When should you worry about headaches?

Headaches are common, and most don’t cause panic or unnecessary worry. That is, severe headaches, or headaches associated with specific symptoms such as high fever or new neurological deficits (changes in brain, nerve, or muscle function), may be a sign of a potentially life-threatening illness such as a brain infection or a stroke.

Other conditions, such as new headaches or changes in headache patterns during pregnancy, also warrant further investigation.

This article explains some of the main headache symptoms that should alert you to seek medical attention. It also outlines headache types and basic treatment and prevention strategies.

type and reason

Most headaches are primary headaches, which means they exist on their own and are not caused by an underlying health problem.

The most common types of primary headaches are:

  • A migraine is a severe, throbbing headache, usually accompanied by nausea, vomiting, and sensitivity to light/noise, that can last up to 72 hours.
  • Tension-type headaches cause a dull “band-like” feeling of tightness or pressure on the sides of the head that can last anywhere from 30 minutes to 7 days.
  • Cluster headaches cause severe stinging or burning pain in or around one eye or temple for 15 to 180 minutes. Associated symptoms include red and watery eyes, nasal congestion and sweating.

Most primary headaches are likely caused by a complex interaction of factors (eg, genetics, changes in brain structure, and/or sensitivity of pain pathways). Environmental factors, such as stress, lack of sleep, weather changes, alcohol consumption, and menstruation, also appear to contribute to the development of headaches.

Unlike primary headaches, secondary headaches are caused by an underlying disease or situation, such as illness, pregnancy, or medication. With very few exceptions, most secondary headaches are not serious or dangerous.

Examples of less severe (usually) secondary headaches include:

  • Sinus headaches result from sinus inflammation/infection and are usually accompanied by thick nasal green or yellow discharge.
  • Post-infection headaches are often caused by viruses such as the common cold, the flu, or COVID-19.
  • Cold irritation headaches, also known as ice cream or brain freezing headaches, occur after eating cold food or exposing the unprotected head to cold temperatures.
  • Cervicogenic headaches are caused by problems with the bones, joints, or soft tissues of the neck.

severe headache and symptoms

While not a complete list, the following are examples of possible serious causes and symptoms of secondary headaches. In these cases, you should seek urgent medical advice or get emergency medical help.

stroke

A stroke occurs when blood flow to the brain is cut off. There are two types of stroke –ischemic and hemorrhagic– Both may cause headaches:

  • An ischemic stroke occurs when an artery that supplies blood to the brain is blocked.
  • A hemorrhagic stroke occurs when an artery in the brain ruptures and begins to bleed in or around the brain.
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Headache due to ischemic stroke is more common in younger patients, in those with migraine, and in those with a larger stroke. Headaches typically resemble tension headaches and occur at about the same time as neurological deficits (eg, weakness or numbness on one side of the body or slurred speech).

A common example of a hemorrhagic stroke is subarachnoid hemorrhage. This type of brain hemorrhage usually causes a thunderclap headache—a sudden, explosive headache that becomes severe and painful within seconds or less than a minute.

In addition to subarachnoid hemorrhage, thunderclap headaches can occur with other serious health conditions, including:

  • Reversible cerebral vasoconstriction syndrome (sudden narrowing of blood vessels in the brain)
  • Carotid dissection (tear formation in the walls of the carotid or cervical vertebral arteries)
  • pituitary stroke (bleeding or loss of blood supply to the pituitary gland located in the brain)

brain infection

A combination of headache and fever may indicate a brain infection such as:

  • Meningitis: Inflammation of the protective layer around the meninges, brain, and spinal cord.
  • Encephalitis: Inflammation of brain tissue.
  • Brain abscess: When infected fluid builds up in the brain.

Besides fever and headache, other potential symptoms of a brain infection include:

  • nausea
  • stiff neck
  • Puzzled
  • altered consciousness or loss of consciousness
  • Seizures

brain tumor

Brain tumors are collections of abnormal cells that grow in the brain. While headaches are a common (and possibly the only or most severe) symptom of brain tumors, keep in mind that brain tumors are rare overall.

A headache caused by a brain tumor may feel like a migraine or tension-type headache and get worse with coughing or bending over.

Headaches caused by brain tumors may also be accompanied by nausea and vomiting. This is often due to elevated intracranial pressure (ICP) or hydrocephalus – when there is too much cerebrospinal fluid (CSF) in the brain.

Brain Injury

Headaches may occur for a few days after a traumatic brain injury, such as a concussion. Post-traumatic headaches often feel weak, painful, and may be accompanied by dizziness, fatigue, problems with concentration and memory, and irritability.

Post-traumatic headaches from concussions cannot usually be attributed to a structural cause, but can occasionally be caused by abnormal blood collection within the skull caused by head or neck trauma.

