Read this first
When to worry
Headache is one of the most frequent reasons people seek care, and the great majority are benign — tension-type or migraine. A small minority are the first symptom of a bleed, an infection, or raised pressure inside the skull. Those few announce themselves by how they started and what came with them, not by intensity, which is why the list below comes before anything else on the page.
Get help now — same day or emergency
- A sudden severe headache that reaches its peak within a minute or two, often described as being struck on the back of the head. This is the classic presentation of a subarachnoid haemorrhage and it needs emergency assessment even if it then fades.
- Headache with fever and a stiff neck, dislike of bright light, or a rash that does not fade when pressed with a glass.
- Weakness, numbness or drooping on one side of the face or body, slurred speech, sudden loss of vision, confusion, or a seizure.
- Headache after a head injury, particularly if it is worsening rather than settling, or if there was any loss of consciousness or vomiting.
- A headache with vomiting that is worse in the morning or worse lying down, or one that wakes you from sleep — the pattern of raised pressure.
Get it looked at within days
- A new headache after the age of 50, especially with scalp tenderness, jaw pain on chewing, or visual disturbance. Giant cell arteritis can cause permanent sight loss and is treated within days, not months.
- A headache that has changed character — new location, new severity, new triggers — after years of a stable pattern.
- Headache with a painful red eye, haloes around lights, or blurred vision. Acute glaucoma threatens sight.
- Headache that is reliably worse on coughing, straining or bending, or that comes with a persistent visual change.
- A new headache in pregnancy or the first weeks after childbirth, or in anyone with cancer, HIV or a weakened immune system.
This is not a triage tool. If this is the worst headache you have had, or if something feels wrong and you cannot say why, that is a reason to be seen rather than to read further. Everything after this section assumes none of the above applies.
One rule for this whole list: if you are not sure whether a line applies to you, treat it as though it does — and get it checked. Uncertainty is a reason to be seen, not a reason to wait.
Four headaches that behave differently
English uses one word for conditions with entirely different mechanisms and different treatments. Which one you have decides whether the pattern question is even the right question, and it is usually obvious from the shape of the attack rather than its severity.
Tension-type
A band of pressure around the head or across the forehead. Mild to moderate, not throbbing, not made worse by climbing stairs or walking. Tender spots in the neck and shoulders are usual.
Points to Mostly muscular and postural. This is the type the traditional account describes most often, and the one the pattern pages are actually about.
Migraine
Throbbing, usually one-sided, moderate to severe, worse with movement, with nausea or dislike of light and sound. May be preceded by a visual aura — zigzag lines, blind spots, flashing.
Points to A neurological condition with its own treatment. Pattern work can run alongside it; it does not substitute for it.
Cluster
Severe pain around one eye, lasting fifteen minutes to three hours, often at the same hour each day, with a red watering eye and a blocked nostril on the same side.
Points to Needs a neurologist and specific treatment. Do not manage this as a pattern question.
Medication overuse
A daily background headache with periodic worse days, in someone taking painkillers or triptans on more than ten to fifteen days a month for three months or more.
Points to The treatment is to stop the analgesic, which is unpleasant and usually needs supervision. Pattern treatment given alongside continued overuse does not work.
What the patterns describe
The traditional account does not treat headache as one condition. It records where the pain sits, what it feels like, and what arrived with it: a heavy wrapped feeling, a distending pain with irritability, a dull ache with tiredness, a throbbing with heat in the face. Each of those points somewhere different, and each carries its own accompanying signs.
The groupings that recur are these. A tight band that tracks stress, with rib-side tension and sighing, reads liver constraint. A heavy foggy head with a greasy tongue coat, worse in humid weather, reads dampness or phlegm. A dull ache with tiredness, a pale face and palpitations reads blood or qi deficiency. A one-sided throb with irritability, red eyes, a bitter taste and raised blood pressure reads liver yang rising. A dull pain at the back of the head with a sore lower back, night heat and a red tongue with little coat reads kidney or liver yin deficiency.
What these groupings are good for is choosing the accompanying measures: what to eat, when to sleep, where to press, what to stop. They do not identify a cause, and they must never delay the checks above. A pattern reading and a scan answer different questions, and neither replaces the other.
Which patterns it belongs to
These are the patterns this symptom is conventionally grouped under. They are not competing diagnoses — most people meet one, and the point of the list is to show you which questions separate them.
A tight band, worse at the temples or the vertex, moving between sites; rib-side distension, sighing, a wiry pulse; relief after crying, shouting or a long walk.
The most common pattern behind a stress-linked tension headache, and the easiest to test: does the headache follow your mood and your shoulders?
Read the pattern page →Heaviness rather than pain, a muzzy head, a thick greasy tongue coat, a sticky mouth with no thirst, sleepiness after eating, a soggy pulse.
Best fit for a heavy, foggy head — the type that is worst in humid weather, after a heavy meal, or in the morning.
Read the pattern page →A dull ache with a pale face, palpitations, dizziness on standing, dry eyes and blurred vision, a thin pulse, a pale tongue with a thin coat; worse when tired or hungry.
Common with heavy periods, after childbirth, and in long-term under-eating or crash dieting.
Read the pattern page →A dull ache at the back of the head or the vertex with sore lower back and knees, high-pitched tinnitus, night sweats, hot palms and soles, a red tongue with little coat.
