Cocaine and Headaches: Why Your Head Pounds After

Most people who search for cocaine headaches are doing it at an unglamorous hour. It is Sunday afternoon, or Monday before work, and there is a dull band of pressure sitting behind the eyes and across the back of the head that two paracetamol have not touched. It is not the worst thing about the weekend, but it is the thing that will not let you forget the weekend.

I hear about this constantly and it almost never comes up first. Somebody will spend twenty minutes on money, or their partner, or work, and then near the end say — almost as an aside — that their head has been at them for days. So here is a straight answer to what causes it, what it means, the small number of headaches that are an emergency, and what actually changes when you stop.

Why cocaine causes headaches in the first place

There is no single cause, which is why people find the answer confusing. There are usually four or five things happening at once, stacked on top of each other.

The main one is blood vessels. Cocaine narrows them and pushes blood pressure sharply upwards, and both of those changes are felt in the head. Your brain has no pain sensors of its own, but the blood vessels and the membranes around it very much do, and squeezing and pressurising them is a reliable way to produce pain. That is the same mechanism I write about in cocaine and blood pressure, and the headache is often the only part of it you can feel.

Then there is everything else that goes with a session:

• Dehydration. Long hours, alcohol, a lot of talking, very little water. Straightforwardly one of the most common headache triggers there is.
• No sleep. Broken or missing sleep triggers headaches in almost everyone, and cocaine is very good at removing a whole night. There is more on that in cocaine and sleep.
• Jaw clenching and grinding. Hours of clenched jaw and tensed neck and shoulders produces a classic tension headache that wraps around the head like a band. It is the same clenching behind the damage in cocaine and your teeth.
• Alcohol. Almost always in the mix, and a headache-maker on its own.
• Nothing to eat. Appetite disappears, so you go a very long stretch on nothing, then crash.
• The nose and sinuses. Snorting inflames the lining of the nose and can block the sinuses, and blocked sinuses produce a heavy, dull pain across the forehead, cheekbones and behind the eyes. Will my nose heal after cocaine covers what is going on up there.

The comedown headache is the sum of all of that landing at once, in a body that has been running on borrowed energy. If the rest of the comedown is what you are dealing with, the cocaine comedown takes the whole thing in order.

The headache that is not just a headache

Almost every cocaine headache is the ordinary kind described above. But there is one pattern that everybody who uses should know by name, because it is the one where minutes matter.

A thunderclap headache is a headache that arrives at maximum intensity almost instantly — people describe being hit, or a pop, or something bursting. It is not a headache that builds over an hour. That sudden, explosive pain can be a bleed in or around the brain, and cocaine is recognised as a trigger for exactly that kind of event because of the way it spikes blood pressure and stresses vessel walls. Cocaine and stroke goes into it properly, including why it does not politely wait for middle age.

The other patterns worth taking seriously are a headache alongside stroke symptoms — the face, arm and speech signs — a headache with a first seizure, or a headache with crushing chest pain, which belongs with chest pain after cocaine. And any headache that is genuinely new for you, keeps getting worse over days, wakes you from sleep, or comes with vomiting deserves a doctor rather than another painkiller.

I know the fear that stops people going in. You think you will be judged, or that it will end up on a record, or that you will have to explain yourself to somebody at home. In an emergency department they are treating a body, and what they need most is the truth about what is in it. Being honest is the thing most likely to get you looked after properly and quickest.

The trap of treating it with painkillers

Here is the pattern I see most often with regular users, and hardly anyone spots it in themselves. The Sunday headache gets painkillers. Then Monday needs some too, because it is still there. Then it becomes a couple most mornings, just to function.

Taking painkillers on most days over weeks can itself keep a headache going — a well-recognised effect where the medication that helped starts to sustain the very thing you are treating. It is worth mentioning to a pharmacist or GP if you have got into that rhythm, because breaking it usually improves things more than any new tablet will.

A short, honest word on what to avoid too. Do not treat a cocaine headache with alcohol, and be careful with anything you have not been prescribed, especially other people's tablets. You are already asking a lot of a system under strain, and mixing more into it is how a bad night becomes a hospital night.

What actually helps in the moment

Nothing here is clever, and all of it works better than searching your symptoms at 3am.

1. Water, steadily. Not a litre in one go. Regular glasses across the day, with something salty and something to eat.
2. Eat, even if you cannot face it. Toast, soup, a banana. Going another six hours empty will make it worse.
3. Sleep in a dark, quiet room. The single most effective thing available to you, and the hardest to get on a comedown.
4. Ease off the caffeine. Coffee to push through is understandable and it tends to dry you out further and wind up the anxiety alongside the pain.
5. Loosen the neck and jaw. Heat on the shoulders, a hot shower, and consciously unclenching the jaw does more for a tension headache than people expect.
6. Screens down. Light sensitivity is real on a comedown and a bright phone in a dark room feeds it.

If the headache travels with dread and a racing mind, the physical side is only half of it — cocaine hangxiety deals with the other half, and the two are much easier to manage together than separately.

Do the headaches stop when you stop?

For most people, yes, and faster than they expect. The dehydration, missing sleep, clenching and vessel stress are ongoing consequences of ongoing use, and when the cause goes, the headaches largely go with it.

Expect a rough patch first. In the early days off, headaches are common alongside fatigue, low mood and poor sleep, and if you have been leaning on daily painkillers there can be a period of things being worse before better. What happens when you stop cocaine lays out that timeline in full, and coming off cocaine safely covers what to know before you stop. Beyond that, headaches that persist for weeks after you have stopped, or that follow a new pattern, are worth taking to a GP rather than assuming they are just part of it. Sometimes they are, and sometimes there is something else going on that has been hidden underneath all this for a long time.

The question underneath the question

Nobody books a session with me about headaches. But a headache is a hard thing to argue with, because it is your body making a point that your mind has been talking its way around for months. It is not a moral verdict. It is information.

If you have found yourself planning your week around how bad your head will be, or quietly wondering whether this is doing damage you cannot see, that is not paranoia — that is your own judgement working properly. Am I addicted to cocaine is the plainest place to take that thought next, and the confidential self-assessment takes three minutes and stays on your screen.

You do not have to be at the bottom of anything to be allowed to stop. A head that hurts every Monday is reason enough.

Related reading

• The Cocaine Comedown: Why It Hits and How to Get Through It
• Cocaine and Blood Pressure: The Silent Strain on Your Body
• Cocaine and Stroke: The Risk That Doesn't Wait for Middle Age

Gary Clinton

Ireland's cocaine addiction specialist — CBT-qualified therapist, bestselling author of Never Give Up, and in long-term recovery himself. Private one-to-one help for professionals, online and worldwide.