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Headaches

Almost everyone gets headaches, and most are not a sign of anything serious. Knowing your type, your triggers and how often you reach for pain relievers helps a lot — and a few warning signs need emergency care.

Call 911 or go to the emergency room now for a headache with any of these:

Don’t drive yourself — call 911 so treatment can begin on the way (CDC).

Call or see a doctor right away for:

  • A new, constant headache, especially after age 50; headaches that get worse over days or weeks or change in pattern; two or more headaches a week; or new headaches with a history of cancer or HIV (NINDS).
  • A headache with vision problems or vomiting, one made worse by coughing, sneezing, bending or exercise, or one with jaw pain when eating or a tender scalp (NHS).
  • A child’s headache that is getting worse or wakes them at night (NHS).
  • In pregnancy: a severe headache, blurred vision or flashing lights, pain just below the ribs, vomiting or sudden swelling of the face, hands or feet can be signs of pre-eclampsia, which usually starts after 20 weeks. Call your maternity care provider (NHS).

Don’t wait for a chiropractic, acupuncture or massage appointment for any of these.

How common are headaches?

Headache is the most common form of pain and a major reason people miss work or school (MedlinePlus). Worldwide, headache disorders affected about 40% of people — some 3.1 billion — in 2021, more often women (WHO). More than 300 in every 1,000 people have tension headaches, 100 to 150 have migraines and about 1 in 1,000 has cluster headaches (InformedHealth). The good news: most headaches go away on their own and are not a sign of anything serious (NHS).

Primary and secondary headaches

How doctors find the cause

A doctor will ask about your health and headaches and do a physical and neurological exam (NINDS). Usually that is enough; a scan such as an MRI is needed only in rare cases, when questions remain (InformedHealth). Scans aren’t usually used to diagnose migraine but may be ordered if another condition is suspected (NINDS). Bring a headache diary (see below) — it helps the doctor find the type of headache and the best treatment (NINDS).

Headaches and other conditions

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Over-the-counter pain relievers on a limited number of days; triptans and other migraine medicines; oxygen, triptans and verapamil for cluster headache; preventive medicines such as amitriptyline for frequent tension-type headache; and treating any underlying cause. Cost estimate being researched. Most headaches ease with simple measures and occasional pain relievers. Taking them too often can cause rebound headaches. Prevention may take months to work.
Chiropractic Spinal manipulation and mobilization of the neck, often with neck exercises, mainly for neck-related (cervicogenic) and tension-type headache. About $50–$200 a visit without insurance; first evaluations $100–$250. Medicare Part B covers only spinal adjustment for subluxation (20% coinsurance). Some evidence of benefit for cervicogenic headache; mixed evidence for tension-type headache. Mild soreness is common; neck manipulation carries a rare, debated stroke risk.
Acupuncture A course of needle treatments to prevent frequent tension-type headaches or migraines. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. A Cochrane review found it helps prevent frequent episodic or chronic tension-type headache; part of the effect is also seen with sham needling. Few complications with sterile needles.
Herbal medicine Peppermint oil on the forehead and temples for tension-type headache; butterbur, feverfew, magnesium and riboflavin studied for migraine prevention. Cost estimate being researched. Small studies only. Use only PA-free butterbur (liver concerns); feverfew may slow blood clotting and isn’t for pregnancy. Check every supplement with a pharmacist.
Massage therapy Neck, shoulder and head massage, including trigger-point work, for tension-type headache. About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas. A few small trials suggest benefit for chronic tension-type headache, but in a placebo-controlled trial a sham treatment helped about as much. Low risk.
MBHA Wellness Coach A headache diary, regular sleep and meals, fluids, steady caffeine, screen and posture breaks, stress skills, exercise and limiting pain-reliever days. Cost estimate being researched. Supports — never replaces — medical care. Simple lifestyle changes and a headache calendar are often a big part of relief.

Approach 1 of 6

Conventional medicine (AMA)

The first step is to look for any condition causing the headaches, because treating it can help (NINDS).

Over-the-counter pain relievers

We don’t list doses; ask your doctor or pharmacist what is safe for you.

Migraine medicines (in brief)

Triptans such as sumatriptan are a common treatment for migraine attacks; ergot medicines, CGRP medicines and anti-nausea medicines are other options (NINDS). Triptans help migraine and cluster headache but not tension headaches (InformedHealth).

Cluster headache

Ordinary pain relievers don’t work. During an attack the main treatments are triptans (by injection or nasal spray) and oxygen breathed through a mask (NHS). To prevent cluster periods, most doctors choose verapamil first (NINDS); corticosteroids or lithium are other options (NHS).

