Pounding, throbbing, stabbing, aching — welcome to the world of headaches, an ailment that affects more than 45 million Americans each year.


Humans have been suffering from the malady for millennia. Recorded depictions date back to at least 4000 B.C. in Mesopotamia, where it was thought that Tiu, the evil spirit of headaches, was to blame. The shenanigans of evil spirits were assumed to be the cause of headaches throughout many cultures, and gave rise to trephination — a procedure in which a small circular portion of the skull was removed, creating egress for the pain-triggering spirits.


Given how agonizing a headache can be, rowdy evil spirits wreaking havoc doesn’t seem all that much of a stretch. Fortunately we know better now, and in most cultures no longer rely on holes drilled in the head for relief. But if not evil sprits, what does cause the pain?


There are many catalysts that can create the ache, and medical literature has complied a lengthy compendium of causes. Culled from several sources, below is a summary of the most common triggers for migraine, cluster, rebound and tension headaches. Some of them you may be familiar with, but there is no shortage of surprising ones. 


  1. Overuse of common prescription or over-the-counter pain medication: Half of chronic migraines, and as many as 25 percent of all headaches, are actually “rebound” episodes triggered by the overuse of common pain medications.
  2. Beer
  3. Red wine
  4. Aged cheese
  5. Soy
  6. Smoked fish
  7. Meats containing nitrates (bacon, hot dogs, salami, cured meats)
  8. Processed foods
  9. Fermented foods
  10. Pickled foods
  11. Marinated foods
  12. Chocolate
  13. Nuts
  14. Dairy products
  15. Aspartame
  16. Skipping meals
  17. Bright lights
  18. Sun glare
  19. Loud sounds
  20. Pleasant scents, such as perfume
  21. Unpleasant odors, such as paint thinner and secondhand smoke
  22. Smoking
  23. Hormonal changes in women before or during their periods, during pregnancy, or menopause
  24. Oral contraceptives and hormone replacement therapy
  25. Jet lag
  26. Changes in wake-sleep pattern
  27. Not enough sleep
  28. Too much sleep
  29. Sleeping in a cold room
  30. Sleeping with the neck in an abnormal position
  31. Holding your head and neck in an abnormal position while working (typing, microscope viewing, etc)
  32. Intense physical exertion
  33. Sexual activity
  34. Change of weather or barometric pressure
  35. High altitudes (hiking, air travel)
  36. Heat (hot weather, hot baths)
  37. Colds, the flu or a sinus infection
  38. Jaw clenching or teeth grinding
  39. Eye strain
  40. Head injury
  41. Stress
  42. Depression
  43. Anxiety

Serious causes of headaches are rare, but sometimes headaches warn of a more serious disorder. The National Institutes of Health recommends letting your health care provider know if you have sudden, severe headaches. Get medical help right away if you have a headache after a blow to your head, or if you have a headache along with a stiff neck, fever, confusion, loss of consciousness or pain in the eye or ear.


Have you determined something surprising that causes headache for you? Share with us in the comments.


For more information on the specific causes listed above, see The New York Times Headache Health Guide and Mayo Clinic.


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