Headaches are among the most common health complaints, often brushed aside as fatigue, stress, or migraine. But according to neurologists, some headaches carry warning signs that demand immediate medical attention. It’s crucial to remember that not every headache is harmless, some may indicate serious underlying neurological conditions. Experts reveal when you should worry and what symptoms signal the need for urgent evaluation.
When Headache Needs Medical Attention
Dr Parul Dubey, Consultant, Neurology, Manipal Hospital, Goa, says, “Though the majority of headaches are what we call primary headaches, and are benign in nature, there are certain ‘red flags’ which may point towards a more serious underlying cause and must not be neglected. If a headache occurs in the setting of fever or other systemic or infectious symptoms or along with neurological deficits like vision disturbances, speech difficulty, limb paralysis, neck stiffness, etc.”
Dr Dubey reveals, “It needs quick medical attention. If there is a first ever headache of one’s life, a ‘thunderclap’ headache which has the greatest severity at onset, or a progressively worsening headache over days, if headache has started after a trauma or has started for the first time in old age or is associated with changes in posture, cough, sexual activity etc. or has appeared during the course of pregnancy an urgent neuroimaging should be done to evaluate for causes like stroke, aneurysm, cerebral venous thrombosis, tumors etc.”
All headaches may be just migraine and may need urgent medical attention in the presence of above-mentioned pointers to a more serious type of headache.
Dr Rohit Pai, Consultant, Neurology, KMC Hospital, Mangalore, says, “How often do you have a headache while working in front of a computer completely daylong? This is a typical migraine headache. This is usually associated with photophobia, phonophobia, and nausea or vomiting. What if a headache is extremely severe, described as the worst headache of life? This could be due to a subarachnoid hemorrhage. Patients usually have projectile vomiting with impaired sensorium, depending on the severity of the blood.”
Idiopathic Intracranial Hypertension
“If the headache is more in the morning, associated with visual obscuration or double vision or pulsatile tinnitus, it could be due to a condition called idiopathic intracranial hypertension. This is seen in middle-aged obese women,” says Dr Rohit.
Headache, which is a new onset, more in the morning, associated with other localising signs like weakness, behavioral, cognitive changes or maybe associated with seizures, could be due to a brain tumor. This is nonspecific, dull initially, and becomes more severe or persistent over time.
Nevertheless, migraine and tension headaches referred to, as primary headaches are more common. History and careful examination is crucial in distinguishing it from secondary headaches.
Dr Aakash Agrawal, Consultant Neurologist, Manipal Hospital, Bhubaneswar, says, “Chronic headache or headache that has been present for a quite a long time are relatively “benign” primary headaches like migraine or tension type headache, of which migraine is more severe in intensity and brings the patient to OPDs. However, there are several red flags, which cautions the doctor to look for a more “malignant” reason behind secondary headaches that needs immediate attention.”
Dr Agrawal says, “One such symptom, like sudden severe headache or the ‘worst headache of my life,’ may point to vascular aetiology behind headaches like sub-arachnoid haemorrhage or cerebral venous sinus thromboses, which may be life-threatening if not immediately treated.”
Similarly, headache associated with systemic features like fever, weight loss, decreased appetite or vomiting dominating the clinical picture may signal serious conditions like meningitis and tumours requiring further investigation. A recent change in the nature of usual headache or its severity makes the clinician wary and warrants thorough search through history and imaging.