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When to seek medical assistance

Here are worrying signs that your headaches may be stemming from a serious underlying medical condition.

Seek immediate medical attention if:

  • Your headache is severe and starts suddenly.
  • Your headache is accompanied by neurological symptoms such as fever, stiff neck, seizures, fainting, confusion, or weakness or numbness.
  • Your headache is accompanied by painful red eyes or tenderness near the temples.
  • Your headache patterns are changing (for example, becoming more frequent) or interfering with daily activities.
  • Your headache is caused by sneezing, coughing, or exercising.
  • Your headache occurs after a blow or injury to the head.
  • You have new headaches or changes in headaches during pregnancy or immediately after giving birth.
  • You have a history of headaches and cancer or a weakened immune system (eg HIV/AIDS).
  • You are over 65 years old and you are experiencing a new type of headache.
  • Your headache is accompanied by pain medication overuse (indicating a possible medication overuse headache).

treat

Treatment for headaches depends on the type and severity.

primary headache

Most primary headaches can be treated with a combination of medication and home remedies.

For example, tension-type headaches can often be treated with an over-the-counter (OTC) pain reliever such as Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) Advil (ibuprofen). Taking a hot bath or drinking a caffeinated beverage may also help.

Likewise, mild-to-moderate migraine headaches are usually treated with NSAIDs. A class of oral medications called triptans—for example, Imitrex (sumatriptan)—is used to treat moderate-to-severe migraine headaches. For those who cannot tolerate triptans, try Reyvow (lasmiditan).

Napping in a quiet, dark room and applying a cold compress to your forehead can also be effective in relieving migraines.

For cluster headaches, oxygen therapy (inhalation of high-flow oxygen), Imitrex (sumatriptan) injections, and Zomig (zolmitriptan) nasal sprays can be used as acute treatments.

talk to your doctor

Consult your healthcare professional before taking any medication for your headache. If you are taking blood thinners or have kidney, liver, or ulcer disease, your doctor will want you to avoid certain over-the-counter medications or take lower doses.

secondary headache

Treatment of secondary headaches requires addressing the underlying disease.

For example, sinus headaches can be treated with over-the-counter pain relievers like Tylenol or ibuprofen. Your doctor may also recommend saline nasal sprays and/or corticosteroid nasal sprays to reduce sinus inflammation. In rare cases of bacterial sinusitis, antibiotics may be prescribed.

Dangerous secondary headaches such as stroke or brain infection require more intensive care, such as close hospital monitoring, intravenous (IV) medications and/or surgery.

prevention

Like treatment, prevention depends on the type and severity of the headache.

primary headache

Lifestyle changes as well as drug and non-drug treatments can help prevent primary headaches.

Migraine headaches, for example, can be prevented by avoiding triggering foods, sounds, and smells, sticking to regular sleep habits, and engaging in certain therapies such as acupuncture. For patients with chronic migraine headaches, Botox or preventive medication may be recommended.

For people with cluster headaches, preventive medications, such as Karan (verapamil), may be recommended. Certain lifestyle behaviors, such as quitting smoking, are also often recommended.

secondary headache

Depending on the underlying cause, certain types of secondary headaches can be prevented.

For example, strokes can be prevented by ensuring that risk factors such as high blood pressure and high cholesterol are controlled.

Likewise, wearing a helmet during potentially high-intensity sports or recreational activities can prevent post-traumatic headaches.

Frequent handwashing and vaccinations (if applicable) can prevent headaches caused by viral infections such as colds or the flu.

generalize

Most headaches are nothing to worry about and go away with medication, self-care strategies, and/or addressing the underlying cause. That said, headaches associated with certain symptoms or characteristics, such as fever, neurological deficit, pregnancy, old age, or a weakened immune system, require prompt medical attention.

VigorTip words

There is no doubt that headaches can be burdensome and stressful. If you’ve been diagnosed with a headache disorder, stay committed to finding ways to help you get the relief you deserve. During your headache journey, don’t hesitate to seek emotional guidance and comfort from a loved one or a support group.

Frequently Asked Questions

  • Why do I wake up with a headache every morning?

    There are many possible causes of headaches in the morning. They may be primary headaches, such as migraines or tension-type headaches. They can also come from a hangover, caffeine withdrawal, or an underlying health problem such as sleep apnea.

  • What is a tension headache?

    Tension headaches (also called tension-type headaches) are the most common form of headache. It can cause pressure or tightness in the head or neck and can last from 30 minutes to 7 days.

  • What does a COVID headache feel like?

    Headaches reported in patients with COVID-19 have been described differently. Typical headaches are moderate-to-severe headaches located on the sides of the head, forehead, or around the eyes, and are throbbing or pressing in nature.