Why Does My Head Hurt Today? A 60-Second Diagnostic

The 60-second read

Your head is throbbing right now. You opened this tab because a search engine thought the phrase why does my head hurt today might have an answer, and you have about sixty seconds of patience before the pain makes reading unpleasant. I will not waste them.

Here is how this article is built, in the order you need it: first the red flags that mean stop reading and call a doctor, second a 60-second diagnostic that tells you which kind of headache you are most likely in, third a short note on what the sky looked like this morning (because today might be a pressure-drop day and that changes the story), and fourth the specific things to try in the next ten minutes. No preamble. Scroll.

Read this FIRST: red flags that mean call a doctor now

Before the diagnostic, the uncomfortable paragraph. Most headaches are benign. A small minority are not, and the ones that are not tend to announce themselves with one of the patterns below. If you recognise yourself in any of these, close this tab and get help.

• Thunderclap headache. A sudden, severe, worst headache of my life pain that peaks to maximum intensity inside sixty seconds. This is the classic red flag for subarachnoid haemorrhage from a ruptured aneurysm, and it is a same-hour emergency. Not "wait and see." Not "see if ibuprofen helps." Emergency room, right now.
• Headache with fever, stiff neck, and bright-light intolerance together. Meningitis often presents with exactly that triad. Photophobia on its own is ordinary in migraine and does not count — it is the combination with fever and a neck you cannot flex that matters.
• A new focal neurological deficit — sudden one-sided weakness, slurred speech, a drooping face, numbness that will not fade, or vision loss in one eye. Migraine aura is usually visual, usually lasts 15 to 60 minutes, and resolves before or soon after the pain arrives. Anything beyond that timescale, or any non-visual deficit, is treated as a stroke or TIA until proven otherwise in an emergency department.
• First severe headache after age 50. If you are not a headache person and suddenly you are, after fifty, that deserves a same-week workup. Giant cell arteritis is the one the textbooks worry about first.
• Headache after a recent head injury, even a mild one, especially if it is getting worse across the 24 to 72 hours since the hit. Delayed subdural bleeding is real and it is fixable if you catch it early.
• A headache that woke you from sleep tonight out of nowhere, or a headache with a new seizure, or a severe headache in the third trimester of pregnancy — each of those earns its own call.

If none of that matches what is happening to you, keep scrolling. If any of it does — close this tab and get help.

The 60-second diagnostic: which kind is this?

The International Classification of Headache Disorders, 3rd edition (ICHD-3, International Headache Society) is the taxonomy every neurologist uses. It splits primary headache into roughly a dozen categories, but five of them account for almost everything you are likely to be feeling. Here is the shortest version I can write that is still useful.

Migraine, with or without aura. Usually one-sided, but it can be bilateral. The pain is throbbing or pulsing — matching the heartbeat, almost — and it gets worse when you climb stairs or walk quickly. Light hurts. Sound hurts. The thought of your usual coffee makes you slightly nauseous. An attack typically lasts four to 72 hours if untreated. About a third of patients get aura first — usually visual, zig-zag lines or a blind spot that drifts across one side for 15 to 60 minutes. If this reads like what you have right now, you are probably in a migraine attack, and weather may be part of why today specifically. More on that in the next section.

Tension-type headache. Bilateral, pressing or tightening, like a band across your forehead or around the back of your head into the neck. Mild to moderate, not severe. No nausea worth mentioning. Bright light is annoying, not punishing. It does not get meaningfully worse when you walk upstairs. It responds reasonably well to a basic NSAID plus a warm shower and a neck stretch. It is, by American Migraine Foundation counts, the most common primary headache in the world — vastly more common than migraine, though much less disabling per episode.

Cluster headache. Strictly one-sided, boring into the eye or temple, and severe — the medical literature routinely calls it the worst pain syndrome in neurology. Cluster attacks last 15 minutes to three hours and come with unmistakable autonomic signs on the SAME side as the pain: a watering eye, a red eye, a dropping eyelid, a congested nostril. Men between 20 and 50 are the stereotype but women get them too. Cluster is rare, but the ER misses it often. If that description matches, do not leave without the words "cluster headache" written in your chart — the treatment is very different from migraine and timing matters.

