Headaches: Tension, Migraine or Sinus? How to Identify and Treat Them

Your head hurts. Again. You reach for a tablet and hope that this time it'll work. But sometimes it works, sometimes it doesn't. Sometimes the pain passes in an hour, sometimes it drags on all day. And you start wondering: why are these headaches so different? Why do medications that helped last time not work today?

The answer is simple: not every headache is the same. There are different types, different causes and - most importantly - different treatments. If you want to effectively fight pain, you first need to know what you're dealing with.

Today we'll walk you through the three most common types of headache: tension, migraine and sinus. You'll learn to identify them, find out which medications to use and when you absolutely must see a doctor. No textbook theory - just practical information.

Tension headache - the most common type

This is the true king of headaches. It affects about 70-80% of the population - almost everyone has experienced it at least once. How to recognise it?

Tension headache symptoms

• Pressing, squeezing pain - as if you had a helmet or tight band around your head
• Bilateral location - both sides of the head hurt, often around the temples, forehead or neck
• Intensity: mild to moderate - doesn't stop you functioning, but is unpleasant
• No nausea or vomiting (or very rarely)
• Not worsened by physical activity - you can walk and work (though uncomfortably)
• Can last 30 minutes to 7 days (most commonly a few hours)
• Sometimes sensitivity to light OR sound (not both at once)

What triggers tension headaches?

The causes are mundane - and you probably know them well:

• Stress - emotional or physical
• Neck and shoulder muscle tension - working at a computer, poor posture
• Fatigue, lack of sleep
• Dehydration
• Hunger (skipping a meal, blood sugar drop)
• Too much screen time (computer, phone)
• Noise, intense smells

In short: the modern lifestyle is a perfect recipe for tension headaches.

How to treat tension headaches?

1. Over-the-counter (OTC) medications

These usually suffice:

• Ibuprofen - 200-400 mg
• Paracetamol - 500-1000 mg
• Acetylsalicylic acid (aspirin) - 500-1000 mg
• Naproxen - 220-440 mg

Which tablet is best? It depends:

• Ibuprofen - works fast (30-60 min), effective, but not for people with stomach problems
• Paracetamol - safer for the stomach, but weaker (takes 45-60 min)
• Aspirin - fast (20-30 min), but can irritate the stomach, not for children (risk of Reye's syndrome)
• Naproxen - long-acting (up to 12 hours), good for persistent pain

Golden rule: Take the medication as soon as the pain appears. The longer you wait, the harder it is to control.

2. Non-pharmacological methods

Sometimes you don't need tablets. Try:

• Cold compress on the forehead or neck - constricts blood vessels, reduces pain
• Massage of the temples, neck, shoulders - relaxes tense muscles
• Warm bath or shower - relaxes the whole body
• Rest in a dark, quiet room
• Breathing techniques, meditation, yoga - reduce stress and tension
• Fix your posture - sit up straight, especially at the computer
• Drink a glass of water - dehydration is a common cause of headaches

3. When is it chronic tension headache?

If headaches occur 15 or more days per month for at least 3 months - it's chronic tension headache. You'll need a neurologist's help. Possible therapies:

• Preventive medications (e.g. amitriptyline - prescription only)
• Physiotherapy, relaxation exercises
• Cognitive behavioural therapy (CBT)
• Acupuncture

Migraine - this is not an "ordinary" headache

If you've ever had a migraine, you know it's a completely different league. It's not an ordinary headache you can wait out. It's a neurobiological disorder that can completely knock you out of life for several hours or days.

Migraine symptoms

• Pulsating, throbbing pain - as if a hammer were hitting your skull in rhythm with your heartbeat
• Usually one-sided - half the head hurts (but can be bilateral)
• Intensity: moderate to severe - often prevents normal functioning
• Worsened by physical activity - climbing stairs, bending over, etc.
• Nausea, often vomiting
• Hypersensitivity to light (photophobia) and sound (phonophobia) - you need to lie in a dark, quiet room
• Sometimes visual disturbances (aura) - flashes of light, spots, vision disturbances (more on this in a moment)
• Lasts 4-72 hours (untreated)

Phases of a migraine - not just pain

A migraine typically has four phases (though not everyone experiences all of them):

1. Prodromal phase (warning signs) - 1-2 days before

• Mood changes (irritability, euphoria, melancholy)
• Fatigue or excess energy
• Yawning
• Craving specific foods (often sweets)
• Neck stiffness
• Frequent urination

2. Aura - 5-60 minutes

Occurs in about 25-30% of migraine sufferers. These are neurological symptoms that appear before or at the start of pain:

• Visual disturbances: flashes of light, zigzags, spots, blurred vision, loss of part of the visual field
• Sensory disturbances: tingling, numbness (usually starts from the hand, moves to the face)
• Speech disturbances: difficulty speaking, finding words
• Less commonly: dizziness, tinnitus

Important: The aura itself doesn't hurt, but it's a warning: "pain is coming soon".

