Quite often headaches aren’t indicators of a serious and dangerous disease, but sometimes they are the first sign indicating a life-threatening medical situation that must be treated immediately.
How can you tell the difference between taking an Advil or running to the ICU? Here are a few pointers.
A headache is one of the most common complaints a family or ICU doctor hears about.
This phenomenon is so common that most people are expected to experience it in some form during their lifetime.
It can be in the form of a hangover, after a night of drinking, a stress related headache or many other kinds of headaches.
In the vast majority of cases a headache isn’t anything dramatic, serious or severe. It’s usually just a plain headache, or another physical phenomenon that the head is responding to, or some indisposition. The chance of a headache indicating something severe and significant is very-very low.
There is a variety of situations that can cause and will cause a headache. First of all, of course, are the brain’s processes such as a migraine or sinusitis (that usually occurs in the nasal cavities, inside the skull). There are also a lot of other situations that are systemic and “external” of the brain that can cause headaches, such as having a fever, a viral infection, dehydration, hormonal disorders etc.
So what does a doctor do when confronted with a patient complaining about a headache? First of all, like in any proper medical situation the doctor receives an anamnesis: a brief history of the disease, retelling of the symptoms, actively listening to the patient and his complaints. The patient is asked to answer questions such as: when did it start? Where exactly does it hurt? What type of pain? Can it be relieved in any way? Does anything make it worse? Etc.
The “when” of the pain’s beginning is obviously quite significant: if we’re talking about a chronic headache that’s been around for 10 years and hasn’t changed its nature – the chances of it being something serious are pretty slim.
When should a headache raise a flag?
Some types of headaches should be qualified to raise a flag. They require a fast immediate inquiry, without delay, because they can indicate cases of life threatening situations. These situations (for instance, after having a stroke) have, after several times, a wonderful medical solution, but the kind that has a very limited window of opportunity lasting a few hours, after which the damage will be irreversible. Therefore, any case that raises a flag requires a fast and urgent inquiry – without waiting for a doctor’s appointment, not even within a few hours. You must see a doctor immediately.
- “The worst-ever Headache”
The first type of headache that should raise a flag is defined in medical terms as “The Worst-Ever Headache”. When a patient describes their headache as such – it is a situation requiring a fast and immediate inquiry, because it can indicate a life threatening situation. You can also find there is an internal logic and correlation here between the two things: if you feel a headache so immediately strong and awful – it indicates to a severe problem that needs taking care of at that moment, without postponing treatment.
- Headache accompanied by a symptom
Another flag is a headache accompanied by another symptom, for example: a headache accompanied by a fever; confusion; severe dizziness; weakness in the arms or legs; speech impairment; a sudden difficulty in walking; an extreme change of behavior; etc. Any headache of that sort should raise a flag requiring an immediate and urgent checkup to eliminate life threatening situations.
- A sudden change in the migraine type
A third flag that should be raised relates to patients that suffer from migraines. Those who have migraines should notice a sudden change in their headaches. For example, if for years someone has a migraine formed by pains + nausea + lying down for 24 hours in bed and suddenly it comprises of a general strong headache + dizziness + difficulty in standing up – this shows a significant difference in the type of headache and should be treated seriously and examined quickly.
- A headache following a trauma
A fourth situation considered to raise a flag is a headache following trauma. It doesn’t have to be dramatic like a severe blow to the head in a car accident,, but can even be someone who hit his head hard (by any kind of furniture or anything else trivial) and suddenly, after several hours, starts having a light headache. That too is a case that should be looked into immediately.
Just to be calm: even severe headaches won’t necessarily lead to a life threatening situation. It’s very common that a headache accompanied by a fever will turn out to be a viral harmless disease. But the doctor needs to eliminate in such a case significant infectious processes and acute situations, like meningitis or severe sinusitis.
- Significant increase in pain
There’s also a less important flag raising situation that doesn’t require an immediate inquiry – but should definitely require a fast inquiry, within a few days. This refers to a significant severity of the pain. For example: someone who is normally healthy and well-functioning, that would tell his doctor that he can’t remember the last time he took a sick-day – but is forced to take one now because of a headache that has taken a turn to the worst and interferes with his ability to function.
Such cases don’t call for an ambulance, but definitely require a CT scan or MRI within a few days. This is also right for a common headache that started to become worse and has also changed its pattern, like starting to show up every day instead of once a week.
Mustn’t be missed diagnoses
In emergency medicine there’s a thing called “mustn’t be missed diagnoses”: a headache combined with neurological disorders, like weakness in the hand or leg or difficulty in walking or speaking that can indicate an episode of cerebral blood vessels, meaning a stroke – which requires immediate care. Such a complaint always requires a referral of the patient to have an immediate CT or MRI scan.
Today, being at the age of progressive treatments around the whole subject of strokes, it is crucial to arrive at an accurate diagnosis as fast as possible. There are several kinds of cerebral hemorrhages that can be drained, and there’s excellent medication that can treat obstructive strokes – but in any case, there’s only a small window of opportunity during which medical intervention can be made, after which the damage would become irreversible, and can even be severe.
Medicine today talks about how a man suspected of having a heart attack, complaining about having cold sweat and tightness in his chest would be treated seriously, so should a stroke be treated, as a “Brain-Attack” and we should actively and aggressively search for signs among patients that we suspect are going through a process that could lead to a stroke.
The majority of headaches aren’t dangerous, and you should definitely not stop taking painkillers that help you and instead “run” to be examined at the beginning of every minor headache. Yet it is still important to remember that in the case of a headache “when in doubt – there is no doubt”.
A headache is not a back ache, and if someone has a headache similar to the ones listed previously or a different headache that worries them – it’s better to bring them in to be examined and assessed by a doctor rather than to miss a diagnosis of a problematic situation, that would then be treated too late.
thomasomallory. your sounds like your blood sugar drops. i have had mine do that. Im having headaches right after i eat . can anyone explain that?
Headaches seem to arrive when I am getting hungry just before meal time or during the day. What cause this and how can I prevent them?