External Compression Headaches

External compression headache is an infrequently cited cranial neuralgia resulting from continued stimulation of the cutaneous nerves caused by the application of pressure over the forehead or scalp. The headache can result from wearing a tight band around the head, a tight hat, or sports goggles. They include a constant nonpulsating head pain felt in the area subjected to pressure that increases over minutes, is not associated with other symptoms, and often disappears within 1 hour after removing the causative stimulus.

If the causative stimulus is prolonged, external compression can lead to a more severe, migrainous headache or to a full-blown migraine attack in predisposed patients. This is a primary-type headache, not associated with organic cranial or intracranial disease, and thus does not require further investigation when the diagnostic criteria are fulfilled and the intermittent presentation is clear. The goal of this study was to evaluate headache in police officers subsequent to wearing helmets during ordinary patrolling assignments.

The mechanism causing external compression headache in some patients and not in others remains unknown. Although intimately related to the use of headgear for work or leisure, including hats, headsets, caps, goggles, and even surgical frontal lux devices, external compression headache may be misdiagnosed as tension-type headache or as transformed or chronic migraine in previously episodic migraineurs because of similarities in the clinical presentation of bilateral and/or diffuse location, pressure type, moderate-severity head pain, and a lack of associated features. However, our study demonstrated that the development of the headache was clearly associated with wearing a helmet, and headache remission was clearly associated with removing the helmet, although some patients experienced other types of primary headache in which the presentation and the disappearance were quite different.

To end your headache, remove the headwear that's causing the pressure. Further treatment is rarely needed. If you have a history of migraines, wearing tight headwear may trigger an attack that requires migraine medication for relief.