A headache concentrated at the very top of your head—the crown or vertex—can feel strange and sometimes alarming. Unlike the typical band-like pressure of a tension headache or the one-sided throb of a migraine, vertex headaches feel localized to a specific spot at the peak of your skull. If you’re experiencing this type of pain, you’re likely wondering what’s causing it and whether it’s something to worry about.
The good news is that most headaches at the top of the head are benign and stem from common causes like tension, posture problems, or external compression. Vertex headaches account for a small but notable portion of headache presentations, and while several conditions can cause pain in this location, effective treatments exist for most of them [1].
Track your vertex headaches
Because top-of-head headaches can have multiple causes, tracking your symptoms helps identify patterns. Our headache diary lets you log location, intensity, triggers, and what provides relief. Over time, this information can reveal whether your headaches relate to stress, sleep position, physical factors, or something else. Of course, persistent or severe symptoms should be discussed with a healthcare provider.
What causes headaches at the top of the head?
The vertex, or crown of the head, can be affected by several different headache types and conditions. Understanding the most common causes helps you identify what might be triggering your pain.
Tension-type headache
Tension headaches are by far the most common cause of top-of-head pain. While tension headaches classically feel like a band around the entire head, many people feel them most intensely at the vertex.
Characteristics:
- Pressing or tightening quality (not throbbing)
- Mild to moderate intensity
- Bilateral (affects both sides)
- No nausea or significant sensitivity to light/sound
- May worsen with stress, poor posture, or fatigue
The muscles at the top of the head (part of the epicranial muscles) can become tense from stress, clenching, or sustained postures like looking down at a phone or computer [2].
External compression headache
This straightforward cause is often overlooked. When something presses on your head, it can cause localized pain exactly where the pressure occurs.
Common culprits:
- Tight hats, caps, or beanies
- Helmets (cycling, motorcycle, construction)
- Headbands or hair accessories
- Tight ponytails or buns (sometimes called “ponytail headache”)
- Headphones or VR headsets worn for extended periods
- Swim goggles or diving masks
The International Headache Society recognizes external compression headache as a distinct diagnosis [3]. The good news: relief comes quickly once you remove the offending item.
Primary stabbing headache (ice pick headache)
These brief, intense stabs of pain can occur anywhere on the head—including the vertex. The pain lasts only 1-3 seconds but can be quite sharp and alarming.
Characteristics:
- Sudden, stabbing or jabbing pain
- Lasts a fraction of a second to 3 seconds
- May occur singly or in short series
- No accompanying symptoms
- Often occurs randomly without obvious triggers
Primary stabbing headaches are benign, though their sudden intensity can be frightening. They’re more common in people who also have migraines [4].
Cervicogenic headache
Problems in the upper neck (cervical spine) can refer pain to various parts of the head, including the vertex. The neck contains nerves that converge with head pain pathways in the brainstem.
Characteristics:
- Often starts in neck and radiates upward
- May worsen with neck movement or sustained postures
- Often one-sided
- Reduced neck mobility
- Tender points in neck muscles
Poor posture—especially forward head position from desk work or phone use—frequently contributes to cervicogenic headaches that affect the top of head [5].
Occipital neuralgia
Though primarily causing pain at the back of the head, occipital neuralgia can sometimes radiate to the top of the head. This condition involves irritation of the occipital nerves.
Characteristics:
- Sharp, shooting, or electric-shock-like pain
- Often starts at base of skull, may radiate upward
- Scalp may feel tender to touch
- Can be triggered by neck movement
Migraine
While migraines more commonly affect the temples, forehead, or behind the eyes, they can occasionally present with vertex pain, especially in children and adolescents.
Sleep-related causes
How you sleep can affect your head:
- Pillow problems: Inadequate neck support can cause muscle tension
- Sleep position: Pressure on one part of the head all night
- Sleep deprivation: A known headache trigger
What does a headache at the top of head feel like?
The sensation can vary depending on the cause:
| Cause | Sensation | Duration |
|---|---|---|
| Tension headache | Pressing, tightening, dull ache | 30 min to hours/days |
| External compression | Localized pressure, aching | While compression present |
| Primary stabbing | Sharp, jabbing, “ice pick” | 1-3 seconds |
| Cervicogenic | Aching, may spread from neck | Variable |
| Occipital neuralgia | Shooting, electric, burning | Seconds to minutes |
How can I find relief from top-of-head headaches?
Treatment depends on the underlying cause, but several strategies help with most vertex headaches.
For tension-related causes
- OTC pain relievers: Acetaminophen, ibuprofen, or aspirin
- Heat or massage: Apply warmth to neck and shoulders; gently massage scalp and neck muscles
- Stress management: Relaxation techniques, deep breathing, breaks from work
- Posture correction: Keep head aligned over shoulders; adjust workstation ergonomics
- Stretching: Gentle neck stretches throughout the day
For external compression
- Remove the cause: Take off the hat, loosen the ponytail, adjust the helmet
- Prevention: Choose properly fitted headwear; take breaks from helmets/headphones
For cervicogenic causes
- Physical therapy: Exercises to strengthen and stretch neck muscles
- Posture improvement: Especially reducing forward head position
- Ergonomic adjustments: Monitor at eye level, proper chair height
- Heat therapy: Warm compress on neck
For primary stabbing headaches
- Reassurance: These brief pains are benign
- Indomethacin: Prescription NSAID that may help if episodes are frequent
- Most cases: No treatment needed; episodes are so brief they’re over before treatment could work
When should I see a doctor about top-of-head headaches?
Most vertex headaches are harmless, but see a healthcare provider if:
- Headaches are new and you’ve never experienced this type before
- Pain is severe or progressively worsening
- Headaches are occurring frequently (more than twice a week)
- You notice scalp tenderness, lumps, or visible changes
- Pain is accompanied by other symptoms (vision changes, weakness, confusion)
- Over-the-counter treatments aren’t helping
- The headaches are affecting your quality of life
Seek immediate care if:
- Sudden, severe “thunderclap” headache at top of head
- Headache with fever, stiff neck, or rash
- Headache after head injury
- Accompanying neurological symptoms
Understanding your vertex headaches
A headache at the top of your head, while sometimes unusual-feeling, is most often caused by tension, external pressure, or referred pain from the neck. By paying attention to patterns—when headaches occur, what might trigger them, and what helps—you can usually identify the cause and find effective relief.
Start with the basics: check your stress levels, evaluate anything that might be pressing on your head, consider your posture and sleep setup, and try simple remedies like OTC pain relievers or heat. If these approaches don’t help, or if your headaches are concerning, a healthcare provider can help identify the cause and recommend appropriate treatment.
The top of your head isn’t a common headache location—but when pain strikes there, understanding why empowers you to respond effectively.