When Is a Headache Serious?

Laura Mitchell's picture
By Laura Mitchell on January 12, 2018

A headache is pain or discomfort in the head, scalp or neck. Headaches can be minor annoyances or cause debilitating pain, and in rare cases they can indicate the onset of a dangerous condition such as stroke or aneurysm.
 
Serious causes of headaches are rare, however. Most headaches respond to lifestyle changes, learning ways to relax and occasional over-the-counter medicines.
 
What do your headache symptoms indicate and when should you seek medical care?

The most common type of headache is tension headache. The pain may feel dull or squeezing, like a tight band or vice. Your shoulders, neck or jaw may feel tight or sore. It is likely caused by tight muscles in your shoulders, neck, scalp and jaw. A tension headache:

  • May be related to stress, depression, anxiety, a head injury or holding your head and neck in an abnormal position
  • Tends to be on both sides of your head, often starting at the back of the head and spreading forward

A migraine headache involves severe pain. It usually occurs with other symptoms, such as vision changes, nausea and sensitivity to sound or light, and it can be preceded by an aura, or a group of warning symptoms. Migraine pain may be throbbing, pounding or pulsating. Migraines:

  • May be triggered by foods, such as chocolate, certain cheeses or monosodium glutamate (MSG)
  • May also be triggered by caffeine withdrawal, lack of sleep or alcohol
  • Tend to begin on one side of your head and may spread to both sides
  • Increase in intensity as you try to move around

Cluster headaches are sharp, very painful headaches that are short-lived but occur daily or more for a period of months before stopping. Weeks or months may pass before they return, and for some people, they never return. Cluster headaches:

  • Tend to occur at the same times every day
  • Are marked by excruciating, stabbing and penetrating pain centered around the eye
  • May be accompanied by swollen or droopy eyelids, contracted pupils and sensitivity to light and sound  
images and descriptions of various types of headaches

Rebound headaches are headaches recur multiple times. They are also known as medicine overuse headaches, because they can develop in response to overuse of pain medicines. People who take pain medicine more than three days a week on a regular basis can develop rebound headaches.

Headaches can also be related to:

  • Sinus congestion—pain in the front of the head and face that worsens when you bend forward and when you first wake up in the morning
  • Viral illness—such as colds, the flu, a fever
  • Menstruation—as a symptom of premenstrual syndrome
  • Temporal arteritis—an inflamed artery that supplies blood to part of the head, temple and neck area

Headache Care at Home
There are things you can do to manage headaches at home, especially migraines or tension headaches. Try to treat the symptoms right away.
 
When symptoms begin:

  • Drink water to avoid getting dehydrated, especially if you have vomited
  • Rest in a quiet, dark room
  • Place a cool cloth on your head
  • Use any relaxation techniques you have learned
  • Take any prescribed headache medications as instructed
  • For tension headaches, try acetaminophen, aspirin or ibuprofen

Knowing your triggers can help you avoid them. For recurrent or migraine headaches, a headache diary is invaluable. When you get a headache, write down the following:

  • The day and time the pain began
  • What you ate and drank during the prior 24 hours
  • How much you have slept
  • Where you were and what you were doing when the pain started
  • How long the headache lasted and what made it stop

Review your diary with your health care provider to identify triggers or a pattern to your headaches. This can help you and your provider create a treatment plan. Be sure to let your provider know if you are taking pain medicines three or more days a week.

When to Seek Medical Help
In rare cases, a headache can be a sign of something more serious, such as:

  • Bleeding in the area between the brain and the thin tissue that covers the brain (subarachnoid hemorrhage)
  • Blood pressure that is very high
  • Brain infection, such as meningitis or encephalitis, or abscess
  • Brain tumor
  • Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus)
  • Buildup of pressure inside the skull that appears to be, but is not a tumor (pseudotumor cerebri)
  • Carbon monoxide poisoning
  • Lack of oxygen during sleep (sleep apnea)
  • Problems with the blood vessels and bleeding in the brain, such as arteriovenous malformation (AVM), brain aneurysm or stroke

Seek medical help immediately if you experience any of the following:

  • This is your first headache and it interferes with your daily activities
  • Your headache comes on suddenly and is explosive or violent
  • Your headache is "the worst ever," even if you regularly get headaches
  • Your headache is accompanied by slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion or memory loss
  • Your headache gets worse over 24 hours
  • You also have a fever, stiff neck, nausea and vomiting
  • Your headache occurs with a head injury
  • Your headache is severe and just in one eye, with redness in that eye
  • You just started getting headaches, especially if you are older than 50
  • Your headaches are associated with vision problems, pain while chewing or weight loss
  • You have a history of cancer or immune system condition (such as HIV/AIDS) and you develop a new headache

This article was reviewed by Carilion Clinic stroke coordinator Kathy A. Robertson, M.S.N., R.N., on Jan. 11, 2018.