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Is it normal to have a headache with shingles?

It is common for people with shingles to experience headache along with the classic shingles rash. Shingles is an infection caused by the varicella zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant in the body. Years later, it can reactivate as shingles. When active, the virus causes a painful rash and blisters on one side of the body.

Headache is one of the many possible symptoms of shingles. Up to 70% of people with shingles experience headache before or during the infection. The headache associated with shingles tends to be moderate to severe. It may occur on just one side of the head or both sides.

Some key facts about headaches and shingles:

  • Headache often precedes the shingles rash by days or weeks.
  • The headache usually occurs on the same side as the shingles rash.
  • It typically feels like a migraine or tension-type headache.
  • Pain medications may help relieve shingles headache.
  • Treating the shingles infection often resolves the headache.

Below we will explore the link between shingles and headache in more detail. We will look at what causes these headaches, where the pain is located, and how to find relief.

What causes headache with shingles?

Shingles headache is thought to arise from inflammation of cranial nerves and tissues near the shingles rash. The varicella zoster virus directly invades and inflames sensory nerves. This nerve inflammation is what triggers the pain of shingles.

When shingles affects the head, neck or face, the infected sensory nerves are located in the trigeminal nerve network. The trigeminal nerve supplies sensation to facial areas. Trigeminal nerve inflammation is likely what underlies headache in many cases of shingles.

Some researchers believe that in certain cases, headache may also result from the body’s immune response to the virus. Brain inflammation may play a role.

In rare cases, shingles can cause meningitis or encephalitis (brain inflammation and infection). These severe complications can lead to severe headache along with fever, neck pain and altered mental status.

Shingles headache location

As mentioned above, shingles headache often occurs on just one side of the head. The pain is usually located on the same side as the shingles rash.

For example, if shingles affects the left side of the forehead and eye, the accompanying headache will typically be felt only on the left side of the head.

This one-sided nature occurs because shingles infects a single sensory nerve network located on one area of the body or face. The virus does not cross over to the other side.

Less commonly, the headache of shingles may be felt bilaterally or all over the head. Even in these cases, the pain is often worse on the side affected by the shingles rash.

Shingles headache symptoms

Shingles can cause several types of headache pain:

Throbbing pain

Many people describe shingles headache as a throbbing, pulsating pain. This may resemble a migraine headache. Throbbing pain tends to be more severe. It may feel like pounding or stabbing.

Dull, aching pain

In some cases, shingles headache feels like a constant dull ache. This may resemble a tension-type headache. While not as intense as throbbing pain, an aching headache can also be quite uncomfortable.

Sensitivity to light or noise

Up to 50% of people with shingles headache experience sensitivity to light (photophobia) or sound (phonophobia). Exposure to light and noise intensifies the head pain. This light and sound sensitivity is also common with migraines.

Nerve pain

Some individuals describe nerve-related pain with shingles headache. This includes burning, tingling or shooting pains. It may feel like electric zaps or stabs in the area of the rash.

Stiff neck

Stiffness and pain in the neck muscles sometimes occurs with shingles headache. This is more common if the rash affects the neck or base of the scalp. Inflamed nerves in these areas can cause neck spasms and reduced range of motion.

How long does shingles headache last?

The duration of headache symptoms varies from person to person:

– Some people only have headache in the prodromal stage before the shingles rash breaks out.

– Others continue to experience headache after the rash appears, until the blisters crust over and heal.

– A few unlucky patients deal with lingering headaches for months or longer following a shingles outbreak. This may be postherpetic neuralgia (chronic nerve pain).

On average, significant headache symptoms last around 1 to 3 weeks for most shingles patients. But every case is unique. Be sure to follow up with your doctor if headaches persist beyond one month.

Treatment for shingles headache

The main shingles treatments capable of relieving headache include:

Antiviral medication

Powerful antiviral drugs like valacyclovir (Valtrex) and acyclovir (Zovirax) fight the varicella zoster virus. By bringing the infection under control, antivirals help calm the inflammation and nerve pain causing headache. These medications are most effective when started within 72 hours of rash onset.

Pain control medications

Over-the-counter pain relievers may offer some relief from headache. Options include acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be careful not to exceed maximum daily doses.

For more severe headache pain, prescription medications may be prescribed. These include stronger NSAID pills, migraine medications, nerve pain drugs (anticonvulsants, tricyclic antidepressants), and even opioids in some cases.

Steroid injections

Corticosteroid injections around the shingles rash can ease local nerve inflammation. This often provides substantial headache relief. However, the benefits tend to be temporary.

Numbing patches

Over-the-counter medicated numbing patches containing lidocaine may temporarily relieve shingles pain. This includes many headaches, though not all respond.

Antiviral creams

Topical antiviral creams like acyclovir and penciclovir may help accelerate rash healing and reduce inflammation when applied directly to the blisters. This may indirectly improve headaches.

Rest and stress reduction

Getting adequate rest and avoiding stressors can help minimize headache pain during shingles. Relaxation techniques like meditation, yoga, or deep breathing may also lessen headache intensity.

Home remedies for shingles headache

A number of home remedies may supplement medical treatment for shingles headaches:

– Cold compresses – Applying ice packs or cool cloths to painful areas can temporarily numb nerve pain.

