Pulsating Headache? Don’t Ignore It! Here’s What to Know.

Pulsating Headaches: Causes, Types, Symptoms, and Treatment

Headaches can be a nuisance, but pulsating headaches can be especially concerning. A pulsating headache is characterized by throbbing or pounding sensations in the head that may accompany other symptoms, such as light and sound sensitivity or nausea. Throbbing and pulsating headaches are an unwelcome experience, characterized by a rhythmic pulsating or pounding sensation that can affect the entire head or a specific area… such as pulsating on the right side of the head. Throbbing, pounding, or pulsating headaches are terms used interchangeably for the same sensations. Their intensity ranges from mild discomfort to severe pain.

Pulsating headaches can range from mild to severe. By far, the most common cause of a pulsating or throbbing headache is migraine. However, there are other causes of pulsations in the head to be aware of. Pulsating headaches originate from either a primary headache disorder, such as migraines (most commonly), or a secondary headache disorder caused by other medical conditions such as high blood pressure, caffeine withdrawal, giant cell arteritis (a disease that inflames blood vessels in the temples), or a brain aneurysm. Any of these can cause potential head pulsing, but there are certainly others too.

In less common cases, a throbbing severe headache might be a signal of a potentially life-threatening situation, including a stroke, which involves either a blocked blood vessel or bleeding in the brain, or a tear in the blood vessel of the neck (artery dissection).

Types Of Pulsating Headaches / Causes

Migraine is the most common cause of a pulsating headache most of the time. There aren’t a lot of other headache types that are well known for a pulsating quality such as migraine is. Throbbing headaches can be classified into primary and secondary headache disorders. Primary headache disorders are generally benign headache conditions, whereas secondary headaches are caused from another disease process, some of which require more urgent treatment and evaluation.

Primary Pulsating Headache Disorders

Migraines

If you have a throbbing, pulsating, or pounding headache, migraine is almost always going to be the most common cause. Migraines are headaches that can cause throbbing pain and often come with nausea and light and sound sensitivity. They often occur on only one side of the head. However, they can also occur on both sides, or alternate sides.

Migraines are the most common cause of throbbing, pounding, and pulsating pain. They can last anywhere from 4 hours (untreated or unsuccessfully treated) to several days at a time. They can happen a few times per year to a few per month (episodic migraine) to once daily (chronic migraine). These headaches classically affect one side of the head such as a pulsating headache on the right side. However, they can also be both sides or even pulsating in the back of the head (or front). They are often worsened by movement such as physical exertion. They can cause visual or sensory disturbances. Migraine attacks are associated with nausea and/or sensitivity to light and sound.

It is important to contrast migraine pain and tension-type headache pain, since they often get confused. Tension-type headaches are the most commonly experienced type of headache. They cause pain on both sides of the head and can be accompanied by neck tightness or tenderness (although migraine can do this too). The pain of tension type headache is described as an aching, tightness, dull, band-like, or pressure. If there is any pulsating, throbbing, or pounding, this puts it into the migraine category, and moves it out of the tension-type category. By International Headache Society criteria, tension type headache cannot have a pulsating, throbbing, or pounding character. So if you feel this, it is more likely migraine. Tension-type headaches typically last from 30 minutes to 7 days. 

Cluster Headaches

Cluster headaches are characterized by a sharp stabbing pain on one side of the head that occurs around the eye on one side only and facial pressure or flushing. An ice pick pain through the eye area is often described. Sometimes the pain is also described as having an associated pulsating, throbbing, or pounding component as well, so I figured I would mention it. However, it is most often severe stabbing, sharp, and very intense. They are associated with prominent autonomic features which can include redness and tearing of an eye, droopiness or puffiness of an eyelid, one sided nasal congestion or runny nose, forehead or facial sweating, a sense of restlessness or agitation, or smaller pupil on the side of the pain. Migraine can also cause some of these symptoms, but they tend to be more prominent in cluster attacks.

Cluster headaches last 15 minutes up to 3 hours at max, and can occur several times per week up to 8 times per day. They often occur around the same time every day or night (such as waking the person up at the same time every night). They occur in clusters of attacks (thus, the term “cluster headache”) over periods lasting days, weeks, or months. Then they just stop and may not occur for a long time afterwards. They tend to occur often during season changes and time changes. 

Secondary Headache Disorders (not a complete list, but some to be aware of)

Thunderclap Headaches

Thunderclap headaches are a rare but severe type characterized by sudden, intense, abrupt pain that reaches maximum severity within seconds to minutes. They are called “thunderclap” headaches because the pain is often described as a sudden, explosive thunderclap in the head. Sometimes it is described as an intense pulsating pounding pain. Patients often complain of it as the “worst headache of their life”. This type of headache requires emergent medical evaluation, especially the first time that it happens. Testing is necessary to exclude aneurysm rupture, bleeding (hemorrhagic) stroke, or some other concerning cause. 

