Headaches - danger signs

A headache is pain or discomfort in the head, scalp, or neck.
Common types of headaches include tension headaches, migraine or cluster headaches, sinus headaches, and headaches that begin in your neck. You may have a mild headache with the common cold, the flu, or other viral illnesses when you also have a low-grade fever.
Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and sometimes taking medications.

Emergency Causes of Headaches

Problems with blood vessels and bleeding in the brain can present as a headache. These include:

• An abnormal connection between the arteries and veins in the brain that usually forms before birth. This problem is called an arteriovenous malformation, or AVM.
• A stroke, when blood flow to part of the brain stops.
• A weakening of the wall of a blood vessel that can break open and bleed into the brain, called a brain aneurysm.
• Bleeding in the area between the brain and the thin tissue that cover the brain, called a subarachnoid hemorrhage.

Other worrisome causes of headaches include:

• Blood pressure that is very high
• Brain tumor
• Hydrocephalus
• Infection in the brain or the tissue that surrounds the brain, as well as a brain abscess
• Pseudotumor cerebri, a process affecting the brain that appears to be -- but is not -- a tumor. It is often reversible.
• A swollen, inflamed artery (which supplies blood to part of the head, temple, and neck area) called temporal arteritis.

When to Call the Doctor

Take the following symptoms seriously. If you cannot see your health care provider right away, go to the emergency room or call 911 when:

• This is the first headache you have ever had in your life and it interferes with your daily activities.
• You develop a headache just after activities such as weightlifting, aerobics, jogging, or sex.
• Your headache comes on suddenly and is explosive or violent.
• You would describe your headache as "your worst ever," even if you regularly get headaches.
• You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache.
• Your headache gets worse over a 24-hour period.
• You also have fever, stiff neck, nausea, and vomiting with your headache.
• Your headache occurs with a head injury.
• Your headache is severe and just in one eye, with redness in that eye.
• You are over age 50 and your headaches just began, especially if you also have vision problems and pain while chewing.
• You have cancer and develop a new headache.

See your health care provider soon if:

• Your headaches wake you up from sleep.
• A headache lasts more than a few days.
• Headaches are worse in the morning.
• You have a history of headaches but they have changed in pattern or intensity .
• You have headaches often, and there is no known cause.

References

Digre KB. Headaches and other head pain. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 405.