Is my headache serious? Seven red flag symptoms

By Lisa Salmon

Most people get a headache occasionally, and will normally grin and bear it, or pop a few painkillers and wait for it to ease. But what if your headache is more than a dull ache and the pain persists?

While it’s easy to panic if your head really hurts and the pain won’t go away, most headaches are still nothing to worry about, say doctors. But that doesn’t mean they are never a sign of something more concerning – you just need to know what to look for.

“Headache is the most prevalent symptom in the general population with 97 per cent of people having suffered from headaches at some stage,” says consultant neurologist Dr Fayyaz Ahmed, a trustee of the International Headache Society. “The good news is that the vast majority – nearly 99 per cent – are benign. Only one per cent or even less are serious.”

And Dr Ben Turner, a consultant neurologist confirms: “Headaches are usually unpleasant but harmless, and just occasionally serious.

“Most serious headaches are sudden onset, severe, unrelenting and not eased by resting or lying down. If associated with additional features such as fever, and cognitive issues, then these are of more concern.”

The two major headache categories are secondary and primary headaches. Turner says secondary headaches can be caused by a bleed or tumours in the brain, and also by something less sinister such as a sinus infection from a cold.

Primary headaches occur when there is no structural cause for the headache, and the pain is related to abnormal signals in the brain, he says. There are two major types of primary headache – a tension headache, which is the most common type, and a migraine.

“Sometimes people have a headache as if their head is being squeezed or they have pressure inside the head,” explains Ahmed. “This is often termed as tension headache and doesn’t have any nausea, vomiting or sensitivity to light, sound or smell.”

Most primary headaches, especially those caused by tension, can be treated with over-the-counter medication, says Turner, who points out that alternative therapies, including acupuncture and massage therapy, may also help.

Drinking plenty of water – headaches can be a dehydration symptom – getting plenty of rest, and relaxing can help to ease some headaches.

The second type of primary headache is a migraine. The Migraine Trust says migraine attacks can last anything from four to 72 hours and have a wide variety of symptoms, often including a severe throbbing headache.

Ahmed says: “If you don’t have a serious headache, then the most likely headache you have is migraine. This is more common in women than men. In migraine, you have a moderate to severe one-sided or both-sided headache that’s pulsating or throbbing (you feel your heart is beating inside your head), with nausea and/or vomiting and sensitivity to light, sound and smell.”

 

7 red flag headache symptoms that should be checked

Sudden onset

The abrupt onset of a severe headache may be reason for concern, says Turner – an example could be if the headache is at its peak in less than a minute or two. Ahmed describes these as thunderclap headaches, and explains: “This means a sudden onset of headache as if someone has hit your head with a cricket bat.”

Neck stiffness & fever

If the headache is coupled with neck stiffness or a fever, Turner warns these are possible features of meningitis and require urgent medical attention.

Possible stroke symptoms

If you have a headache alongside symptoms such as double vision, loss of vision, alteration in consciousness, weakness of a limb or a seizure, these could be signs of a stroke, and should be checked even if they’re short-lived.

Headache that wakes you in the night

Turner says that if a headache is waking a patient up in the night, or worsening when lying down or in the morning, it can be associated with raised pressure in the head. This increased intracranial pressure, or intracranial hypertension (IH), can occur suddenly after a severe head injury or stroke, or, rarely, it can be a persistent, long-lasting problem, with no clear cause.

Headaches caused by straining

Ahmed says headaches caused by straining such as coughing, sneezing or bending forward could indicate a serious problem and should be checked.

Change from normal

If a previously existing benign headache changes its characteristics, it’s worth getting this checked out too, says Ahmed.

Headaches in older people and those with pre-existing medical conditions

The new onset of headaches in people above the age of 50 or in those on steroids, or who have had cancer or HIV could be a red flag symptom, warns Ahmed. And Turner adds: “The older the patient, the greater chance a headache is likely to be associated with a more serious medical condition.”