Preventive medicines

Doctors may also suggest biofeedback, relaxation training, cognitive behavioral therapy, physical therapy, massage and gentle exercise (NINDS). If pain relievers and lifestyle steps don’t help, or the cause isn’t clear, you may be referred to a specialist (NHS).

What it costs

Doctor visits, prescription medicines and scans: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Spinal manipulation — a controlled force applied to a spinal joint by hand or with a device — is often used for headaches (NCCIH). The evidence depends on the type of headache.

Neck-related (cervicogenic) headache: some evidence

Tension-type headache: mixed

  • The 2011 guideline found manipulation can’t be recommended for episodic tension-type headache and made no recommendation either way for chronic tension-type headache; gentle mobilization of the upper neck may help (Bryans et al., 2011). The 2026 guideline supports manipulation for tension-type headache only within a wider care plan (guideline, 2026).
  • An older Cochrane review found amitriptyline worked better than manipulation during treatment of chronic tension-type headache, though manipulation did better shortly after both stopped (Cochrane review, 2004). Cochrane withdrew this review in 2014 as out of date.
  • Overall, NCCIH says it is uncertain whether manipulation helps headaches, because studies have had contradictory results (NCCIH).

Safety

Mild soreness, stiffness or headache are common and usually pass within 24 hours. Neck manipulation has been linked to rare tears in neck arteries that can cause a stroke; the risk appears low and experts disagree about whether manipulation causes them, but you should be told about it (NCCIH). Get a new or unusual headache checked medically first. A separate MBHA Neck guide is on the way.

Coverage and cost

Medicare Part B covers only spinal adjustments to correct a subluxation; you pay 20% after the deductible (Medicare.gov). Without insurance a visit costs about $50–$200 and a first evaluation $100–$250; with insurance an adjustment is about $15–$50 (MedicalCostInfo).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Tension-type headache

A 2016 Cochrane review of 12 trials (2,349 adults) found (Cochrane review, 2016):

  • Compared with usual care, far more people having acupuncture saw their headache days at least halved — 48% versus 19% in one large trial.
  • Compared with sham acupuncture the edge was smaller: 51% versus 43% (moderate-quality evidence).
  • No trial found acupuncture better than physiotherapy, massage or exercise.
  • The authors concluded acupuncture appears effective for frequent episodic or chronic tension-type headache, but more comparison trials are needed.

Migraine

Moderate-quality evidence suggests acupuncture may reduce how often migraines happen, slightly more than sham acupuncture (NCCIH). NCCIH notes that much of its benefit for headache may come from expectation and placebo responses rather than the needling itself (NCCIH).

Safety and cost

Few complications have been reported; the FDA requires sterile, single-use needles and most states license acupuncturists (NCCIH). Medicare covers acupuncture only for chronic low back pain, not headaches (Medicare.gov). Cash prices run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Supplements for headache have mostly been tested in small studies, and they can have side effects and interact with medicines (NCCIH).

Peppermint oil for tension-type headache

Limited evidence suggests peppermint oil on the skin might relieve tension headaches (NCCIH). In a small 1996 study (41 people, 164 headaches), peppermint oil spread on the forehead and temples eased pain more than a dummy solution within 15 minutes and about as well as acetaminophen (Göbel et al., 1996). It can irritate the skin, and should never go on the face of a baby or young child (NCCIH).

Butterbur and feverfew for migraine prevention

  • Butterbur may reduce how often migraines happen. The American Academy of Neurology recommended it in 2012 but stopped in 2015 over safety concerns. The raw plant contains pyrrolizidine alkaloids (PAs) that can damage the liver; use only products labeled PA-free, and even these have rarely been linked to liver injury (NCCIH).
  • Feverfew studies have been small and inconsistent. It may slow blood clotting (stop it at least 2 weeks before surgery), may interact with migraine medicines and should not be used in pregnancy (NCCIH).

Magnesium and riboflavin for migraine

Magnesium was possibly effective in reducing migraine frequency in a small review, but the amounts used exceed the safe limit for supplements, so use it only under medical supervision; it interacts with some antibiotics, diuretics and osteoporosis drugs. Riboflavin (vitamin B2) helped in some studies, more in adults than children, with no reported harms (NCCIH).