3. Headache phase - 4-72 hours

What we described above: pulsating pain, nausea, hypersensitivity to stimuli.

4. Postdromal phase (after the attack) - up to 48 hours

• Feeling "wiped out", exhausted
• Difficulty concentrating ("brain fog")
• Scalp tenderness
• Mood changes

What triggers migraines? Know your triggers

Migraine has genetic and neurobiological origins, but attacks often have specific triggers:

• Hormonal changes - menstruation, ovulation, contraception (that's why women suffer 3x more often than men)
• Stress (but also sudden relaxation after stress - "weekend migraine")
• Lack of sleep or too much sleep
• Change of circadian rhythm - shift in sleep times, jet lag
• Hunger, skipping meals (blood sugar drop)
• Dehydration
• Certain foods: chocolate, mature cheeses, cured meats (contain tyramine), MSG, artificial sweeteners (aspartame), alcohol (especially red wine)
• Caffeine - paradoxically both excess and sudden withdrawal
• Intense stimuli: bright or flickering lights, loud sounds, intense smells
• Weather changes - atmospheric pressure changes
• Physical exertion (in some people)

Practical advice: Keep a "migraine diary" - note when an attack occurred, what you ate, how you slept, what was happening. After a few months, you'll see patterns and identify your triggers.

How to treat migraines?

1. OTC medications - for mild attacks

You can try:

• Ibuprofen - 400-600 mg (up to 1200 mg/day)
• Naproxen - 500-550 mg
• Acetylsalicylic acid - 900-1000 mg
• Combination preparations (e.g. paracetamol + caffeine + acetylsalicylic acid)

Important: Take the medication as early as possible - ideally during the aura phase or at the very onset of pain. The later, the less effective.

2. Prescription medications - for moderate and severe attacks

If OTC medications don't work, a doctor may prescribe:

Triptans - specialist anti-migraine drugs:

• Sumatriptan (Imigran, Sumatriptan)
• Zolmitriptan (Zomig)
• Rizatriptan (Maxalt)
• Eletriptan (Relpax)

How do they work? They activate serotonin receptors, constrict dilated cerebral blood vessels and inhibit pain signalling.

Effectiveness: 60-70% of patients experience significant relief within 2 hours.

Warning: Do not use if you have coronary heart disease, hypertension or basilar migraine with aura. Always consult a doctor.

Anti-emetics: Metoclopramide, Ondansetron - help with nausea and improve absorption of painkillers.

3. Prevention - if attacks are frequent

If migraine occurs more than 4 times per month or attacks are very severe - you need preventive treatment. A doctor may recommend:

• Beta-blockers (e.g. propranolol, metoprolol)
• Anti-epileptic drugs (e.g. topiramate, valproic acid)
• Antidepressants (e.g. amitriptyline)
• CGRP antagonists - new generation drugs (erenumab, galcanezumab - monthly injections)
• Botulinum toxin (Botox) - injections every 3 months (for chronic migraine)
• Magnesium - 400-600 mg daily (may reduce attack frequency)

4. Non-pharmacological methods

• Rest in a dark, quiet room
• Cold compress on forehead or neck
• Relaxation techniques, biofeedback
• Acupuncture (some studies confirm effectiveness)
• Regular meals, hydration, sleep
• Avoiding triggers

Sinus headache - when the sinuses make themselves felt

Sinus headache appears when the paranasal sinuses are inflamed and filled with discharge. The problem? Many people think they have a "sinus headache" when it's actually a migraine. Let's learn to tell them apart.

Symptoms of a true sinus headache

• Pressure, fullness around the sinuses - forehead, cheeks, around the nose, above the eyebrows
• Worsens when bending your head forward (e.g. tying shoes)
• Accompanied by nasal symptoms, sinusitis - purulent discharge (yellow or green), blocked nose
• Sometimes fever, general malaise
• One-sided or bilateral pain - depending on which sinuses are inflamed
• Intensity: mild to moderate (rarely severe)

Key difference: If you don't have nasal/sinus symptoms (discharge, blocked nose) - it's probably NOT a sinus headache, but a migraine or tension headache.

What causes sinus headaches?

