Headaches are never fun, and each type of headache can produce its own unique symptoms. Headaches that occur on the top of the head may cause the sensation of having a heavy weight placed on the crown of your head.
Identifying exactly what type of headache you’re experiencing is crucial to finding the right treatment and getting relief.
What causes a headache on the top of your head?
Several different conditions can cause headaches on top of your head, including:
Tension headaches are the most common cause of headaches that occur on the top of the head. They cause a constant pressure or aching around the head, which may feel like a tight band has been placed around the head.
You may also feel pain in your neck and near the back of your head or temples. The pain is dull and doesn’t throb, and it’s often much less severe than that of a migraine. Although these headaches are uncomfortable, many people with tension headaches are able to resume normal activities.
Learn more about tension headaches.
Migraines also cause headache pain on the top of the head, though it may also appear on or travel to one side of the head or the back of the neck. Migraines can cause a severe throbbing pain, along with symptoms like:
light and sound sensitivity
Migraines may be felt on the right or left side of the head, but they’re most common on the left side.
Learn more about migraines.
Sleep deprivation headaches
Sleep deprivation headaches can affect anyone, even if you don’t typically get headaches. They can be caused by insufficient or interrupted sleep, and they typically cause a dull ache combined with a heaviness or pressure on the top of the head.
Learn more about how sleep deprivation affects your body.
Cold-stimulus headaches — commonly known as “brain freezes” — come on quickly and are felt near the top of the head. They will be severe, and typically only last a few seconds.
Learn more about brain freezes.
In some cases, chronic headaches can resemble tension headaches and cause pain near the top of the head. Like tension headaches, these may be provoked by stress. They can also be caused by persistent loud noises, poor sleep, or other triggers.
Learn more about chronic headaches.
Occipital neuralgia occurs when the nerves that move from the spine to the scalp are damaged, irritated, or compressed. They can cause pain at the back of the head, or a tight, band-like feeling around the top of the head.
Other symptoms include:
jolts of pain that feel like electric shocks
symptoms that increase upon movement
Learn more about occipital neuralgia.
Rare causes of headaches on the top of the head
While rare, these causes are medical emergencies.
Reversible cerebral vasoconstriction syndrome (RCVS)
This is a rare condition where the blood vessels in the brain constrict, triggering a severe “thunderclap” headache near the top of the head.
This condition may cause strokes or bleeding in the brain, and other symptoms include severe weakness, seizures, and blurred vision.
Hypertension headaches occur when severe high blood pressure causes pressure to build in the cranium. This headache is distinctive, feeling like you’ve pulled your hair tight into a pony tail at the top of your head.
You may experience a “whooshing” noise during the headache; the pain is severe, and often sends people to the emergency room. Other symptoms may include confusion, shortness of breath, or blurred vision.
Learn more about hypertension headaches.
Which muscles are at fault?
Headaches on the top of the head — especially tension headaches and migraines — are typically caused by just a few muscles.
The first is a group of muscles called suboccipital muscles, which are responsible for movement between the first and second vertebrae in the neck and the skull. These muscles can become tense due to factors like grinding your teeth, eye strain, or poor posture. This alone can trigger tension headaches and migraines. If these muscles become too tense, they can compress the occipital nerve, causing occipital neuralgia.
The splenius cervicus and splenius capitus muscles, which run up the neck, can also cause headache pain at the top of the head if they’re too tight. Tension in these muscles can also cause a stiff neck or neck pain in addition to headaches.
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How are headaches on the top of the head treated?
The first line of defense against headaches will be over-the-counter pain relievers like acetaminophen (Tylenol), which can effectively reduce headache symptoms. For stubborn headaches or migraines, you can try extra-strength Tylenol or Excedrin Migraine. Don’t take both medications together, as they both contain acetaminophen. Taking too much can cause an overdose.
Getting more sleep, reducing stress, and maintaining good posture (even when sitting) can all help prevent many types of headaches from ever forming. Invest in an ergonomic chair if you’re sitting at a desk for work.
If overly tense muscles are thought to be the cause of your headaches, your doctor may recommend that you see a massage therapist or chiropractor regularly.
If your headaches are frequent or more severe, your doctor may prescribe you medications or develop a customized treatment plan. Treatments varying by underlying cause:
Tension headaches may be treated with prescription pain relievers if severe enough.
Migraine treatment may involve both preventative and immediate-relief medications. Triptans may be prescribed to constrict blood vessels and reduce pain. Beta-blockers, antidepressants, and anti-seizure drugs may be used to prevent migraines.
Occipital neuralgia can be treated with physical therapy, massage, warm compresses, anti-inflammatory medications, and muscle relaxants. Anti-seizure drugs may be used for preventative purposes.
Reversible cerebral vasoconstriction syndrome may clear up without treatment, but calcium channel blockers may help reduce headaches caused by the condition (though they do not reduce the risk of stroke).
Hypertension headaches, which typically occur in a dangerous state called hypertensive crisis, require immediate emergency treatment to reduce risk of brain bleeding, stroke, or other serious conditions. Medications will be administered to bring blood pressure down as quickly as possible; this is typically done through an IV. To prevent hypertension headaches, eat a low-sodium diet, exercise regularly, and take blood pressure medications prescribed by your doctor.
If your doctor prescribes treatment that isn’t working for you, or you struggle with the side effects of the medication, let them know. There are often multiple treatment plans and medications you can try for different headaches.
When to see a doctor
Mild headaches can be managed at home and typically aren’t a cause for concern. Certain symptoms indicate that you should make an appointment with your doctor to diagnose your headaches, create a treatment plan, and potentially check for underlying conditions. These symptoms include:
changes in headache patterns, including type of pain, location, severity, or frequency
headaches that become progressively worse
headaches that interfere with your normal routine or daily activities
headaches that don’t resolve with treatment, including over-the-counter treatments
Some symptoms that come with headaches could indicate a medical emergency. Call 911 or go to the emergency room if you experience:
a severe, sudden headache that came out of nowhere and is causing debilitating pain
confusion or poor alertness to the point where you’re struggling to understand speech or what’s happening
numbness, weakness, or paralysis on one side of your body; this includes facial paralysis
blurred vision or difficulty seeing
trouble speaking, which may include verbal disruptions or slurred speech
persistent nausea or vomiting that lasts more than four hours
balance problems that make it difficult to walk
stiff neck combined with a high fever