Causes of "Headache Top Of Head"
"Headache Top of Head" is a common search term used by people looking for information on headache symptoms.
I've hand-searched headache journals (Cephalalgia and Headache) and some textbooks and come up with 34 different causes which I am about to describe to you.
Exercise-induced headaches and low-pressure headaches seem to feature prominently, so if a "headache top of head" is provoked by exercise, change in posture, coughing or sleep then this will require further investigation.
Diagnosis of a "Headache Top of Head" will require additional information about the clinical features of the headache, such as quality of pain, additional symptoms like nausea, watery eye, nasal symptoms and duration of headache episodes.
Common Causes of "Headache Top of Head"
- Surveys show that about 20% of adults report the top of the head as the location of Tension-type headache.
In children, especially boys for some reason, top of head is also a common, location.
Tension-type headache is a featureless pressure or weight in the head with no provoking features such as worsening with physical activity. It does not sit on one side more than another.
About 38% of people in any given year experience one bout of Tension-headache. Severity of Tension-headache is mild-moderate, unlike migraine which is more severe.
This has to be the most common cause of "headache top of head" as 20% of 38% is 7.6% of the population!
Chronic Daily Headache
- 20% of people with migraine headache will report it as a "Headache top of head".
However they are different from tension-type headache as nausea, preference for dark, worsening with usual physical activity will be present.
People with migraine will commonly feel their headaches in other parts of the head too.
If migraine is the cause of a top of head pain, then it is likely that there have been pains elsewhere from time to time.
12% of the population (6% of men and 18% of women) experience migraine. So about 2.4% of people will experience a headache on top of the head due to migraine at some point in their lives
Idiopathic Stabbing Headache
- In one large Korean Headache Clinic where these cases were carefully recorded, 10% of 115 cases experienced these intense sudden, brief sharp pains (of no serious causes) in the vertex or top of the head.
Repeated intense cases can be treated with Indomethacin.
Stabbing pains are more common in people with a history of migraine headaches too.
However, this must be one of the most common causes of a brief "Headache Top of Head"
Cold-stimulus Headache or Ice-cream Headache or Brain Freeze
- About 8% of the general population are liable to get brain freeze headaches.
In one survey, 12% of adolescents experienced their brain freeze headache on the top of the head.
Another study looking at ice-cream headache in people with migraine found that 2 out of 17 people with migraine who experienced ice-cream headache said it was a "Headache Top of Head".
- Strictly speaking the pain of cervicogenic headache is unilateral - one side only.
However, maps of pain relieved by lateral atlanto-axial joint injection show that a "headache top of head" affecting both sides can originate from the cervical spine.
The lateral atlanto-axial joint is the second most common joint causing cervicogenic headache after the C2/3 facet joint.
As pain on top of the head can be referred from the neck, you should consider an assessment with a specialist physiotherapist if pain on top of the head has been a problem for you.
I would normally recommend an assessment to the Apex Headache Clinic, Belfast for people who live in Ireland.
Causes of a Provoked "Headache Top of Head"
Provoked headaches include those due to low pressure inside the head, and those brought on by exertion.
Post Lumbar Puncture Headache
- A low pressure headache follows between 10-50% of lumbar puncture procedures.
About 21% of post-lumbar puncture headaches are a "headache top of head"!
The pain of low pressure headache is relieved within seconds to minutes of lying completely flat. It returns within seconds to minutes of standing back up. This phenomenon is called a Postural Headache
Most of these resolve within 6 days, but any that are severe and persistent will require an epidural blood latch to fix, especially if they are functionally disabling.
Spontaneous Intracranial Hypotension
- This is a rare cause of new onset postural headache and probably occurs in at least 5 per 100,000 people per year
Headache on top of the head is a common feature, as is a pain on both sides of the head.
There is often tinnitus, nausea or dizziness. Some people describe the pain like their "brain is falling down a waterfall".
The headache settles on lying flat, and resumes on standing up again - usually it takes between 15-30 minutes for pain to resolve, but in some it can be nearly instantaneous.
People with spontaneous intracranial hypotension will often remember the precise day, if not hour, of onset of their headaches.
Untreated this can cause years of daily headache - often in the "second half of the day".
The usual cause is a leak of spinal fluid from a tiny tear in the lining of the spine called a nerve root diverticulum.
Treatment of choice is an epidural blood patch which can be curative, even after months and months of headache.
- Pain on the vertex is fairly common in this headache provoked by coughing. In one series of 83 cases, 74 had no obvious cause for their cough headache, and of these 15/74 (20%) experienced a "headache top of head".
9 cases had a cause identified, and 2 of these 9 (22%) had pain on top of their head.
Cough Headache requires a brain scan to rule out a secondary cause such as Chiari malformation.
- This is a rare headache (about 1% of headache clinic attenders) and is brought on by sleep.
The usual story is someone in their 50-70s who is woken every night at about the same time with a diffuse head pain. One published paper found 1/22 (5%) with a top of head pain only.
