While enduring a splitting headache, a person would likely find it difficult to engage in their daily routine, whether that’s at home, work, or school.
This article will review the symptoms, causes, and treatment of a splitting headache. It will also discuss when your splitting headache may be a sign of something serious, warranting immediate medical attention.
Symptoms of a Splitting Headache
A splitting headache may be felt on both sides of the head or be localized to one area, like the temple, back of the head, or even the face. Depending on the cause of the splitting headache, it can be described in different ways—for example, throbbing, stabbing, piercing, or burning, among others.
Likewise, several unique symptoms may accompany a splitting headache. Examples of these symptoms include:
Nausea and/or vomitingSensitivity to light, sound, or smellFacial flushing and sweatingEye redness and tearingStuffy noseAgitation and restlessnessNeurological abnormalities, such as weakness or numbness on one side of the bodyFever and stiff neck
Causes of Splitting Headache
A splitting headache may be classified as either a primary or secondary headache.
Primary headache disorders that may cause splitting head pain include:
Migraine headaches usually occur on one side of the head, are often worsened by physical activity, and may be preceded by an aura (reversible visual, sensory, or speech disturbances). Migraine headaches are throbbing and range in severity from mild to severe. Cluster headaches are severe one-sided headaches, usually sharp or stabbing in nature. The pain is typically localized in or around the eye or temple. These headaches occur as attacks that last from 15 to 180 minutes, up to eight times a day.
There are multiple secondary causes for a splitting headache.
One worrisome cause is a potentially life-threatening condition called a subarachnoid hemorrhage. This is a type of brain bleed in which blood collects in the space between the brain and the skull.
A subarachnoid hemorrhage can cause a thunderclap headache. This is an explosive, extremely severe headache that begins suddenly. It rapidly peaks in intensity in seconds or within a minute. It’s sometimes referred to as the “worst headache of your life.”
Other serious conditions that can produce a thunderclap headache include:
Cervical artery dissection: Tear in the wall of either of two neck arteries, the carotid or vertebral artery Pituitary apoplexy: Bleeding into or loss of blood flow to the pituitary gland, which is located deep in the brain Stroke: When blood flow to the brain is interrupted Reversible cerebral vasoconstriction syndrome: Blood vessels in the brain suddenly narrow Spontaneous intracranial hypotension: Low spinal fluid pressure in the brain Cerebral venous thrombosis: Blood clot within a vein in the brain
Examples of other health conditions that may cause a splitting headache are:
Meningitis: This is inflammation of the tissues that protect and cover the brain and spinal cord. It may be accompanied by a fever, stiff neck, and sensitivity to light, among other symptoms. Trigeminal neuralgia: This rare condition develops from irritation or compression of the trigeminal nerve (your fifth cranial nerve). It causes severe piercing or stabbing pain on one side of the face. Giant cell arteritis (GCA): This is the most common form of vasculitis (blood vessel inflammation) that affects individuals over the age of 50. It causes a severe headache, typically located over the temples. Scalp tenderness, jaw claudication (pain when chewing), and vision loss may also be present.
How to Treat a Splitting Headache
The treatment of a splitting headache involves addressing the underlying cause. For example, obtaining relief from a splitting headache identified as a migraine usually requires some type of over-the-counter or prescription medication for relief.
The medications used for the acute treatment of migraines include:
A nonsteroidal anti-inflammatory drug (NSAID), like Advil (ibuprofen) or Aleve (naproxen) A triptan, like Imitrex (sumatriptan): These drugs work on serotonin (a brain chemical) docking sites in the brain to stop a migraine and are available in multiple formulations, including tablets, nasal sprays, and injections. A combination NSAID/triptan drug, like Treximet (sumatriptan/naproxen) Reyvow (lasmiditan): This drug targets serotonin but does not cause blood vessel narrowing (which triptans do). A calcitonin gene-related peptide (CGRP) inhibitor, such as Nurtec ODT (rimegepant) or Ubrelvy (ubrogepant)
Along with medication, a migraine headache may be soothed by resting in a dark, quiet room, and placing a cold pack or compress on the area of head pain.