"Sinus" headache — usually not actually sinus. Pain across the front of the face, under the eyes or across the forehead, worse when you bend forward. If there is a fever and thick yellow or green nasal discharge and it is day three of a cold, yes, a real sinus infection can do this. But ICHD-3 and the ENT literature both note that most of what patients call sinus headache turns out to be migraine with autonomic features — facial pressure, watery eyes, a stuffy nose, all on the migraine side. If you have been treated for recurrent sinusitis and the antibiotics keep not working, the question is worth reopening.

Cervicogenic headache. Starts in the back of the head or upper neck, usually one-sided, and is provoked or worsened by neck movement or sustained bad posture. People with old whiplash injuries, long desktop days, or a disc problem in the upper cervical spine are the typical pattern. If you can reliably make the pain worse by tilting your head a particular way, cervicogenic is on the table.

Now the rhetorical pause: which of those five paragraphs described the headache you are in right now?

What the sky looked like this morning

If your best-fit answer above was migraine, or a sinus-feeling headache that might really be migraine, or a pressure-pattern tension headache that keeps showing up on specific days, the next question is whether today is the kind of day that tends to set people like you off.

The 2019 narrative review by Maini and Schuster in Current Pain and Headache Reports (PMID 31707623) went through the barometric-headache literature and surfaced one finding that almost no casual article quotes: mean pressure values are almost useless as a predictor. It is the rate of change that matters. A steady 998 hPa for three days will not light anyone up. A 9-hectopascal drop across three hours, the kind that announces a cold front, will. The 2024 systematic review by Denney, Lee, and Joshi in the same journal (PMID 38358443) bundles the broader weather literature and concludes that weather variables collectively account for roughly one in five self-reported migraine triggers, with barometric change and temperature swing the most consistent signals across studies.

Here is where I can save you a step. Instead of opening NOAA, then the Kp index page, then a separate Schumann resonance chart, you can check today's live score in one tap. It folds barometric change from 32 cities, the NOAA Kp index, and Schumann resonance amplitude into a single 0–100 number with a label: Calm, Elevated, Active, or Storm. If it is Active or Storm and your head is hurting, the weather half of the story just got a lot more plausible.

What to do in the next ten minutes

Not medical advice. Just the things that guidelines and practice notes say to try before you escalate.

Drink water. Dehydration does not cause most headaches but it makes almost all of them worse. Darken the room, or get under a hoodie if that is what you have. Put a cold pack on your forehead or the back of your neck, whichever feels better — both help some people and neither help others, and it is free to find out. If you have access to an NSAID or a triptan and you know your personal dose, take it early — the triptan window for migraine is widest during aura or the first hour after pain onset, not after two hours of trying to tough it out.

One caveat almost nobody mentions. If you are taking painkillers for headache more than about ten days a month, the pill you are about to swallow might be contributing to the cycle. Medication overuse headache is a real and reversible pattern, and the fact that your head hurts today does not mean today's pill is wrong — it means the question is worth asking on a calm day with your doctor.

If your diagnostic paragraph above was cluster headache: ask for 100% oxygen by non-rebreather mask at 12–15 litres per minute, and a subcutaneous triptan. Both are first-line for acute cluster in the guidelines from the U.S. Headache Consortium and the European Headache Federation, and both get missed in emergency departments because cluster is rare enough that most general physicians have never run the protocol.

Why this happened today specifically

Your head is not a random number generator. It reacts to pressure drops, to geomagnetic storms, to temperature swings, to a short night, to a late coffee, to a missed meal, to a jaw clenched for three hours in a bad meeting. A single bad day is hard to explain. Two weeks of bad days with a diary next to them is much easier.

That is the quiet argument for using the headache forecast alongside a pen-and-paper log, or just bookmarking what the sky is doing and checking it on the mornings you wake up already wrong. The goal is not to predict the future. The goal is to give your past two weeks a shape you can actually read. Most of the people I have heard from who finally cracked their own pattern did it by noticing that the bad days clustered around a trend they had never been tracking — a front rolling in, a Kp spike, a daylight-saving shift, a magnesium month and a non-magnesium month next to each other.

Tomorrow's headache might not answer the question why does my head hurt today. But the one after that might.