Lithium Carbonate 200mg to 400mg at night can help about 70% of cases.
Lithium Carbonate is a strong prescription only medication that requires medical supervision to use.
- Heart Disease (cardiac) can cause headaches (cephalalgia). Six of the 32 cases (19%) reported in the medical literature, had pain on top of the head.
The headache is usually brought on and relieved by rest - angina pain in the head.
Acute heart attack pain can present as a , so an ECG should always be performed in people with thunderclap headache.
Treating the heart disease treats the headache.
Sexual Activity Headache
Bath related Thunderclap Headache
- These are sudden severe headaches brought on by immersion in hot water. Many of these are also likely to be due to reversible cerebral vasoconstriction syndrome. Similar to sexual activity headache, 33% (7/22) in one series had pain on top of the head.
Headache after Acoustic Neuroma Surgery
Sleep Deprivation Headache
- 10% of people (usually women) who tie their hair in pony tails will sometimes experience pain on top of the head related to traction from the pony-tail. There is an obvious solution - let your hair down!
Chiari Malformation causing Laughter Headaches
Reversible Cerebral Vasoconstriction Syndrome
- Classically cluster headache is in or around the eye, and associated with tears, nasal symptoms and agitation lasting about 30-180 minutes.
One series from Taiwan found that 22% of 104 cases had pain on top of the head.
Other series quoted figures of 3.5% (553 cases) and 7% (230 cases).
The pattern of bouts of intense pain on a daily basis for several weeks, with associated features should give away this diagnosis.
- 9% of 43 cases reported from London in 2007 has top of head pain.
SUNCT stands for Sudden, Unilateral, Neuralgiform headache with Conjunctival injection and Tears.
It is notoriously difficult to treat, but Lamotrigine is often recommended.
Fortunately it is really rare.
Isolated Sphenoid Sinusitis
- 61/72 (85%) cases of isolated sphenoid sinusitis reported headache. Of these 61, 20 (33%) reported pain in the top of head.
This was the most common site of pain in isolated sphenoid sinusitis.
11/86 cases had a chronic headache and no other features.
The pain of sphenoid sinusitis is often severe, unremitting and worse when lying or with exertion. Classic sinus symptoms like runny nose or nasal congestion are usually lacking.
Surgical drainage can be curative.
Chronic Headache Following Whiplash Injury
Airflight headache with chronic rhinosinusitis
Causes of "Headache Top of Head" (not triggered by a provoking stimulus)
These are all unprovoked by physical stimulus or change in environment, and are usually reported as isolated cases - so they are all fairly rare.
- Pituitary tumous are often associated with headache.
In one series of 84 tumours, headaches were located in the top of the head in 26 (31%).
One case of pituitary apoplexy presented with a thunderclap headache followed by an enduring "headache top of head"
- The classic location for nummular headache is on the side of the head - temple or parietal areas. There are published cases of pain on the top of the head - at the vertex. Some of thee cases will have hair loss at the site of pain.
The site of pain in nummular is a well circumscribed area about the size of a large coin. It can be tender, prickly, itchy or burning in quality.
A serious underlying cause is not usually found.
Cephalgic Alopecia Areata
- One very well characterised case of areas of painful hair loss which was studied using skin biopsy.
The patient was treated successfully with botulinum toxin injections, which have also been proposed as a treatment for nummular headache.
Disorders of the skin or the scalp are therefore a potential cause of "headache top of head"
- This is usually a condition of people with increased body mass index (obesity). The headache is chronic, daily and non-descript. In one series, 2/58 cases (3%) had pain on top of the head only.
The clue to diagnosis from the history is the symptom of pulse-synchronous tinnitus.
Incidence of this condition is about 5/100,000 per year, but if detected requires long term follow-up.
Occipital Condyle Syndrome
- This condition usually occurs in people known to have cancer. The syndrome is caused by spread of cancer to the base of the skull (the occipital condyle).
The nerve to the tongue muscle (hypoglossal nerve) travels just above the occipital condyle.
The syndrome causes a headache, which is usually in the back of the head, but can be a cause of "headache top of head" with weakness of the tongue.
Tongue weakness causes difficulty speaking or chewing.
Headache in Acute StrokeAbout 4% of headaches that accompany acute stroke are located in the top of the head. Always remember that a one-sided headache and stroke may indicate arterial dissection.
- One case reported in 2009 found a case of secondary syphilis associated with pain which was located in the top of the head. Headache resolved when treated with penicillin.
- Another isolated case of pain on top of the head, found to be due to the very rare entity of one-sided hydrocephalus. It was relieved by a ventriculostomy procedure.
Thrombotic Thrombocytopenia Purpura
- This usually presents with headache and focal neurology. There can be evidence of internal of external bleeding. Pain is described radiating to the top of the head in at least one case. This is a very rare condition too.
Read about other locations of pain, not just "Headache Top of Head"
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