About Throbbing Headaches

What is Throbbing Pain?

A throbbing headache is head pain that feels rhythmic, pulsing, or pounding. It is a description of pain rather than a diagnosis. Throbbing pain is common with migraine, but it can also occur with other primary headache disorders or with headaches caused by another health condition. Tension-type headaches are more often described as pressure or tightness, and true sinus headaches are uncommon; many headaches attributed to sinus problems are migraine. Headache pain involves complex activity in nerves, brain pathways, and blood vessels, so it should not be explained simply as increased blood flow or widened blood vessels. Some headaches improve with rest and appropriate self-care, but a new, sudden, severe, or changing headache may require prompt medical evaluation. Identifying the headache pattern, associated symptoms, and possible triggers can help a healthcare professional determine the cause and recommend treatment.

Causes and Risk Factors of Throbbing Pain

Throbbing pain can occur with several headache disorders. It is not usually caused by a simple change in blood flow. Common causes and contributing factors include:

• Migraine: A neurologic disorder that often causes moderate to severe pulsing or throbbing pain, sometimes on one side of the head. Attacks may last from several hours to several days and may include nausea or sensitivity to light, sound, or smells.
• Caffeine withdrawal: People who regularly consume caffeine may develop a headache after suddenly reducing or stopping it.
• Alcohol: Alcohol can trigger migraine in some people, and headache may also occur as part of a hangover because of several factors, including dehydration, sleep disruption, and alcohol’s effects on the nervous system.
• Hormonal changes: Fluctuations in estrogen, including those around menstruation, can trigger migraine attacks in some people.
• Other triggers: Stress, changes in sleep, skipped meals, dehydration, certain sensory stimuli, and medication overuse may contribute to headaches in susceptible people.

Less commonly, a new or unusual throbbing headache can be caused by a serious condition, such as bleeding in or around the brain, stroke, meningitis, very high blood pressure with organ injury, giant cell arteritis, or a brain tumor. Serious causes are uncommon, but warning signs should be evaluated promptly.

Throbbing Pain Symptoms

A throbbing headache may feel like a pulse or heartbeat in the head. Symptoms vary with the cause. Migraine commonly causes:

• Moderate to severe pulsing or throbbing pain, often but not always on one side
• Nausea or vomiting
• Sensitivity to light, sound, or smells
• Pain that worsens with routine physical activity
• In some people, temporary neurologic symptoms called aura, such as visual changes, tingling, or difficulty speaking. Aura symptoms usually develop gradually and resolve, often within an hour. New, sudden, prolonged, or markedly different neurologic symptoms require urgent evaluation because stroke and other serious conditions can cause similar symptoms.

Other symptoms can point to a different cause. Fever with a stiff neck may suggest an infection. In adults older than 50, a new headache with scalp or temple tenderness, jaw pain while chewing, or vision changes can be a sign of giant cell arteritis and requires urgent medical evaluation. A painful red eye with headache and vision changes also needs urgent assessment.

Call 911 or seek emergency care for a headache that:

• Begins suddenly and becomes extremely severe within seconds or minutes
• Occurs after a significant head injury
• Occurs with weakness or numbness, trouble speaking, confusion, fainting, a seizure, difficulty walking, or new severe vision changes
• Occurs with fever, a stiff neck, or a widespread rash
• Occurs with a painful red eye and reduced or blurred vision

Contact a healthcare professional promptly for a new headache during pregnancy or after childbirth; a new headache after age 50; a headache that is progressively worsening or changing in pattern; headaches that repeatedly occur with coughing, exertion, or changes in position; or a new headache in someone who has cancer, a weakened immune system, or another serious systemic illness.

How Throbbing Pain is Diagnosed

A healthcare professional usually diagnoses a headache disorder from the medical history and a physical and neurologic examination. They may ask when the headaches began, how quickly the pain develops, where it is located, how long it lasts, how often it occurs, what the pain feels like, which symptoms accompany it, what may trigger or relieve it, and which medicines are being used.

Brain imaging is not routinely needed for a stable headache pattern that fits migraine or another primary headache disorder and has a normal neurologic examination. A CT scan or MRI may be recommended when the headache is sudden, new, progressively worsening, associated with abnormal examination findings or other warning signs, or occurs in someone with risk factors for a secondary cause.

Additional tests depend on the suspected cause and may include:

• Blood tests to look for infection, inflammation, or metabolic problems
• Lumbar puncture (spinal tap) when meningitis, bleeding not seen on initial imaging, or abnormal pressure around the brain is suspected
• Eye examination when eye disease or pressure-related problems are possible
• Inflammatory blood tests and, when indicated, temporal artery ultrasound or biopsy for suspected giant cell arteritis

The choice and urgency of testing depend on the person’s symptoms, examination findings, age, medical history, and headache pattern.

Treatment Options for Throbbing Pain

Treatment for throbbing pain depends on the cause of the headache. The goals may include relieving the current attack, reducing future headache frequency and severity, and treating any underlying condition.

Options may include:

• Acute medicines: For some headaches, a healthcare professional may recommend over-the-counter pain relievers or a prescription migraine-specific medicine. These medicines should be used as directed because frequent use can cause medication-overuse headache.
• Preventive treatment: People with frequent or disabling migraine attacks may benefit from preventive medicines, including certain oral medicines, injections, or other migraine-specific therapies.
• Self-care and behavioral strategies: Regular sleep, meals, hydration, physical activity, stress management, relaxation training, biofeedback, or cognitive behavioral therapy may help some people. A headache diary can help identify patterns and triggers.
• Procedures or devices: Depending on the diagnosis, options may include nerve blocks, onabotulinumtoxinA for chronic migraine, or noninvasive neuromodulation devices.
• Treatment of an underlying condition: Secondary headaches require care directed at the cause and may need urgent treatment.

Because treatment choices depend on the diagnosis, other health conditions, pregnancy status, and current medicines, work with a healthcare professional to choose a safe and effective plan.