When is a headache a cause for concern?

Most of us have often experienced extremely painful and even debilitating headaches. Though these could cause great discomfort, we aren’t overly concerned, knowing it’ll pass, and at the most, use over-the-counter pain medication. Though most headaches are benign, triggered by dehydration, tension in the neck muscles, nerve pain, fever, caffeine withdrawal, excess alcohol consumption, or even by some foods, sometimes a seemingly routine headache could be a red flag for a serious health condition.

There are over 300 types of headaches which can be divided into two broad categories: primary and secondary. The most common headaches are primary headaches, which just happen without an underlying illness or injury. Tension headaches, migraines and cluster headaches are all forms of primary headaches. Of these, migraine headaches can be particularly severe and debilitating.

Secondary headaches have a definite cause, which could be an existing illness, hormonal changes, sinus, a tooth or gum inflammation or a side effect of a medicine.

When should you be concerned?

If the onset of your headache is sudden and explosive, accompanied by slurred speech, vision problems, difficulty in moving your limbs, loss of balance, confusion or sudden memory loss, call for medical help immediately.
Sometimes, a violent headache with one or more of these symptoms could be a sign of some serious health conditions like:

• Severe dehydration
• High blood pressure
• Heatstroke
• A Stroke
• A Concussion
• A Meningococcal disease (brain, spinal cord, or blood infection)
• Preeclampsia
• Cancer
• Brain tumor or aneurysm
• Brain hemorrhage

Here is a comprehensive checklist of symptoms to be mindful of to rule out a serious condition:

• Sudden, intense or ‘thunderclap’ headache
• Severe/sharp headache for the first time
• Stiff neck and high fever
• Nausea and vomiting
• Nosebleed
• Fainting
• Dizziness or loss of balance
• Heaviness in the back of your head
• Headache that wakes you up from sleep
• Double or blurred vision or auras
• Tingling in the face
• Confusion
• Drooping of one side of your face
• Weakness on one side of your body
• Slurred/garbled speech
• Difficulty walking
• Hearing loss
• Constant pain in the same area of your head
• Seizures

Treatment for serious headaches

The treatment protocols for serious headaches are guided by the underlying cause. It is possible that you are referred to a neurologist (a specialist in brain and the nervous system). You might be advised a bunch of tests and imaging to help determine the cause. These could include:

• Medical history and physical exam
• Eye & ear workup
• Blood tests
• Spinal fluid test
• CT scan
• MRI scan
• EEG (brain wave test)

Acute dehydration: If the headache has been triggered by severe dehydration and/or heatstroke, you may need intravenous fluids. Blood pressure medications for hypertension could also be prescribed and if there’s a serious infection, you will need antibiotics or antiviral medication.

Hypertensive crisis: In fact, without prompt treatment, a hypertensive crisis can trigger life-threatening conditions like stroke, heart attack, pulmonary edema, or an aortic dissection. A headache is often a very common symptom of hypertension. Brain tumor: In case of a brain tumor, the treatment would depend on the location of the tumor and whether or not it has metastasized. The patient might need surgical removal or radiation or chemotherapy to shrink the tumor.

Carotid artery dissection: If the headache is caused by a carotid artery dissection (a tear in the layers of one of the carotid arteries that supply blood to the brain), treatment options could include blood-thinners, endovascular treatment or even surgery. A carotid artery dissection can lead to stroke, brain damage, and even death.

Concussion: For headaches from concussion, treatment includes resting and limiting physical activity to allow the brain to heal.

Eclampsia: Preeclampsia can progress to eclampsia, a severe form of pregnancy hypertension which can potentially lead to seizures or a coma, posing a threat to both the patient and the fetus. Immediate intervention is imperative to prevent life-threatening complications of eclampsia.

Stroke: A stroke can be another life-threatening condition presenting as a headache. The treatment for stroke depends on the type of stroke — ischemic or hemorrhagic. The options include medicines to break up a clot, surgical removal of a clot or repairing a damaged blood vessel.

The Neurosciences Institute at Medica is comprehensively equipped to deal with all kinds of complications of the brain and spine, neuro emergencies and critical trauma.