After a long day or a big night out, it’s not uncommon to get a headache. But if you’re wondering why your head feels heavy, there are a few factors to consider. In truth, there are a variety of reasons why your head feels heavy. “The first thing we need to identify is what you mean by ‘heavy’. They can be different things, including sensations like pain, fatigue, dizziness, confusion, and nasal congestion or pressure,” says Matthew Wright, PA-C, RD, certified physician assistant and primary care provider, and faculty member of Rutgers University School of Health Professions, Physician Assistant Program. “Then we would take a full history, asking about any other symptoms you may have.”
Other questions your provider may ask include: When did it start; if it has gotten worse since it started; what causes it; if something makes it better or worse; when it occurs; And how severe is the discomfort? “The answers help us narrow down the likelihood that it’s causing this sensation, which will help us determine if we need testing and imaging, as well as possible treatment plans,” says Wright.
These are the most common reasons why your head feels heavy.
“I hear this complaint often, and it’s often associated with allergic rhinitis,” says Devon Stutzman, DO, a family medicine physician with Cooper Care Alliance, Cooper University Health Care. “It is also described as pressure or tightness, and can be accompanied by many other symptoms.” These include sneezing, itchy eyes, watery eyes, and a runny or itchy nose (but no fever). Symptoms may return at the same time each year or may be constant throughout the year.
Allergies can be diagnosed through an office exam and patient history. “We try conservatively by offering a trial of a steroid nasal spray, especially if there is congestion, and an oral antihistamine such as fexofenadine, cetirizine, or loratadine,” says Dr. Stutzman. “I also suggest that people keep a journal about what they eat or have been around to see if they can uncover a potential link.” If you don’t get relief from these medications, you may be referred to an allergist for testing to identify specific allergens or allergy-causing substances.
upper respiratory tract infection
Many different viruses cause upper respiratory infections. Symptoms may include headache, throat pain, fever, cough and wheezing. “During the story, I will also ask you if you have tested for covid or have had contact with sick people,” says Dr. Stutzman.
If you have an upper respiratory infection, your provider will recommend supportive care to help you feel better, says Dr. Stutzman. That includes rest, saltwater gargles, oral lozenges, hot showers or baths to loosen mucus, and use of a neti pot to thin secretions.
If it’s COVID, you may be given an antiviral drug, but it’s mostly used in those most at risk, such as people over 65 or those who are immunocompromised. “The drug interacts with many medications and has many side effects, such as a metallic taste and diarrhea, so it’s not always prescribed for everyone,” says Dr. Stutzman.
If a cold suddenly gets better and then worse, you may have developed a sinus infection. Cold symptoms improve in about a week, but a sinus infection is suspected when symptoms last more than seven to 10 days. Signs include pain in the cheeks, eyebrows, and forehead, with sinus pressure that can worsen when you lean forward, says Wright.
Despite what you have read, the color of your mucus it is not very helpful in determining if it is actually a sinus infection. “We focused more on the duration of symptoms and facial pain,” says Wright. If you have a sinus infection, you will likely be given antibiotics such as amoxicillin or doxycycline. Over-the-counter medications like acetaminophen for pain, an antihistamine like fexofenadine for the drip, and plenty of fluids can help you feel less miserable.
Some medications can make you feel weird, including a feeling of heaviness in the head or lightheadedness, says Wright. If you’ve recently started taking a new medication (or supplement), talk to your health care provider about possible side effects and alternatives. Medications that can cause a feeling of heaviness in the head include antihistamines, muscle relaxants, antidepressants, and some anti-seizure medications, pain relievers, and beta-blockers.
If you’ve recently had a head trauma, such as being rear-ended in a car accident (even a minor one), hitting your head while participating in sports, or a fall, you may have a concussion, says Dr. Stutzman. . Signs may include headache, dizziness, memory loss, trouble concentrating, or nausea and vomiting. These symptoms may worsen in bright light or with physical or cognitive activity.
Your health care provider will examine you for signs of concussion, including checking that your pupils dilate normally on both sides and that their strength is similar on both sides.
You won’t need imaging, such as a CT scan, unless you’ve lost consciousness (in which case, you’re usually taken from the scene of the accident directly to the emergency room), says Dr. Stutzman.
Care includes physical rest for several days, reduction of work or school responsibilities to provide cognitive rest, and absence from sports or other strenuous activities for up to two weeks. You should gradually resume activities and reduce again if symptoms return with activity, says Dr. Stutzman.
With all those hours on the computer (or hunched over your phone), you may experience a feeling of heaviness or tightness in your upper back and neck due to muscle tension. This may also be accompanied by a tension headache, which is a crushing headache. Stress can also exacerbate the sensations.
Muscle pain can be identified in the office, and you may receive a prescription from physical therapy to learn stretches and strengthening exercises to relieve discomfort and prevent future episodes, Wright says. Hot baths or showers, a heating pad which increases blood flow to the area to reduce muscle spasms, and over-the-counter pain relievers can help.
If you have recurring muscle pain from sitting too long, get in the habit of frequently changing positions, such as using a standing desk, says Wright. Also, if your workplace has an occupational therapist, assess your workstation to see if ergonomic changes can be made.
Anxiety and depression
If your symptoms don’t match any of the above, your health care provider may screen you for mental health issues, Wright says. Depression and anxiety disorders can make you feel overwhelmed, fatigued, irritable, sad, or unable to enjoy activities that normally make you happy. Changes in eating and sleeping patterns are other common symptoms. Treatment options include therapy, medication, or a combination of both.
Other underlying problems
In rare cases, heaviness in the head can be a sign of a more serious condition, such as a brain tumor. “This is rare, and other neuromuscular symptoms are usually present as well, such as decreased strength on one side or pupils that don’t react normally,” says Dr. Stutzman. His healthcare provider will first evaluate him for other possible causes of head heaviness. Then, if your history warrants it, you may need imaging tests such as an MRI.
The bottom line is that any symptoms that persist or concern you should be checked out by your provider. “The Internet can be a great tool for investigation, but don’t jump to the worst case scenario. The feeling of heaviness in the head can be due to a wide range of causes,” says Wright. “If you’re worried, get evaluated.”
Arricca SanSone has written on health and lifestyle topics for Prevention, Country Living, Women’s Day and more. She is passionate about gardening, baking, reading, and spending time with the people and dogs she loves.