For patients · Reading time 9 minutes · Version 1.0 · Translation of the German page, medically reviewed on 8 October 2026 · the German version is authoritative · Diese Seite auf Deutsch
Headache: which kind is dangerous, which just hurts, and what the diary reveals
Almost everyone gets headaches, and almost never is there anything dangerous behind them. The few exceptions are recognised by certain signs, not by intensity. Here you will find those signs, the four common kinds of headache to recognise, a diary for the four weeks before your appointment, and what painkillers really achieve, in numbers.
The essentials in three sentences
- A headache that is there within a minute like a blow, or one with weakness, difficulty speaking, or a stiff neck and fever, is an emergency. All others almost never.
- Painkillers on at most ten days a month. Beyond that they cause headaches themselves.
- Four weeks of diary say more than any conversation. Fill it in, print it, bring it with you.
1
Signpost: when it is urgent
Sixteen signs, four levels. Tick whatever applies and the page tells you how urgent it is.
Tick whatever applies. If nothing applies, leave everything blank.
No warning sign
Then it is most likely one of the common headaches described below. Unpleasant, but not dangerous. Get in touch if a warning sign appears.
Your ticks are neither stored nor sent anywhere. This list does not apply to children: with a new, severe headache in a child, please come to the practice.
2
Four pictures: which headache is it?
The four common kinds, how to recognise them, how long they last and what helps in each case.
Two out of three people know it. The most common headache of all.
How to recognise it
- Both sides, like a band or a helmet, pressing, not throbbing
- Mild to moderate: unpleasant, but daily life goes on
- No nausea, at most sensitivity to light or noise, not both
- Movement does not make it worse, often even better
How long
Half an hour to several days.
What helps
Exercise in the fresh air, peppermint oil on the temples, warmth on the neck, relaxation. Painkillers work, but modestly: ibuprofen 400 mg makes about 7 out of 100 additionally pain-free. On more than two days a week it belongs at the practice, before the tablets become the problem.
3
Your headache diary
Four weeks before your appointment. One entry per headache day. The page counts headache days, painkiller days and migraine days and tells you when the pattern belongs at the practice. For printing.
0
Headache days
0
of which with painkiller
0
of which migraine-like
In the last 28 days. Painkillers on at most ten days: 10 of 10 still free.
Your entries stay on this device. They are not sent anywhere, and nobody but you sees them. If you clear your browser history, they are gone: print the diary before your appointment. You do not need to enter days without headache.
4
Painkillers: what they achieve, how to take them
Pain-free after two hours, out of 100 people, from the Cochrane reviews. Plus dosing as per the package leaflet and the rule that protects against medication-overuse headache.
Ibuprofen 400 mg
Migraine
26 out of 100 pain-free after two hours, 12 even without the active ingredient. Gain: 14.
Rabbie 2013, Cochrane
Paracetamol 1000 mg
Migraine
19 out of 100 pain-free after two hours, 10 even without the active ingredient. Gain: 9.
Derry 2013, Cochrane
Sumatriptan 50 mg
Migraine
16 out of 100 additionally pain-free after two hours.
Derry 2012, Cochrane (NNT 6)
Ibuprofen 400 mg
Tension-type headache
7 out of 100 additionally pain-free after two hours.
Derry 2015, Cochrane (NNT 14)
Paracetamol 1000 mg
Tension-type headache
5 out of 100 additionally pain-free after two hours.
Stephens 2016, Cochrane (NNT 22); 500 mg no better than placebo
What the dots mean
Light green: would be pain-free even without the active ingredient. Dark green: gain from the medicine. Grey: still in pain after two hours. Relief, meaning "clearly better", is reached by more: with ibuprofen 57 instead of 25 out of 100. No medicine helps everyone, and taken early every one helps better.
The ten-day rule
Painkillers for headache on at most ten days a month, and no more than three days in a row. That applies to all of them: ibuprofen, paracetamol, aspirin, triptans, combinations. Anyone who needs them more often does not need more tablets but prevention. The diary counts the days for you.
As per the package leaflet
Ibuprofen 400 mg
One tablet, if needed again after six hours at the earliest, at most three a day. Without medical advice no longer than four days. From 12 years.
With some food. Not with a stomach ulcer, severe kidney weakness, in the last third of pregnancy or together with blood thinners without consulting a doctor.
Paracetamol 500 mg
One to two tablets, at least six hours apart, at most eight tablets a day. Without medical advice no longer than three days.
For headache only 1000 mg works; 500 mg is no better than placebo. Not more than stated: the liver does not forgive overdoses. Caution with liver disease and regular alcohol.
Acetylsalicylic acid (aspirin) 500 mg
One tablet, if needed a second after four hours at the earliest, at most two tablets a day. Without medical advice no longer than three to four days. Not for children and young people under 12.
Faster as an effervescent tablet. Not with a stomach ulcer, blood thinners, asthma with painkiller intolerance or before operations.
Sumatriptan 50 mg or naratriptan 2.5 mg (over the counter in Germany)
Only if migraine has been diagnosed by a doctor. One tablet at the start of the headache, not during the aura. A second after two hours at the earliest (sumatriptan) or four hours (naratriptan), at most two a day.
Not after a heart attack, stroke, with angina, untreated high blood pressure or circulation disorders. Taken early, it works much better. With more than three attacks a month, discuss prevention.
Adult dosing according to the package leaflets of over-the-counter packs in Germany. The leaflet in your hand takes precedence; with pre-existing conditions or other medicines, ask at the pharmacy or at the practice first.
