When Should You Worry About Your Headache and Seek Immediate Help?

How do you know when to be concerned about your headache? What signs can help you distinguish between an ordinary headache caused by stress, one occurring as part of a migraine attack, and one caused by something much more serious, such as a stroke or a brain tumor?

One clue that a headache is a sign of something serious is when it’s significantly worse than the headaches you usually get. Another clue is when the headache is accompanied by other symptoms that are new to you.

When the headache is accompanied by the following signs, it’s serious, says Alexander Mauskop, MD, the founder and director of the New York Headache Center and a professor of neurology at the State University of New York Downstate Medical Center in Brooklyn.

• Fever
• Neck stiffness
• Weakness or numbness on one side of the body
• Difficulty speaking
• Loss of consciousness
• Confusion
• Loss of vision
• Any other neurological symptom

If in doubt, call 911 or go to the emergency room, Dr. Mauskop says.

The SNNOOP10 Tool Identifies Headache Red Flags

• Systemic Symptoms Symptoms you feel in other parts of your body, besides your head. This could be a fever, loss of appetite, or weight loss. Conditions that may cause such symptoms include meningitis, vasculitis (inflammation of the blood vessels), cancer, and infection.
• Neurological Symptoms Confusion, blurry vision, personality changes, weakness on one side of the body, numbness, or sharp facial pain can indicate a tumor or a stroke.
• Onset Sudden or Abrupt The headache happens suddenly, without warning. Sometimes these are called “thunderclap” headaches. This can occur when headaches are caused by bleeding in the brain.
• Older Age If you’re over 50 and experience a new or progressive headache, it’s more likely to be due to a secondary cause or illness.
• Pattern Change or Progression A new headache is cause for concern if it is significantly different from your typical headaches, if your headaches are happening more often, or if it is the worst headache you have ever had.
• Precipitated by Sneezing, Coughing, or Exercise 
• Positional If your headache comes on from sitting or standing, it may be related to high or low spinal fluid pressure.
• Papilledema, or optic nerve swelling, occurs when pressure in or around the brain is increased; the presence of papilledema may confirm a diagnosis of idiopathic intracranial hypertension.

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Here are some causes of serious headache.

Symptoms of Headache Caused by Stroke

It may not always be possible to distinguish the pain of a headache caused by stroke from a tension-type headache or a migraine attack. But you may be able to tell them apart based on their accompanying symptoms. Stroke generally causes negative symptoms, indicating loss of neurological function, such as:

• Weakness
• Numbness
• Slurred speech
• Blindness

Migraine, on the other hand, often produces symptoms such as bright flashing lights, spots, or zigzags in a person’s field of vision and the perception of hearing sounds like buzzing or music.

But some migraine symptoms can resemble those of stroke. For example, a person who has migraine with aura may experience loss of sight for short periods; tingling and numbness in the face, hands, or other areas of the body; and speech and language problems, such as being unable to say words, slurring, or mumbling during a migraine attack.

A person with familial or sporadic hemiplegic migraine (a rare type of migraine) may have the same symptoms as those that occur in migraine with aura as well as motor (muscle) weakness on one side of the body.

When an ischemic stroke (a stroke caused by a blockage in a blood vessel) occurs as a complication of migraine with aura, it’s called a migrainous stroke or migrainous infarction. Like any stroke, a migrainous infarction is considered a medical emergency.

A stroke requires immediate treatment for the best chance of recovery, so anyone experiencing symptoms of stroke should get to a hospital emergency department as quickly as possible.

Headache From Extremely High Blood Pressure Is a Medical Emergency

Possible Symptoms of Headache Caused by a Brain Tumor

A brain tumor can also be accompanied by:

• Seizures
• Forceful vomiting
• Weakness
• Double vision
• Speech impairment
• Personality changes
• Confusion

If a brain tumor is suspected, a thorough evaluation by a doctor is crucial.

Symptoms of Cluster Headache

While technically not life-threatening, cluster headaches cause such severe pain that some people contemplate suicide.

And unlike migraine, which often makes a person want to avoid physical activity, bright lights, and loud sounds and to take refuge in a dark room, cluster headaches instead make a person feel restless and agitated from the severe pain.

Cluster headaches are so named because they come in clusters — daily for a month or more, for example, and then none for a year. Treatment can be high-flow oxygen through a mask or medication to prevent the headaches in the first place.

In most instances, head pain is unpleasant but isn’t something to worry about; it has less serious causes and is not accompanied by the red flags of secondary headaches (covered by the SNNOOP10 screening tool discussed above).

