How long can I wait out a headache? How to spot a dangerous one
This answer is a draft. It stays unpublished until legal review and source verification are complete.
Headaches are generally described as a chronic problem for one in three or four people in Japan, and over-the-counter painkillers are a mainstay of every drugstore (Matsumoto Kiyoshi, Welcia, etc.). Most are "primary headaches" (migraine and tension-type headache) that do not threaten life, but occasionally a headache caused by a brain condition is mixed in. Here is how to tell them apart, and what to watch when using painkillers.
Telling common headaches apart
| Type | Features | Duration | What to do |
|---|---|---|---|
| Tension-type headache | A squeezing feeling from the back of the head to the whole head. Comes with stiff shoulders and neck. Not worse with movement. The most common type | 30 minutes to several days | Warmth, stretching, posture, sleep. Over-the-counter painkillers |
| Migraine | Throbbing on one or both sides. Light, sound and smells hurt, nausea, worse with movement. Some people get an aura (zigzag lights). Women are affected 3–4 times as often as men; triggers include periods, air pressure, lack of sleep, hunger, cheese and wine | 4–72 hours | Rest in a dark, quiet place; cool the head. If over-the-counter medicines do not work, prescription drugs (triptans, and since 2021 preventive injections) |
| Cluster headache | Excruciating pain as if the back of one eye is being gouged out, tears, runny nose, red eye. Every day at the same time for 1–2 months. More common in men | 15 minutes to 3 hours | Headache clinic (oxygen inhalation, prescription drugs) |
| Medication-overuse headache | Taking painkillers on 10 or more days a month (15 or more for simple analgesics) for 3 months or more. A heavy or aching head almost every day | Chronic | Adjust the medicines at a headache clinic. Stopping suddenly on your own can make it worse |
Danger signs (see a doctor at once / emergency)
| Sign | What it may indicate |
|---|---|
| Sudden, "worst of my life" pain peaking within seconds to a minute (thunderclap headache) | Subarachnoid haemorrhage |
| Fever + a neck too stiff to bend + headache | Meningitis |
| Numbness or weakness in the limbs, trouble getting words out, slurred speech, loss of part of the visual field, clouded consciousness | Stroke, brain tumour |
| Headache after a blow to the head (even hours to weeks later) | Epidural or subdural haematoma (in older people, chronic subdural haematoma weeks later) |
| A first-ever headache after age 50; a headache that worsens day by day | Temporal arteritis, tumour, etc. |
| Headache brought on by coughing, straining or exercise | A structural problem in the brain |
| Severe headache during pregnancy or after childbirth | Hypertensive disorders of pregnancy |
- Choosing an over-the-counter medicine: acetaminophen (paracetamol) (gentle on the stomach, easier for children and pregnant women), ibuprofen and loxoprofen (reduce inflammation, harder on the stomach). Products with added caffeine feel more effective but are more likely to cause overuse headache. The basic rule is "one dose early, as soon as the headache starts"; if you hold out until it is severe, it works less well.
- How often: no more than 10 days a month. Beyond that, ask a headache clinic, neurologist (神経内科・脳神経内科) or neurosurgeon (脳神経外科) about preventive medicines.
- Headache diary: recording date, time, pain level, triggers (sleep, period, weather, food) and what you took speeds up diagnosis at your appointment. There are many apps.
- Living with migraine: regular sleep (oversleeping is also a trigger), avoid hunger, keep caffeine intake steady, anticipate changes in air pressure (apps), manage light with sunglasses and screen brightness.
- Children's headaches: children get migraines too, and stomach ache or nausea may be the main symptom. If morning headaches with vomiting continue, see a paediatrician.
- Where to go: a headache clinic (the Japanese Headache Society publishes a list of certified specialists), neurology (神経内科・脳神経内科), neurosurgery (脳神経外科). Danger signs: call an ambulance (119).
[Verify] Check the prevalence of headache, the female-to-male ratio for migraine and the definition of medication-overuse headache (10 / 15 days a month) against the Japanese Headache Society's "Clinical Practice Guideline for Headache Disorders 2021".
Misunderstanding 1｜My headaches are routine, not worth a doctor's visit
Usually true, but "sudden severe pain", "fever with a stiff neck", "numbness or speech problems" and "a first headache after 50" are the exceptions. The danger signs alone are worth memorising.
Misunderstanding 2｜Over-the-counter painkillers are safe, so daily use is fine
10 or more days a month for 3 months, and the medicine itself becomes the cause of the headache (medication-overuse headache). If your use is rising, go to a headache clinic.
Misunderstanding 3｜Painkillers work better if you wait until the pain is strong
For migraine, taking one early, at the start, works better. Once the pain has built up it works less well.
Misunderstanding 4｜Migraine is just "being a headache person" and nothing can be done
Prescription triptans and, since 2021, preventive injections (anti-CGRP antibodies) can greatly reduce the impact on daily life. Seeing a doctor is a shorter route than going on with over-the-counter medicines.
Misunderstanding 5｜If nothing happens right after a bang on the head, you are fine
In older people, a chronic subdural haematoma can cause headache, unsteadiness and forgetfulness weeks later. See a doctor about any change after a fall.
---
Sources
- Japanese Headache Society and Japanese Society of Neurology, "Clinical Practice Guideline for Headache Disorders 2021" [頭痛の診療ガイドライン2021]
https://www.jhsnet.net/guideline_GL2021.html
- Japanese Headache Society, "List of certified headache specialists / headache clinics" [頭痛専門医リスト・頭痛外来]
https://www.jhsnet.net/
- Ministry of Health, Labour and Welfare (MHLW) e-Health Net, "Headache" [頭痛]
https://www.e-healthnet.mhlw.go.jp/information/dictionary/
⚠️ Editorial note: the source URLs above were identified by search. Our working environment cannot reach go.jp domains, so the contents have not been checked against the text. Verify every source before publication and record who checked it and when.
About this article
What we share here are ideas and everyday practices passed down among people living in Japan, together with general information drawn from public sources. They are not official recommendations, and they are not professional instruction. Practices vary between households and regions.
This is general information. Results vary from person to person and depend on your own conditions and surroundings.
Please decide for yourself, using your own judgement, whether any of this suits your situation. We cannot accept responsibility for any damage, loss or injury arising from following this article.
This article is not meant to diagnose or manage any specific medical condition. If you are worried about your health, see a doctor rather than relying on your own judgement.
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