Common from the fifties onward, and in people who have kept late nights for years.
Read the pattern page →A heavy head with nausea, copious sputum or constant throat clearing, a thick slippery tongue coat, a slippery pulse, dizziness on movement.
The type that sits behind the eyes with nausea, and that worsens with dairy, fried food and damp weather.
Read the pattern page →The signs behind it
Each line below is one entry in the sign table — the same table the self-check draws its follow-up questions from. The tier says how strongly that sign points at the pattern: a defining sign is expected, a common one is usual, a supporting one is optional.
- Tension headache Liver qi stagnationsupporting ·Dampnesssupporting ·Blood deficiencysupporting ·Liver yin deficiencysupporting
- Dizziness with a sense of heaviness Phlegmdefining ·Dampnesscommon
- Dry eyes or blurred vision Liver yin deficiencydefining ·Blood deficiencycommon ·Kidney yin deficiencycommon ·Liver yang risingcommon
- Distension or moving pain under the ribs Liver qi stagnationdefining ·Dampnesssupporting
Not every sign listed here will apply to you — a sign only counts alongside the others. The self-check is the place to weigh them against your own answers.
Telling them apart
Four questions do most of the work. Each one splits the field in half, and after two or three the pattern is usually clear enough to act on — or clear enough to know that the answer is medical rather than traditional.
| Question | If yes | If no |
|---|---|---|
| Does the headache track your mood, your shoulders, or your jaw? | Worse on stressful days and better on holiday, with neck and shoulder tightness → liver qi stagnation, and in Western terms tension-type. The measures overlap, which is convenient. | No clear link to stress, but a clear link to weather, meals or tiredness → look at dampness, blood deficiency or yin deficiency instead. |
| Is the pain throbbing, one-sided, and worse when you move? | Yes, with nausea, dislike of light, or a visual aura → migraine. Have it assessed and treated as migraine before anything else. | A band of pressure on both sides that does not worsen with movement → tension-type, and the pattern question is worth asking. |
| Is the head heavy and foggy rather than painful? | Yes, with a thick greasy tongue coat and worse in humidity → dampness or phlegm. | Pain without heaviness, with a dry mouth and a red tongue → heat or yin deficiency, not dampness. |
| How many days a month do you take a painkiller? | More than ten → medication overuse is likely, and it will keep the headache going whatever else you do. | Occasional use only → the pattern reading is not being undermined by rebound. |
What you can do at home
None of this treats a named condition, and none of it replaces assessment. These are the ordinary measures attached to this symptom — low risk, and worth doing while you work out what is actually going on.
- Keep a two-week diary: time of day, what you ate, how you slept, what you were doing. Tension headache and migraine have different triggers, and two weeks of notes separates them faster than any description.
- For the tension type, fix the screen height, get the phone off your shoulder, and stand every forty minutes. A large share of what gets called a stress headache is a neck headache, and the neck answers posture faster than anything else.
- Do not push through a migraine on a normal working day. Dark, quiet and flat for an hour early in an attack does more than an hour of stoicism followed by a worse attack.
- Cap painkillers at the label dose and at ten days a month. Past that, the medicine starts causing the headache it treats, and pattern work becomes irrelevant.
- For the heavy-head type the traditional measures are ordinary: fewer raw and cold foods, fewer fried and dairy-heavy meals, regular meal times, a dehumidifier in a damp bedroom, twenty minutes of walking.
Classical sources
Quoted in the original, with our own translation and the chapter it comes from. We do not reproduce existing English translations — they are someone else's reading.
头者，精明之府。 tóu zhě, jīng míng zhī fǔ
The head is the residence of the essential brightness.
太阳之为病，脉浮，头项强痛而恶寒。 tài yáng zhī wéi bìng, mài fú, tóu xiàng qiáng tòng ér è hán
Greater yang disease is marked by a floating pulse, stiffness and pain of the head and nape, and aversion to cold.
头痛多主于痰，痛甚者火多。 tóu tòng duō zhǔ yú tán, tòng shèn zhě huǒ duō
Headache is mostly governed by phlegm; where the pain is severe, fire is much involved.
The two classical passages are quoted from the received text. The Zhu Danxi line is widely repeated in modern textbooks and is given here as a historical position; we have not yet collated it against a Ming edition.
Terms used on this page
One concept, several names. The standard term comes first; pinyin and characters are there so you can search and cross-check; older aliases are what you will meet in other people's writing.
| Standard term | Pinyin | 中文 | Also written as |
|---|---|---|---|
| Headache | tóu tòng | 头痛 | Cephalgia (medical) |
| Liver yang rising | gān yáng shàng kàng | 肝阳上亢 | The pattern behind a one-sided throb with irritability and a bitter taste |
| Wiry pulse | xián mài | 弦脉 | Feels like a taut cord under the finger |
| Essential brightness | jīng míng | 精明 | The classical term for the head as the seat of the senses and spirit |
Check your own pattern
Headache is a symptom, and symptoms appear in several patterns. The self-check weighs twelve questions against all twelve patterns and shows you what fits — and what doesn't quite.
Start the self-checkAbout four minutes. No account, nothing stored on a server, and an address for the printable report is optional.