Treatment of other causes of a splitting headache involve the following:
These include:
An oral (by mouth) prescription medication like certain anti-seizure drugs—for example, Topamax (topiramate)—or certain blood pressure drugs—for example, Inderal (propranolol) A CGRP inhibitor, like the monthly injection Aimovig (erenumab) or the infusion (through your vein) given every three months Vyepti (eptinezumab) Botulinum toxin injections (Botox), which blocks chemical signals that cause muscles to contract
Cluster headaches: Inhaling high-flow oxygen, Imitrex (sumatriptan) injection, and Zomig (zolmitriptan) nasal spray may be used as an acute treatment. Giant cell arteritis: High doses of corticosteroids (a strong anti-inflammatory medication) Trigeminal neuralgia: The anti-seizure medication Tegretol (carbamazepine) or Trileptal (oxcarbazepine)
Potentially life-threatening secondary headaches like a brain bleed or meningitis require hospital care, including close monitoring, intravenous (IV) medications, and/or surgery.
Complications Associated With a Splitting Headache
Depending on the underlying diagnosis, various complications may arise from a splitting headache.
For example, two rare complications associated with migraine include:
Migraine-triggered seizure: Uncontrolled brain electrical activity during a migraine with aura Migrainous infarction: One or more migraine aura symptoms associated with an ischemic stroke (when blood flow to the brain is interrupted)
Complications associated with an untreated dangerous “splitting headache,” like a thunderclap headache, include permanent neurological deficits (e.g., weakness or loss of sensation on one side of the body), seizure, or even death.
Are There Tests to Diagnose the Cause of a Splitting Headache?
The diagnosis of your splitting headache as a migraine usually requires a medical and family history and neurological exam.
Imaging or other diagnostic tests are not typically needed unless the neurological exam is abnormal and/or a cluster headache or secondary headache is suspected.
Some of these tests may include:
A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the brain A magnetic resonance angiography (MRA) of the brain (an MRI of the brain’s blood vessels) A lumbar puncture (spinal tap) Blood tests, like an erythrocyte sedimentation rate (sed rate, a marker of inflammation) to help diagnose GCA
When to See a Healthcare Provider
A splitting headache that is new or associated with worrisome symptoms warrants urgent or emergent medical investigation.
Be sure to see your healthcare provider in the following situations:
Your headaches are occurring more frequently or are interfering with your daily routine. You have a headache and a history of cancer or a weakened immune system (e. g. , human immunodeficiency virus (HIV). You have a new headache or a change in your headache pattern and are pregnant or postpartum. You are age 65 or over and are experiencing a new type of headache. Your headache is set off by sneezing, coughing, or exercising. You are experiencing rebound headaches from taking pain medication regularly.
Summary
There are many possible causes of a “splitting” or severe headache. A common cause is a migraine, which is a throbbing headache that is aggravated with movement. Less commonly, a splitting headache is indicative of a cluster headache, or a sign that something serious is going on in the body, such as a stroke or brain infection.
Is severe, begins suddenly, and/or is the “worst headache of your life"Is severe and accompanied by a painful red eye, high fever, stiff neck, fainting, or confusionIs accompanied by stroke symptoms, such as weakness, numbness, or vision changesOccurs after a head trauma
In order to get to the bottom of your splitting headache, your healthcare provider may order various diagnostic tests, like a scan of your brain. Treatment depends on the underlying diagnosis but often involves taking some sort of medication or (very rarely) undergoing a health intervention, like surgery.
A Word From Verywell
Teasing out the diagnosis or the “why” behind your splitting headaches can be tricky and require investigative work from both you and your healthcare provider. In the meantime, engaging in healthy lifestyle behaviors like setting a consistent sleep schedule, exercising regularly, and staying hydrated can go a long way in keeping your headaches at bay.
