What Causes a Pounding Headache?

By far the most common cause of a pounding headache or a throbbing pain in the head is Migraine.

A Migraine Headache can be diagnosed if the following apply:

1. Several Episodes of Headache lasting several hours
2. The Headache Pain is of moderate to severe intensity - that means bad enough to make you want to stop what you are doing
3. Associated symptoms of "sensory sensitivity" - which means that during the headache there is one or more of the following symptoms:
   • nausea, loss of appetite and vomiting
   • intolerance of light ("photophobia" - some people will describe a preference for the dark!)
   • intolerance of noise ("sonophobia" - or a preference for quiet)
   • worsening of headache with movement
   • intolerance of smell ("osmophobia")
   • not wanting to be touched

4. There is no other explanation for the headache, which means that you have a normal general and neurological examination.

   Many general practitioners will also do some blood tests to rule out other illnesses

Usually the pain of a migraine will build up over an hour or so to its maximum, but there is a lot of variation.

Some people experience fairly sudden pain reaching its worst within 5 minutes, others may be aware from wakening in the morning that a headache is looming but do not experience maximum pain until the afternoon or evening.

In some cases the sensory sensitivity is less pronounced but it must be present to make a migraine diagnosis.

Surveys of people using the question "do you get episodes of sickening headache that make you want to lie down?" have found that people who answer "yes" have a 90% chance of having a diagnosis of migraine confirmed by a doctor.

It is very important if you have migraine to pay attention to lifestyle - I recommend to everyone with migraine to try and follow a "headache-friendly-lifestyle".

The good news about migraine is that treatments are effective in most people, most of the time.

Other causes of a throbbing head pain

1. Hangover Headache
2. Systemic Illness Headache

Serious causes of throbbing headache are given away by other clues from the history:

1. Meningitis - there is a fever and the headache devlops rapidly over a few hours
2. Arterial Dissection - the onset pain is often sudden and located in the neck as well as the head

These serious causes are very rare as they occur in about 10 people per 100,000 per year.

This should be compared to migraine which affects 12,000 per 100,000 per year.

In pounding headaches the odds are heavily stacked towards a diagnosis of migraine.

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