Check with your doctor or pharmacist before any supplement, especially if you take migraine medicines or a blood thinner, or are pregnant, breastfeeding or planning surgery. Some medicine-and-supplement combinations can be dangerous (NINDS), and “natural” doesn’t always mean safe (NCCIH). We don’t list doses.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

What the research says

  • A 2014 review found 6 trials of manual therapy for chronic tension-type headache (one of massage, five of physiotherapy) and concluded both appear effective, though the trials had weaknesses (Chaibi and Russell, 2014).
  • In a 2015 trial of 56 people, headaches became less frequent with trigger-point massage and with a sham treatment, with no difference between them — though the massage group reported more improvement in pain (Moraska et al., 2015).
  • Only a few studies exist and results are inconsistent (NCCIH). The NHS suggests relaxing activities such as exercise, yoga and massage for tension headaches (NHS).

Safety and cost

Massage has few risks with a trained therapist, but people with health conditions and pregnant women should check with their provider first (NCCIH). Expect about $60–$120 for 45–60 minutes privately or $50–$90 at clinics and spas (CostHelper). Medicare doesn’t cover massage ordered by a chiropractor (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Regular sleep and exercise, healthy meals, enough fluids, less alcohol and a headache calendar are often all that is needed for relief (WHO). An MBHA Wellness Coach can help you build these habits — alongside, never instead of, medical care.

Another approach

Types of headache at a glance

Tension-type headache

The most common type: usually mild to moderate, constant pressure or a tight band around the head, on both sides, without nausea and not made worse by walking or climbing stairs. It lasts from 30 minutes to 7 days (NINDS). It is chronic on 15 or more days a month for three months (InformedHealth). Stress can tighten muscles in the neck, face, scalp and jaw (NINDS); an MBHA TMJ guide is planned.

Cluster headache

A sharp, burning pain on one side, around the eye, lasting 15 minutes to 3 hours, with a red, watery eye or a blocked or runny nose on that side; it can make you restless (NHS). Attacks come in bouts over weeks, often in spring and fall, and often wake people from sleep; they may be mistaken for allergies (NINDS) — see our Allergies guide. Go to the emergency room if a drooping eyelid or a smaller pupil appears for the first time (NHS).

“Sinus” headache

Sinusitis causes pain around the cheeks, eyes or forehead, a blocked nose, colored mucus and sometimes a high temperature, and usually clears within 4 weeks (NHS). But many “sinus headaches” are really migraine: in a 2004 study of 2,991 people with “sinus” headache and no sign of infection, 88% met migraine criteria (Schreiber et al., 2004), and migraine can cause facial pain and nasal congestion (Cady and Schreiber, 2004). An MBHA Sinus guide is planned.

Neck-related (cervicogenic) headache

Head pain that comes from a problem in the neck (NCCIH); injuries to the head and neck can cause secondary headaches (InformedHealth).

Another approach

Rebound headaches from pain relievers

Taking pain relievers or migraine medicines very often can cause more headaches (InformedHealth). These rebound headaches may affect up to 5% of some populations, occur on more days than not and are often worst on waking (WHO).

  • What counts is the number of days you take medicine: 15 or more days a month for pain relievers such as acetaminophen, aspirin or ibuprofen, or 10 days for triptans, is overuse (InformedHealth).
  • Many people think their usual headaches have got worse and take more medicine, so a medication diary is the first step (InformedHealth).
  • Treatment means pausing the medicine with your doctor’s help. Headaches can get worse at first before improving; preventive treatment can help, and relapse is common, so stay in touch with your doctor (InformedHealth).

Another approach

Keeping a headache diary

After each headache, note the time, how strong it was and how long it lasted; sensitivity to light, smells or sound; what you were doing; medicines taken; last night’s sleep; stress; the weather or routine changes; and food and drink in the previous 24 hours. Note periods and family history too (NINDS). Marking each day you take a pain reliever shows whether you are heading toward rebound headaches (InformedHealth).

Another approach

Common triggers

Another approach

Headaches in children

Headaches are common in children and teens, and early headaches can develop into migraine (NINDS). Children’s migraines tend to be shorter, with more stomach symptoms (WHO). Treatment usually means more fluids, a better diet, daily exercise, better sleep and over-the-counter pain relievers — always ask a doctor before giving headache medicine (NINDS), and never give aspirin under 16 (NHS).

Call 911 for a child’s headache with trouble speaking, swallowing, balancing or walking, with drowsiness, or within 5 days of a head injury. See a doctor urgently if a child under 12 has headaches that wake them at night or are there on waking, keep getting worse, or come with vomiting (NHS).

Member stories

Living with Headaches? Share your experience

Real experiences help others choose. Tell us what you tried — conventional medicine, chiropractic, acupuncture, herbs, massage or coaching — what it cost and what changed.

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Which approaches have you tried?

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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