– Warm compresses – Some find relief by using heated pads or towels on the affected area several times per day. Avoid direct contact with skin to prevent burns.

– Oatmeal baths – Adding colloidal oatmeal to bathwater may soothe irritated skin and reduce inflammation.

– Wet wrap therapy – Wrapping a wet and dry cloth around painful areas pulls heat away from skin and nerves.

– Distraction techniques – Activities like reading, watching television, listening to music or talking to a friend can help take the mind off headaches.

– Turmeric – There is some evidence the spice turmeric has anti-inflammatory effects that may help calm shingles pain.

– Vitamin supplements – Some patients anecdotally report benefits from supplements like vitamin B12, magnesium or lysine. But clinical evidence is lacking.

Can headache be the only symptom of shingles?

For most people, headache caused by shingles is accompanied by the telltale shingles rash and blisters. However, in rare cases, headache may be the predominant or only symptom of the infection.

This atypical presentation most often affects the trigeminal nerve network inside the head. When the virus invades these interior nerves, it can trigger isolated facial pain and headache prior to any visible rash.

Headache without rash may also occur with:

– Very mild shingles cases
– Shingles inside the ear canal
– Eye involvement without external rash
– Complications like meningitis

Keep shingles in mind as a potential cause if you develop a persistent or worsening headache. Consult a doctor right away, especially if the headache is accompanied by fever, nausea or neck stiffness. Prompt treatment provides the best chance of relief.

When to seek emergency care for headache

Most headaches related to shingles will resolve with standard treatment within a few weeks. But in rare cases, a severe headache may indicate a medical emergency requiring urgent care.

Seek emergency help if you experience headache along with:

  • Sudden severe headache
  • Confusion, memory loss or inability to concentrate
  • Vision problems like double vision or loss of vision
  • Trouble speaking
  • Seizures
  • Numbness or weakness
  • Neck stiffness and pain when moving the neck
  • Nausea, vomiting, and sensitivity to light and sound

These may be signs of dangerous complications like stroke, meningitis, encephalitis or hemorrhage. Left untreated, the consequences can be severe. Urgent medical intervention is needed.

How common is headache with shingles?

Multiple studies have looked at how often shingles patients experience headache:

  • One study found that 66% of shingles patients developed headache.
  • Another study reported a headache rate of 46% among shingles patients.
  • A study specifically examining trigeminal nerve shingles found headache in 37% of patients.
  • Some research suggests that up to 70-75% of all shingles patients will have headache at some point during the illness.

In summary, it is very common to have headache along with shingles. Anywhere from around 40 to 70% of shingles cases involve headache based on studies to date.

Shingles headache statistics

Some key statistics on shingles headache prevalence:

  • Up to 70-75% of shingles patients experience headache
  • 46-66% of shingles patients have headache in studies
  • Trigeminal nerve shingles leads to headache in about 37% of cases
  • 50% of shingles patients have light/noise sensitivity with their headaches
  • Shingles headache lasts 1-3 weeks on average

So in summary, shingles headache is very common, occurring in about half to three-quarters of patients based on available research.

Risk factors for developing headache with shingles

Certain factors appear to increase the risk of headache from shingles:

  • Age over 50 years – Shingles risk rises with age, as does risk of headaches.
  • Location on head or neck – Trigeminal nerve involvement especially prone to cause headaches.
  • Severe rash – More widespread rashes increase risk and severity of headaches.
  • Prior headache history – Pre-existing migraine or headache disorder makes headaches more likely.
  • Immunocompromised state – Weak immune system increases risk of complicated shingles.

The biggest risk factor is having shingles located on the head or neck regions. This allows the virus to directly infect sensory nerves that supply the face and scalp. Ophthalmic shingles and trigeminal nerve involvement have the strongest ties to headache.

Can you have shingles without other symptoms?

It is unusual to have shingles that causes only headache or pain, without any rash or blisters forming. Some other accompanying symptoms are expected in most cases. However, the symptoms may vary in severity.

Some people do develop atypical shingles with:

  • Very mild or limited rash
  • Rash inside the ear canal or eye
  • Severe pain but few blisters
  • Pain preceding rash by days or weeks

So while uncommon, it is possible for headache to be one of the main symptoms of shingles, especially in the early stages before the rash becomes visible.

Shingles without rash symptoms

As noted above, some shingles cases may present with significant pain but very mild or even no rash, especially at first. Possible symptoms of shingles without obvious rash include:

  • Headache (often one-sided)
  • Face pain
  • Neck pain
  • Tingling or burning skin
  • Itching
  • Eye pain
  • Ear pain
  • Tooth pain
  • Dizziness
  • Fatigue
  • Photophobia

Shingles should be considered as a potential cause if you develop pain or headache in a localized facial region even without a rash being present yet. Seek medical evaluation for proper testing and diagnosis.


In conclusion, headache is a very common symptom of shingles, affecting a large proportion of patients. The headache tends to occur on the same side as the shingles rash and may resemble migraine pain or a tension headache.

While uncomfortable, shingles headaches usually resolve once the rash and infection clear. But prompt antiviral treatment and pain management provide the fastest relief. Seek emergency care if you develop an unusually severe headache or other neurological symptoms that could signal complications.

Let your provider know if you experience any headaches developing along with shingles, as this may help guide treatment decisions. With proper care, most shingles-related headaches can be managed effectively.