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DEAR MAYO CLINIC: My mother gets headaches from time to time, but recently she's been reading that some headaches can be signs of serious medical problems. What's the difference between a headache that's just a nuisance and one that needs immediate medical attention?
ANSWER: Most headaches aren't a symptom of a life-threatening condition. Common headaches, including tension headaches and migraines, can be painful and disruptive, but they usually aren't medical emergencies. However, certain headache symptoms shouldn't be ignored because they can signal a serious underlying condition, such as a stroke, bleeding in the brain, meningitis or, less commonly, a brain tumor. Knowing the warning signs can help you decide when to seek emergency care.
You should contact your healthcare team if you experience:
- Headaches that wake you from sleep or are present when you wake up.
- Headaches that become more frequent or progressively more severe.
- Headaches that don't improve with over-the-counter medications such as acetaminophen or ibuprofen.
A severe headache can be described as the "worst headache of your life" — one that develops suddenly and reaches maximum intensity within seconds or minutes. This can be a sign of a medical emergency.
Go to the emergency department or call 911, especially if your headache is accompanied by:
- Weakness or numbness.
- Slurred speech.
- Confusion.
- Loss of consciousness.
- Double or blurred vision.
- Severe dizziness or difficulty walking.
- Fever and a stiff neck.
While serious causes of headaches are uncommon, they do occur. For example, headaches can be associated with brain aneurysms, although these headaches are typically sudden and severe, and they may be accompanied by loss of consciousness.
Brain tumors are rare, but about half of the people who are diagnosed with one experience headaches. These headaches often become progressively worse over time, and may occur in the morning or wake someone from sleep. They're frequently accompanied by nausea or neurological symptoms, such as weakness, numbness or vision changes.
Headaches with vision changes can have several causes. Some people with migraines experience visual disturbances. In other cases, vision changes and headaches may be related to inflammatory conditions such as giant cell arteritis, which is an immune disease that causes swelling and narrowing of medium- and large-sized arteries, and it can cause blindness.
If you're over the age of 50, you should always discuss new headaches with your healthcare professional. Most primary headache disorders, including migraines and tension headaches, begin much earlier in adulthood.
You also should seek medical evaluation if headaches consistently occur with coughing, sneezing or straining, or if they're triggered by exercise and continue to recur. Although these headaches are often benign, they sometimes can signal an underlying structural condition.
After a head injury, it's common to develop headaches. Many go away with rest and over-the-counter pain relievers. However, seek medical care after a head injury if you lose consciousness, have memory loss or repeated vomiting, take blood thinners, are age 65 or older, have obvious head trauma, or were injured in a significant fall or by a direct blow to the head.
If you're being evaluated for headaches, be prepared to describe:
- How severe the headache is.
- When it started and how long it lasted.
- Whether it wakes you from sleep.
- Whether it's different from your usual headaches.
- Any associated symptoms, such as fever, weakness, numbness or vision changes.
- What treatments you've tried and whether they helped.
Depending on your symptoms, your healthcare team may recommend imaging, such as a CT scan or MRI, to help identify the cause.
The bottom line is that most headaches aren't dangerous, but some require immediate attention. Remember the key warning signs. And when in doubt, it's always safest to seek medical evaluation.
Grant Mallory, M.D., Spine Care, Neurosurgery, Mayo Clinic Health System, La Crosse, Wisconsin
