14 warning signs your headache could be serious | The Survival Doctorby James Hubbard, MD, MPH

You’re out cleaning up after a big storm and you start getting a headache. At first it’s pretty mild, barely noticeable. You keep working and it gets worse.

Thinking it’s probably a tension headache, or maybe from dehydration, you take a break, drink a couple of glasses of water, and take some acetaminophen or ibuprofen. But it doesn’t help.

Pretty soon the headache is so severe that you stop working. And a thought crosses your mind—could this headache be serious? Maybe you should you call your doctor. Wait, the phones are down, and she/he’s probably not in the clinic anyway.

Your head is pounding now. What about going to the emergency room? You think of the crowds, the really sick and injured who actually are needing emergency help. But what if you’re one of them? When is a headache an emergency?

Perhaps this might help you decide. The May 15, 2013, American Family Physician magazine, provides a list of signs and symptoms to give hints to doctors that a headache might need emergency attention. These red flags increase the likelihood that the headache could be from a cause serious enough to need immediate attention, meaning delaying tests and treatment might lead to death or permanent disability.

What Are Some Headache Emergencies?

Serious causes of headaches include:

  • Bleeding involving the brain, such as aneurysm or stroke
  • Infection of the brain (encephalitis) or spine (meningitis)
When Is a Headache an Emergency?

If you have one or more of these 14 red flags, get emergency help.

1. Your headache is different.

  • It’s the first headache you’ve ever had.
  • It’s the worst headache you’ve ever had.
  • It’s sudden and severe and reaches maximal intensity within seconds to a few minutes.
  • You have severe temple tenderness.
  • Your headaches are getting progressively worse over time.

2. It has an unusual trigger.

  • It’s triggered by cough, exertion, or sexual intercourse.
  • You have a new onset of a severe headache while pregnant or soon after giving birth.
  • You have a really severe headache after exercise.
Extreme temple tenderness could mean an artery that runs through there is inflamed—a condition called temporal arteritis. If not treated, this can cause permanent vision problems.

Extreme temple tenderness could mean that an artery there is inflamed—a condition called temporal arteritis. This is rare but an emergency. Untreated, it can cause permanent vision problems.

3. It’s not alone.

  • There’s also a change in personality, mental status, or level of consciousness.
  • You also have significant muscle weakness involving any part of the body.
  • Your neck becomes stiff, or flexing your head toward your chest causes severe neck pain.
  • There is an associated fever or rash.

4. You have other risk factors.

  • It’s a new type of headache for you and you’re over 50.
  • It’s a new headache type and you have cancer, HIV, or Lyme disease.

This list is not inclusive, and it’s certainly not 100 percent accurate. It’s only meant to give physicians a guideline—one more tool, along with a complete history and physical, for deciding whether the headache is a true emergency. You can have a serious headache without any of these problems or a nonserious headache with them. But they’re warning signs. If you have one, you should heed it and not take chances.

One other thing. The AFP article gives a link to a good algorithm (decision tree) doctors can follow for headache diagnosis. I cite it for your information only and not to take the place of a doctor visit where he/she can combine it with knowledge, experience, and a physical exam—essential in getting to the most accurate diagnosis.

What about you? Do you have headaches? Anything serious or disabling? What do you do to get rid of them?

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Headache photo: Flickr/Cayusa. Temple drawing: Pearson Scott Foresman.