• Viral infection (usually a complication of a cold)
• Bacterial infection (secondary to viral)
• Allergic rhinitis (pollen allergy, dust, mould)
• Nasal polyps - block sinus drainage
• Deviated nasal septum

How to treat sinus headaches?

1. Painkillers and anti-inflammatories

• Ibuprofen - 400 mg every 6-8 hours
• Paracetamol - 500-1000 mg every 6 hours

2. Decongestants

• Nasal drops/spray with oxymetazoline or xylometazoline - maximum 5-7 days! (after that, risk of rebound congestion)
• Oral pseudoephedrine - reduces swelling, but can raise blood pressure

3. Saline nasal rinse

This really works! Saline solution (isotonic or hypertonic) flushes out discharge, reduces swelling and speeds healing.

• Ready-made products: Various brands of saline nasal sprays
• DIY: 1 level teaspoon of salt (preferably sea salt) per litre of boiled water

How to use? 2-3 times daily, lean over the sink, pour saline into one nostril - it flows out through the other, taking discharge with it.

4. Inhalation, warm compresses

• Steam inhalation with saline (with a nebuliser or "over a bowl")
• Warm compress on the sinuses - dilates blood vessels, improves drainage

5. Antibiotics - only if it's a bacterial infection

Not every sinus infection requires antibiotics! Most cases are viral infections that resolve on their own within 7-10 days.

When are antibiotics needed?

• Symptoms last over 10 days without improvement
• Symptoms are severe (high fever, strong pain, purulent discharge)
• Symptoms suddenly worsen after a period of improvement

The decision about antibiotics is the doctor's!

When to see a doctor? Warning signs

Most headaches are harmless and can be treated at home. But there are situations where a headache signals something serious. See a doctor immediately if:

• "Worst headache of your life" - sudden, thunderclap (possible subarachnoid haemorrhage)
• Headache with fever, stiff neck, rash - possible meningitis
• Headache after a head injury
• Headache with neurological symptoms: limb weakness, speech disturbance, consciousness changes, seizures
• Headache with visual disturbances (apart from migraine aura) - sudden vision loss, double vision
• New headache after age 50
• Headache increasing over days/weeks, not responding to medication
• Headache that wakes you from sleep
• Headache in someone with cancer or HIV

Better safe than sorry. If you have doubts - see a doctor. It could save your life.

How not to overuse painkillers?

Paradoxically, overusing painkillers can actually... cause headaches. This is called medication overuse headache (MOH).

When is there risk?

• You take painkillers more than 10-15 days per month
• You take them "just in case", preventively
• Doses are increasing because the medication stops working

How to avoid it?

• Don't take medication more than 2-3 times per week
• If headaches are frequent - see a neurologist, you need preventive treatment, not symptomatic
• Use non-pharmacological methods
• Don't combine different medications without consultation

Where to buy headache medication and how much does it cost?

Basic painkillers are available without a prescription in pharmacies, drugstores and some shops.

Prices (per pack of 10-20 tablets):

• Paracetamol: €1-4 (generic vs. brand)
• Ibuprofen: €1-5
• Aspirin: €1-4
• Naproxen: €3-6
• Combination preparations: €3-8

It's worth comparing! The same ibuprofen can cost €1 in one pharmacy and €4 in another. That's a 300% difference! Check CheaperForDrug before buying - over a year you'll save a lot.

Summary - how to deal with headaches?

Identify the type: tension (pressing, bilateral), migraine (pulsating, with nausea), sinus (with discharge, worse when bending)

Choose the right medication: ibuprofen/naproxen (fast, strong), paracetamol (safer for the stomach), aspirin (fast-acting)

Take medication early - the sooner, the more effective

Don't overuse - maximum 2-3 times per week, otherwise risk of medication overuse headache

Use non-pharmacological methods: rest, cold compresses, massage, nasal rinse (sinus headache)

Identify triggers - keep a diary (migraine), avoid stress, take care of sleep and hydration

See a doctor if: pain is unusual, very severe, with neurological symptoms, or frequent

Compare prices on CheaperForDrug - the same medications can differ in price by two or three times

Disclaimer

This information is for educational purposes and does not constitute medical advice. If you have frequent, severe or unusual headaches, consult a doctor. Every body is different and may require an individual approach.

A headache is a signal. Sometimes saying "rest, you're tired", sometimes "see a doctor, something isn't right". Learn to listen to your body - and respond wisely.

Take care of your health consciously and affordably. With CheaperForDrug you'll find the best prices on painkillers - quickly, conveniently, cheaply.