Why Does My Ponytail Give Me a Headache?

An ache after pulling your hair into a ponytail is a reason to loosen the style. The American Academy of Dermatology¹ advises changing painful, tightly pulled hairstyles immediately. You do not need to keep wearing one until the headache becomes stronger.¹

The pattern has a name and a time limit

The International Headache Society² calls this external-traction headache. Its classification describes headache caused by sustained pulling on tissues around the head, without scalp damage.²

For the defined diagnosis, clinicians look for at least two episodes with this pattern:²

• The headache begins with sustained pulling and occurs while that pulling continues.
• The pain is strongest where the pulling acts, although it may extend elsewhere.
• The headache ends within one hour after the pulling is released.
• Another headache diagnosis does not explain it better.

These criteria describe a clinical pattern. A headache that continues beyond that hour does not fit the full pattern and should not simply be assumed harmless because it began with a ponytail.²

What women reported after loosening their hair

A report published in 2004 questioned 93 women; 50 had experienced ponytail-related headaches. The pain sometimes stayed at the tie site and sometimes extended toward the forehead, temples, neck or other areas.³

The original abstract reports relief after loosening the hair: four women immediately, 32 within half an hour and five within an hour. Nine were unsure of the duration.³

That small report describes experiences among those questioned. It does not establish how common the problem is in all women, compare different hair ties or tell you a safe amount of pulling.

An experiment also recorded migraine-like episodes

In the 2020 study⁴ from Recife, Brazil, 130 volunteers aged 15–60 wore a ponytail at the top of the head for up to 60 minutes. Researchers removed it when pain developed. 52 participants, or 40%, developed headache.⁴

The sample already included 108 people with a history of primary headache, including 81 with migraine or probable migraine. The 40% finding belongs to that experiment and sample, rather than a population estimate for every ponytail wearer.⁴

Three participants experienced migraine-like episodes; all had a migraine history. Reported pain duration varied widely, including episodes lasting beyond an hour. The experiment therefore should not be used to promise that every headache triggered by pulling will disappear promptly.⁴

Do not recreate the experiment to prove the cause of your symptoms. If headaches recur, note the style, when the pain starts, when you loosen it and what happens afterward. Share that timeline with a clinician.

Pain and hairline damage are separate observations

Repeated pulling can also cause traction alopecia, a form of hair loss. The Academy advises changing a style immediately if it causes pain, stinging, crusts or “tenting,” where sections of scalp are pulled upward. It lists broken hairs around the forehead, a receding hairline and patches of loss at pulling sites as early warning signs.¹

A headache alone does not establish hair loss. Visible hairline changes deserve a dermatologist’s assessment, and continued pulling can eventually cause permanent loss. Our guide to tight styles and traction alopecia covers that longer-term problem.¹

When a headache needs care

The NHS⁵ advises seeing a GP for headaches that recur regularly or are worsening or not improving with self-care. Headache with jaw pain while eating or a sore, tender scalp warrants urgent advice.⁵

Get emergency help for a sudden, extremely painful headache, or headache with weakness, difficulty speaking or walking, confusion or loss of vision. In the UK, the NHS⁵ directs these situations to 999 or A&E; elsewhere, use your local emergency service. Do not wait to see whether changing your hair helps.⁵

Chapter 9 of Hair, Everywhere, “Edges,” includes “Tension,” explaining pulling-related hair loss and the scalp symptoms that should prompt a change in styling.