5
What you can do yourself, and when to prevent
Ordered by strength of evidence. The most effective thing costs nothing and is not a tablet.
Endurance exercise, three times 40 minutes a week
Well establishedIn migraine this reduces attacks as much as a preventive medicine: in one study about one attack less a month, exactly like topiramate and like relaxation training. Cycling, brisk walking, swimming.
Varkey 2011
Learn to relax
Well establishedProgressive muscle relaxation after Jacobson or biofeedback, ten to 15 minutes a day. Courses are mostly paid for by German health insurers; there are also digital health applications (DiGA, "apps on prescription") against migraine that we can prescribe. Works for tension-type headache and migraine.
Nestoriuc 2008
Regularity
Some studies, small effectThe migraine brain dislikes deviation: fixed sleep times even at the weekend, no skipped meals, the same amount of caffeine every day or none at all. The weekend headache is often a lie-in plus coffee too late.
Note triggers, do not hunt them
Some studies, small effectChocolate, cheese, red wine: what looks like a trigger is often already the warning sign of the attack (cravings). A diary shows real patterns; a list of banned foods only makes life smaller.
Drinking
Few, small studiesOne and a half litres more a day brought slightly fewer headache hours in a small study. Costs nothing, does no harm, no miracle cure.
Spigt 2012
Neck and screen
Few, small studiesFor tension-type headache: screen at eye level, stand up every hour, roll your shoulders, warmth on the neck. Physiotherapy for a tense neck helps some people.
Cold or warmth
Few, small studiesFor migraine a cold pack on the forehead or neck, for tension-type headache warmth. Small studies, many satisfied users.
When to prevent, and how
When: From three attacks or four migraine days a month, if the acute medicines work poorly or are not tolerated, or if the ten-day rule can no longer be kept.
Without tablets: Endurance exercise, relaxation and acupuncture work as well as tablets in studies, with fewer side effects. They need three months before you notice.
With tablets: There are medicines that roughly halve the number of migraine days: older, inexpensive ones from blood pressure and epilepsy treatment, and since 2018 antibodies against the migraine messenger CGRP, as an injection every four weeks; these are prescribed by neurology when other things have failed. Which one suits depends on you: weight, blood pressure, sleep, wish for children. That is a conversation, not a prescription.
6
From other traditions, and from advertising
Further reading. Each item says how well it is supported by Western studies.
Acupuncture
China
In migraine, the number of attacks halved in 41 out of 100 compared with 17 without treatment; against sham acupuncture the lead was small (50 against 41). In tension-type headache 48 against 19. At least as good as tablets for prevention, but for headache not covered by German statutory health insurance.
Peppermint oil on the temples
Europe
Ten per cent solution, applied generously to temples and forehead. For tension-type headache similarly effective in studies as paracetamol 1000 mg. Not in the eyes, not for small children.
Caffeine
Everywhere
As an addition to a painkiller it strengthens the effect: the combination of aspirin, paracetamol and caffeine is well established. As a daily habit, withdrawal causes headaches. Both are true.
Magnesium
Supplements
600 mg a day for migraine prevention: small studies, small effect, soft stools. Harmless; anyone who wants to try gives it three months.
Ginger
Asia
In one small study for migraine as effective as sumatriptan, in others not. It helps against the nausea; harmless as tea or capsule.
Butterbur
Europe
Works in studies for migraine prevention, but extracts have caused liver damage. In Germany the licence has lapsed. Do not order it from the internet.
Yoga
India
As an addition to the usual treatment, fewer attacks in small studies. If it does you good, there is no reason against it.
7
Quick check: what will you take away?
Five questions for anyone who likes. No marks.
1. Which headache belongs with the emergency services immediately?
2. On how many days a month may you take painkillers for headache?
3. Which paracetamol dose works for headache?
4. When is the best time to take the medicine for migraine?
5. What reduces the number of migraine attacks as much as a preventive medicine?
No marks, no time pressure. Your progress is kept on this device only.
What this page cannot do
It is for adults. It makes no diagnosis: the signpost sorts by urgency, the four pictures help you recognise a pattern, the diary counts. What your headache is, we clarify together. Take medicines according to the package leaflet in your hand, not according to this page. The numbers "out of 100" are averages from studies; for you personally they are a direction. This page is a translation of the German original, which is the medically reviewed version; where the two differ, the German text applies.
Version 1.0 · Translation of the German page, medically reviewed on 8 October 2026 · the German version is authoritative
Reviewed by Stefan Höhne, Facharzt für Allgemeinmedizin. Numbers, doses and emergency numbers are identical to the German version and checked automatically. If anything is unclear, the German text applies.
Sources: Rabbie et al., Cochrane 2013 (ibuprofen for migraine); Derry et al., Cochrane 2012 (oral sumatriptan) and 2013 (paracetamol for migraine); Derry et al., Cochrane 2015 (ibuprofen for tension-type headache); Stephens et al., Cochrane 2016 (paracetamol for tension-type headache); Linde et al., Cochrane 2016 (acupuncture, two reviews); Varkey et al., Cephalalgia 2011 (exercise as prevention); International Classification of Headache Disorders ICHD-3; guidelines of the German Migraine and Headache Society. Medically responsible: Stefan Höhne, specialist in general practice (Facharzt für Allgemeinmedizin). This page is independent: no sponsor, no advertising, no brand names. All patient information (German)