Headaches are one of the most common reasons patients go to see their physician or seek help at an urgent care or emergency department. There are numerous causes for headaches, too many to cover in a short blog. Our focus here is to learn how to recognize when a severe headache might indicate something more serious—something that deserves or requires prompt attention.
Identifying characteristics that we refer to as “Red Flags” can help distinguish routine headaches from more serious ones, such as:
- Migraine that is much worse or uniquely different than your usual migraine, often described as an explosive headache or “the worst headache I’ve ever experienced.”
- Sudden severe headache comes on with little or no warning as opposed to a more gradual onset or slowly worsening headache.
- Severe headache with altered mental status, in other words confusion, disorientation, difficulty arousing or acting strangely. Sometimes may present as a seizure.
- Speech or balance difficulty, words or conversation that are difficult to comprehend or inability to stand, move or walk independently.
- Severe headache with elevated blood pressure, typically greater than 160/90.
- Weakness, paralysis or numbness affecting the face, an arm or leg.
- Severe headache and fever. Minor febrile illnesses often produce a headache, but a persistent headache that is not relieved soon after taking Tylenol or Ibuprofen is more concerning.
- Severe headache and simultaneous neck pain or stiffness, with or without a new body rash.
Those dangerous symptoms, or red flags, listed above, can be related to conditions like the ones listed below and require immediate evaluation:
- Severe migraine or cluster headache that doesn’t respond to routine prescribed migraine or simple over the counter medications.
- Stroke symptoms. Do you the signs of a stroke? People of all ages, including children, can learn B.E.F.A.S.T and help spot signs of a stroke and save a life. Click here to learn more.
- Subarachnoid hemorrhage, a condition brought on by an aneurysm – a leakage or rupture of a blood vessel within or around the brain.
- Meningitis or encephalitis, brought on by infection in or surrounding the brain or spinal cord tissues.
- Obstructive hydrocephalus, a condition brought on by obstruction in the normal flow of cerebral spinal fluid circulating through the brain.
- Tumors or masses that alter the structural anatomy of the brain and may produce a seizure.
- Hypertensive encephalopathy, a medical condition associated with severe hypertension, considered a pre-stroke condition.
If you or a loved one is experiencing a serious headache condition or any of red flag warning symptoms described above, you should NOT WAIT to be evaluated.
CALL 911: If a headache is ever consistent with signs of a stroke, of it you or someone you love is having a stroke, the most important thing you can do is call 911. DO NOT DELAY! The time-saving notification from the area EMS responders to our emergency department puts our stroke response team in action even before your arrive. When it comes to stroke, time lost is brain lost—so the faster you receive care, the better your chances of recovery.