Stress or Tension-Type Headaches Respond to Self-Care

“Also called tension-type headaches, stress headaches often present with a bandlike sensation around the forehead that worsens as the day progresses,” says Jay Bhatt, MD, a neurologist with Indiana University Health North Hospital and an assistant professor of clinical neurology at Indiana University School of Medicine in Carmel.

Although the discomfort that stress headaches cause is very real, they are generally not serious, says Dr. Bhatt, adding that they “can be treated with a variety of lifestyle modifications or medications.” Aerobic exercise, biofeedback, relaxation training, and meditation are all possible ways to reduce stress and limit head pain from this type of headache.

Allergies Can Cause Headache

Headache or migraine can be a symptom of allergies if the sinuses become inflamed or infected as a result. Allergy-related headaches typically include a feeling of pressure in the forehead, face, or behind the eyes, along with typical allergy complaints such as sneezing, nasal congestion, and itching.

Treatment for allergy headaches may include over-the-counter medications for pain relief, along with treatment of the underlying allergy. Your doctor may recommend or prescribe an allergy drug and help you identify triggers to avoid, such as pollen, dust mites, pet dander, mold spores, certain foods, and other common allergens.

Migraine Attacks

Common migraine symptoms include:

• Light sensitivity
• Sound sensitivity
• Touch hypersensitivity
• Nausea and vomiting
• Aura symptoms
• Neck pain or stiffness
• Fatigue
• Brain fog
• Light-headedness, dizziness, or vertigo
• Depression or anxiety
• Ringing in the ears, or tinnitus
• Tearing of the eyes
• Sinus pain
• Diarrhea
• Aversion to odors

In addition to migraine triggers, which can vary from person to person, hormonal factors can worsen migraine.

“Migraine usually improves after the menopause transition; about 70 percent of women stop having migraine at this time,” says MaryAnn Mays, MD, a neurologist and headache specialist at Cleveland Clinic in Ohio.

But perimenopause can be a very difficult time because hormones are changing and fluctuating so much, adds Dr. Mays. Perimenopause is the period of years when a woman’s body is transitioning to menopause.

Migraine attacks can be triggered by changes in estrogen levels, and estrogen dips around the time that a woman starts her monthly period, according to Nada Hindiyeh, MD, a neurologist and headache specialist with the Metrodora Institute in West Valley City, Utah.

“They can be pretty severe, they can last several days, and they can be quite debilitating,” says Dr. Hindiyeh.

Smoking Can Lead to Headache or Migraine

Nicotine changes the blood vessels in the brain, and cigarette smoke can irritate the nerves in the nose and throat — both of which can lead to migraine attacks or headaches.

Some people complain of headaches while they’re trying to kick the habit, but nicotine gum usually helps, says Ricardo Jorge Komotar, MD, a professor of clinical neurosurgery at the University of Miami Miller School of Medicine and the director of surgical neuro-oncology at the University of Miami Hospital.

The health benefits of quitting smoking still clearly outweigh this possible discomfort.

Too Much Pain Medication Can Cause Headaches

The best treatment for this type of headache is to stop taking the frequently used medication. People who develop MOH should work with their doctor to identify bridge therapy and lifestyle modifications to help with pain relief while they stop the medication and determine how to move forward.

Both Caffeine and Caffeine Withdrawal Can Lead to Head Pain

The relationship between caffeine and headaches can be complicated. Some people drink a cup of coffee or take medication with caffeine to help with a headache, but for others, the stimulant can trigger an attack.

“Caffeine use is a common trigger for headaches and for caffeine withdrawal headaches,” notes Bhatt. “These are often severe, continuous headaches that don’t improve with heavy-duty pain medications but dramatically respond to reinstitution of caffeine use.”

If you are prone to caffeine-withdrawal headaches, talk with your doctor about gradually weaning yourself off caffeine over a month to see whether headache pain decreases.

• If you experience a headache that feels significantly worse than usual or is accompanied by symptoms like fever, neck stiffness, or neurological issues, it could be serious, and you should get medical attention immediately.
• The SNNOOP10 tool provides a helpful checklist for recognizing red flags in headaches that include systemic symptoms, neurological symptoms, sudden onset, and headaches arising in individuals older than 50.
• Most headaches, such as those caused by tension, stress, or allergies, can usually be resolved at home with self-care measures unless they change intensity or pattern, which should then prompt a healthcare consultation.

Additional reporting by Becky Upham.