External Compression Headache: Overview and More

External compression headache, often referred to simply as compression headache, arises due to pressure placed on the temples and scalp. Helmets, hats, personal protective equipment (PPE), and goggles that are too tight are common causes of this headache. Generally, the pain resolves after what’s causing it is removed from your head. Pain medications will also help, if needed.

This article covers the basics of external compression headache, including its causes and how it’s managed.      

External Compression Headache Symptoms

Naturally, head pain is the primary sign of external compression headache. To be an external compression headache, though, you must experience at least two episodes of pain within an hour of sustained pressure on the head and the pain must resolve within an hour after the pressure is relieved.

The pain is described as:

• Moderate in intensity
• Constant and consistent when the source of compression is worn
• Not disruptive to normal activities  
• Focused on areas of direct pressure
• Worsening the longer the cause of compression is worn
• Relieved shortly after the pressure is removed

External compression can also lead to attacks of primary headache disorders, including migraine and tension headaches. Knowing what’s setting them off and working to avoid these triggers is an important means of managing these conditions. In addition to an often one-sided, severe, and pulsing headache, migraines also cause a range of symptoms, including:

• Nausea and vomiting
• Fatigue
• Light and sound sensitivity
• Restlessness
• Visual disturbances (auras)

Causes

Primarily, external compression headaches arise due to pressure placed on the scalp, forehead, and face by wearing helmets, goggles, PPE, and anything else that requires a strap. While the exact mechanisms for this issue aren’t known, the pain can result due to:

• Insufficient oxygen in parts of the brain and head (hypoxia) due to compression
• Excess carbon dioxide in the blood (hypercapnia)
• Pressure on the trigeminal nerve, associated with touch, pain, and temperature sensation in the face
• Pressure on the occipital nerve, which runs from the neck to the scalp

The pressure at the root of these headaches is localized on the scalp and forehead. This can be caused by wearing:

• Motorcycle, bicycle, or military helmets
• Personal protective equipment, such as N95 masks and goggles
• Swimming goggles
• Hats that are too small
• Hardhats
• Tight headbands

The longer you wear something on your head, the greater your chances of bringing on pain. This is why external compression headaches are common in military personnel, construction workers, football and hockey players, and police officers. Additionally, biological women and those who experience migraines are at higher risk of developing these.

Diagnosing External Compression Headaches

Because external compression headaches usually resolve on their own and typically don’t require medical intervention, the focus of diagnosis is to rule out other kinds of headaches or health issues.

When seeing a healthcare provider, you'll be asked about:

• The location and intensity of the headache
• The character of your headache: pounding, pulsating, throbbing, burning sharp, or dull
• What, if anything, you think is causing the symptoms
• Whether you’re experiencing signs of other types of headaches, such as nausea, light sensitivity, and visual disturbances
• Your medical history and status, including any past or current conditions
• Lifestyle factors, such as drinking alcohol, using caffeine, or smoking
• Any medications you’re currently taking

In cases of secondary headache—those arising due to other conditions—additional testing may be needed. This may involve:

• Blood and urine tests to screen for infection, thyroid problems, dehydration, and/or diabetes
• Spinal tap to test for infection of the membranes surrounding the brain and spine (meningitis and encephalitis)
• Electroencephalogram (EEG), magnetic resonance imaging (MRI), or computerized tomography (CT) scan if underlying physiological causes or stroke is suspected

Treatment

Medical help typically isn’t needed, but over-the-counter (OTC) pain medications may be recommended to help with symptoms. These may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin or Advil (ibuprofen) or Aleve (naproxen)
• Tylenol (acetaminophen)

If the external compression headache leads to migraine attacks, your provider may prescribe triptans (such as sumatriptan, zolmitriptan, and rizatriptan) or ergot alkaloids (dihydroergotamine, ergotamine, and others).

When to Seek Medical Attention

While most headaches aren’t a sign of anything serious, they can be signs of significant problems. Get emergency help if you experience any of the following:

• Loss of consciousness after head impact
• A headache that starts very quickly
• Very severe, “thunderclap” headache
• Head pain remains and gets worse over a 24-hour period

It’s also important to call your call provider if, along with headache, you experience:

• Movement and limb coordination problems
• Fever and stiff neck
• Loss of balance
• Slurred speech and memory problems
• Pain and redness behind an eye
• Problems chewing and/or swallowing

Summary

External compression headaches arise due to pressure placed on the scalp and forehead. It’s a cause for concern if you wear helmets, hardhats, goggles, personal protective equipment, and anything else that compresses your head. Typically, the pain resolves within an hour of the pressure being removed.

Pain from an external compression headache is generally mild, dull, and concentrated in areas of increased pressure. External compression headaches can also trigger migraines, which cause more severe pain and other symptoms, such as nausea, vomiting, and light or sound sensitivity.

In most cases, external compression headaches resolve on their own, and medical treatment is rarely needed. However, OTC pain medications, such as Advil/Motrin (ibuprofen) or Aleve (naproxen) may help. If migraines arise, triptans and ergot alkaloid drugs may be prescribed. Get help if you experience severe symptoms, or are experiencing motor and neurological symptoms.      

A Word From Verywell

If you spend long hours wearing PPE, a helmet, hardhat, goggles, or anything else that puts pressure on your head, it’s important to be aware of how your head feels. While this type of headache isn’t dangerous, it can be very debilitating. This is why it’s important that what you wear or strap onto your head fits properly. Be sure to treat headaches promptly, too, and know when to seek help.