treatment may involve the use of analgesics (like acetaminophen or ibuprofen) and antidepressants (like amitriptyline) to reduce the frequency and intensity of headaches.

5. Migraine

A migraine is another common cause of headaches at the top of the head. They can affect one or both sides of the head, and are often described as throbbing. Migraines are associated with symptoms like nausea, vomiting, noise or light sensitivity and worsening of pain with physical activity. They can present very differently from patient to patient - read more about migraine symptoms that can emerge.

What to do: You should exercise regularly, eat regular meals or snacks, and have adequate sleep hygiene to reduce pain and prevent flare-ups. Many patients also report relief with meditation and yoga.

If you suspect you experience migraines on a regular basis, you should see a family doctor or neurologist for treatment, which is usually done with analgesics and anticonvulsants.

6. Brain freeze

Headaches at the top of the head can emerge after eating cold food or drinking a cold beverage. This is also known as brain freeze. Pain is usually felt at the front of the head and disappears within a few minutes.

What to do: To prevent brain feeze, you should consume cold food or drinks at a slow pace, or opt for temperatures that are closer to room temperature where possible.

7. Lack of sleep

Poor sleep quality can cause an intense, heavy headache at the top of the head. It can also worsen overall health and lead to memory loss.

What to do: Sleeping sufficient hours, reducing stress and ensuring a good posture can be beneficial and can prevent headaches at the top of the head. You should aim to sleep 6 to 8 hours per night in a dark, quiet and comfortable room. Using an ergonomic chair is also important if you spend significant amounts of time sitting throughout the day.

However, frequent headaches should be assessed by a family doctor or neurologist. In the meantime, you can read more about tips for a good sleep and for falling asleep quickly.

8. Occipital neuralgia

Occipital neuralgia occurs when nerves that innervate the spine up to the back of the head become damaged, irritated or compressed. This can cause pain at the back of the head, or a sharp headache at the top.

Other symptoms like increased sensitivity to touch in the area, numbness or tingling can also emerge.

What to do: Some patients can obtain relief with warm compresses, massage and physiotherapy. However, treatment should be monitored by a neurologist, and may involve the use of anti-inflammatories, anticonvulsants or even Botox injections.

9. Intense exercise

Overexertion or intense physical activity can lead to a headache that is felt at the top of the head or on both sides. This headache is usually described as pulsating, and is triggered by strenuous exercise.

This headache can be felt while exercising or after it, and can last for minutes to hours. It is different from a migraine, as it does not present with an aura, and tends to improve with rest.

What to do: Your doctor may advise changing your exercise intensity or the way you exercise, like ensuring adequate time to warm-up and cool down. If conservative treatments are not effective, your doctor may prescribe medication to take 30 minutes prior to expected physical activity. Some options include anti-inflammatories to reduce or prevent headaches, or beta-blockers to ensure adequate blood flow to the brain.

10. Hormonal changes

Hormonal changes, particularly changes in estrogen levels in women, can lead to a headache at the top of the head. Drops in estrogen, which can happen prior to a period or during menopause, for example, are associated with a higher likelihood of triggering a migraine in women.

Similarly in men, low testosterone levels appear to be associated with more frequent headaches.

What to do: Given that cyclical hormone changes (like hormone fluctuations that happen during a period, for example) are not always manageable, lifestyle changes may be beneficial in preventing or reducing the intensity of headaches. These can include getting enough sleep, reducing alcohol intake, ensuring adequate hydration and avoiding sugar, fatty and fried foods in your diet.

However, very intense headaches that regularly interfere with your daily routine should be assessed by a doctor to determine whether fluctuations in hormone levels are playing a role in triggering them. Some patients may benefits from analgesics, anti-inflammatories and/or hormone replacement therapy.

11. Tumors

Brain tumors can cause pain at the top of the head and are associated with other symptoms like seizures, nausea, vomiting, and transient vision loss. This headache is usually worse in the morning, when lying down, with coughing or with intense physical activity. Learn more about the signs and symptoms of a brain tumor.

What to do: If you suspect a brain tumor, you should consult a family doctor or neurologist for testing, like a CT scan or MRI. If indicated, treatment may involve surgery and chemotherapy.

When to see a doctor

If it important to seek medical attention if you experience any of the following:

Frequent headaches, especially if you do not have a prior history of headaches
Worsening over time
Increased pain when lying down or coughing
Seizures
Vision loss, even if it is temporary
Double vision
Weakness in some parts of the body
Cancer history
Waking-up at night from pain

In these cases, imaging tests like an MRI or CT may be indicated to rule out serious diseases, like brain tumors. These tests can also help to guide the most appropriate treatment.