Hypertension Headaches (Hypertensive Urgency or Hypertensive Emergency)

High blood pressure (hypertension) can be a cause of pulsating headaches for some patients, called hypertension headaches. Hypertension is defined as blood pressure 140/90 or greater. A clue can sometimes be the pulsating headache in sync with your heartbeat. Hypertensive urgency and hypertensive emergency are situations where the blood pressure increases to unsafe levels. When blood pressure becomes too high, it can cause a pulsations in the head. If blood pressure is too high, additional symptoms can occur besides the headache such as blurred vision, confusion, and stroke-like symptoms. Strokes, brain bleeds (hemorrhagic stroke), or aneurysm development and rupture can also occur if not treated urgently to bring the blood pressure down. It’s important to see your doctor because prolonged high blood pressure can lead to lots of other medical problems including stroke and heart attack.

Caffeine Withdrawal Headaches

Typically occurring on both sides of the head, these caffeine withdrawal headaches are associated with regular caffeine use, which is then abruptly stopped (such as missing your morning cup of coffee when running late for work). There is a chemical in the brain called adenosine. It normally causes blood vessels to dilate (widen), which can trigger a migraine and pulsating pain. It can also be a lower tension type of pain though. Caffeine blocks adenosine receptors, so it causes the blood vessels to constrict (narrow) back down. This is also how caffeine can help headache for some.

Hangover Headaches or Dehydration Headaches

These headaches are experienced on both sides of the head, especially around the forehead and temples, and are known to develop within 12 hours of alcohol consumption. They are often a migrainous type pulsating headache, but can also be a dull achy pressure. This type of headache is often associated with dehydration headache, because alcohol causes excess water loss from the body.

Giant Cell Arteritis (Temporal Arteritis)

Giant cell arteritis (GCA) is a type of vasculitis, characterized by blood vessel inflammation, which primarily affects large and medium-sized arteries in the head and neck. The throbbing and pulsating head pain associated with GCA is classically felt on one or both temples. There can be associated jaw claudication (cramping) during chewing, scalp tenderness, a thickened sore artery felt to the touch in the temple area, and visual disturbances such as blurring. It requires an urgent evaluation including ESR and CRP blood tests for inflammation, and treatment with steroids because it can lead to permanent vision loss if not treated.

Stroke, arterial dissection, or cerebral aneurysm

These are often associated with uncontrolled high blood pressure, are abrupt onset symptoms, and usually associated with other neurological symptoms such as numbness, tingling, vision loss, weakness on one side, double vision, confusion, unconsciousness, unsteady walking, or vertigo. Arterial dissection is a tear in the internal blood vessel wall and, occurs most often in the carotid artery or vertebral artery. These headache types require emergent evaluation and treatment to avoid permanent neurologic disability or death.

Common Causes / Triggers for Pulsating Headaches

• Stress and Anxiety: Stress is one of the most common triggers for pulsating headaches, particularly migraine. 
• Sleep Deprivation or Disruption / Lack of Sleep: Sleeping every night is essential for overall health and can also help reduce the frequency and severity of pulsatile headaches. Inadequate sleep is a common migraine trigger.
• Hormonal Changes in Women are a common trigger for pulsating migraines.
• Foods and food additives are common dietary migraine triggers.
• Weather/barometric changes are common migraine triggers.
• High blood pressure (hypertension)
• Dehydration: Dehydration can also lead to pulsating headaches called dehydration headaches. Dehydration is also one of the most common migraine triggers.

Evaluation and Testing for Pulsating Headaches

If you are experiencing frequent or severe pulsating headaches, it is essential to see your doctor to evaluate the cause and the best course of action. Your doctor should perform a physical exam and may order blood tests and imaging tests such as a CT scan or MRI of the brain, along with MRA or CTA to look at the brain arteries. The specific testing will depend on your symptoms, medical history, office interview, medical and neurological examinations. 

Medications Used to Treat Pulsating Headaches

Medications and treatments of pulsating headaches hinge on the specific diagnosis and headache type causing the pulsating sensation. 

For Primary Headaches:

• Mild migraine headaches can sometimes be relieved with NSAIDs like Advil, Motrin, Aleve, Excedrin, or Tylenol. More often, migraines will respond better to migraine abortives such as triptans, gepants, or DHE.
• Cluster headaches can be treated by inhaling oxygen or using a triptan like Sumatriptan injections or DHE injections or Sumatriptan, Zolmitriptan, or DHE nasal spray.

For Secondary Headaches:

• Hangover headaches generally resolve on their own within 72 hours, and symptomatic relief can be obtained through ibuprofen, rest, and adequate hydration.
• Caffeine withdrawal headaches resolve naturally, but it might take up to a week. In such cases, consuming a small amount of caffeine, roughly equivalent to a cup of coffee can provide relief within an hour.
• Giant cell arteritis is treated with high doses of corticosteroids, potent anti-inflammatory medications.
• High blood pressure pulsing headaches warrant lifestyle and diet changes, decreasing salt intake, and often anti-hypertensive medications. Untreated high blood pressure can also lead to stroke, heart attack, and kidney damage. So it is important to get it under control for general medical reasons beyond just headache.
• Stroke, cerebral aneurysm, and brain tumor causes of pulsating pain all require emergent evaluation and management.

Following your doctor’s instructions and taking medications as prescribed is essential, as this will help ensure the best possible outcome. Additionally, it is vital to keep a headache diary to track changes in symptoms and response to treatment. This can be helpful for both you and your doctor in determining the most effective treatment plan. If the pulsating headaches are frequent enough, headache preventive medications are often used.

Lifestyle Modifications

Lifestyle modifications are vital to managing pulsating headaches and are usually recommended by doctors alongside medications and other treatments. Lifestyle modifications can involve diet, exercise, sleep habits, and stress management changes.

Diet plays a key role in maintaining good health, as certain foods can trigger increased pulsating headaches which are of the migraine type. It is important to ensure you eat a well-balanced diet that includes plenty of fruits and vegetables, whole grains, and lean proteins. Avoiding processed foods and added sugars and salts can also help reduce the frequency of pulsatile headaches. Lifestyle adjustments are integral to migraine management, with the avoidance of triggers playing an important role.

Exercise is also an important component of managing pulsating headaches. Regular physical activity can help reduce stress, improve sleep quality, and boost overall health. An exercise routine has also been shown to significantly decrease migraine frequency. It is essential to consult with your doctor before starting any new exercise routine to ensure it is safe for you.

Finally, getting enough sleep every night is extremely important for overall health and can also help reduce the frequency and severity of pulsatile headaches. Aim for at least eight hours of sleep each night, and avoid electronic devices and other distractions before bed. Smoking cessation and curtailing heavy alcohol consumption are also commonly recommended (Alcohol is a common cluster headache trigger when in a cycle).

Alternative Therapies for Pulsating Headache

Alternative therapies, such as acupuncture and massage therapy, may also be recommended to help reduce the frequency and severity of pulsatile headaches. There is evidence that these therapies may be effective in reducing symptoms for those with headaches caused by tension or stress and for people who experience migraine-type headaches. There are many other home and natural treatments for migraine and headache as well. Speaking with your doctor before starting any alternative therapy is essential to ensure it is safe and appropriate. Additionally, it is important to note that alternative therapies are not a substitute for medical care and should always be used in conjunction with medications or other treatments prescribed by your doctor.

When to Seek Medical Attention?

The bottom line is that any headache, whether throbbing or not, needs to be discussed with your doctor so they can do a proper history, physical examination, and order the appropriate testing to evaluate the headache. You should never assume it’s “just a headache” or benign in nature. You should always get your headache checked out, no matter how mild it may seem. This is especially true if the headaches become more frequent or occur with high fever, vision changes, mental confusion, chest pain, numbness or weakness in the extremities, unsteadiness, or any neurological symptoms at all.

While most throbbing headaches are not typically a cause for concern, there are additional instances when seeking medical advice is crucial:

• If your headache pattern is changing and becoming more frequent.
• If you are pregnant, have recently given birth, or have a history of cancer, unexplained weight loss or a weakened immune system.
• If you’re 50 years or older and are experiencing a new headache problem, or a headache that feels different from your usual ones.
• If your headaches are triggered by activities like sneezing, coughing, sexual activity, exertion, or exercising. Or if they are triggered by certain positions such as lying down or standing up.
• If you’re dealing with rebound headaches from regular painkiller use.

Seeking Emergency Medical Attention

In difficult situations, where immediate action is required and important, do not hesitate to seek emergency medical attention:

• If you experience a sudden, severe headache that intensifies rapidly within seconds or minutes (thunderclap headache; worst headache of your life).
• If you have a headache accompanied by a fever, stiff neck, painful red eye, seizure, fainting, stroke-like symptoms, or any new neurologic symptoms at all.
• If you develop a headache following a head injury or concussion.

Summing It All Up

Pulsatile headaches are a type of headache that is characterized by a throbbing or pulsating sensation. Migraine is by far the most common cause of pulsating or throbbing headache. However, they may be triggered by certain health conditions, such as high blood pressure in some. Treating the underlying condition can help reduce the frequency and severity of pulsatile headaches. Additionally, lifestyle changes, abortive, and preventive medications may also help manage symptoms. It is essential to seek medical attention if you experience persistent pulsatile headaches that interfere with your daily activities or are accompanied by other symptoms such as nausea and vomiting or neurological symptoms. Ultimately, speaking with your doctor, or optimally, a headache specialist, about the best treatment plan for you is essential.