When Should You Worry About a Headache?

Headaches are common, and most are not a cause for alarm or unnecessary worry. That said, a severe headache, or a headache associated with specific symptoms like a high fever or a new neurologic deficit (alteration of brain, nerve, or muscle function), may be a sign of a potentially life-threatening condition like a brain infection or stroke.

Other scenarios like a new headache in pregnancy or a headache changing in pattern also warrant further investigation.

This article explains some of the key headache symptoms that should alert you to seek medical attention. It also provides an overview of headache types and basic treatment and preventive strategies.

Should I Worry About This Headache?

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Types and Causes

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

The most common types of primary headaches are:

  • Migraine is an intense, throbbing headache often associated with nausea, vomiting, and light/noise sensitivity that can last up to 72 hours.
  • Tension-type headaches cause a dull, "band-like" tightening or pressure sensation on both sides of the head and can last anywhere from 30 minutes to seven days.
  • Cluster headaches cause an excruciating stabbing or burning pain in or around the eye or temple on one side and last between 15 and 180 minutes. Associated symptoms include eye redness and tearing, stuffy nose, and sweating.

It's likely that most primary headaches arise from a complex interplay of factors (e.g., genetics, structural brain changes, and/or sensitization of pain pathways). Environmental factors, such as stress, lack of sleep, weather changes, alcohol intake, and menstruation, also appear to contribute to headache development.

Unlike primary headaches, secondary headaches arise from an underlying condition or situation (e.g., illness, pregnancy, or medication). Most secondary headaches are not serious or dangerous, except in rare instances.

Examples of less serious (typically) secondary headaches include:

Serious Headaches and Symptoms

While not a complete list, here are examples of possible serious causes and symptoms of a secondary headache. These are conditions for which you should seek out a medical opinion urgently or get emergency medical help.

Stroke

A stroke develops when blood flow to the brain is cut off. There are two types of strokes—ischemic and hemorrhagic—and both may cause a headache:

  • Ischemic stroke occurs when an artery that supplies blood to the brain becomes clogged.
  • Hemorrhagic stroke occurs when an artery in the brain breaks open and starts bleeding within or around the brain.

A headache from an ischemic stroke is more common in younger patients, those with migraine, and those who have had a larger stroke. The headache classically resembles a tension headache and develops around the same time as the neurological deficit (e.g., weakness or numbness on one side of the body or slurred speech).

A common example of a hemorrhagic stroke is a subarachnoid hemorrhage. This type of brain bleed classically causes a thunderclap headache—an explosive headache that comes on suddenly and becomes severely painful within seconds or less than one minute.

Besides a subarachnoid hemorrhage, a thunderclap headache may also occur with other serious health conditions, including:

Brain Infection

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

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

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

  • Nausea
  • Neck stiffness
  • Confusion
  • Altered consciousness or loss of consciousness
  • Seizures

Brain Tumor

A brain tumor is a collection of abnormal cells that grows in the brain. While headache is a common (and may be the only or worst) symptom of a brain tumor, keep in mind that brain tumors are overall rare occurrences.

The headache from a brain tumor may feel like a migraine or tension-type headache and tends to worsen with coughing or bending over.

A headache from a brain tumor may also be accompanied by nausea and vomiting. This tends to result from increased intracranial pressure (ICP) or hydrocephalus—when there is too much cerebrospinal fluid (CSF) in the brain.

Brain Injury

A headache may occur within days after a traumatic brain injury, such as a concussion. Post-traumatic headaches often feel like a dull, aching sensation felt all over and may be accompanied by dizziness, fatigue, problems with concentration and memory, and irritability.

Post-traumatic headaches due to concussion are generally not attributable to a structural cause, but occasionally can be caused by abnormal blood collections within the skull caused by head or neck trauma.

When to Seek Medical Attention

Below are worrisome signs that your headache may be stemming from a serious underlying condition.

Seek medical attention right away if:

  • Your headache is severe and starts suddenly.
  • Your headache occurs with fever, stiff neck, seizures, fainting, confusion, or neurological symptoms like weakness or numbness.
  • Your headache is accompanied by a painful red eye or tenderness near the temples.
  • Your headache pattern is changing (e.g., becoming more frequent) or interfering with daily activities.
  • Your headache is triggered by sneezing, coughing, or exercising.
  • Your headache occurs after a blow or injury to the head.
  • You are experiencing a new headache or a change in headache during pregnancy or immediately after giving birth.
  • You have a headache and a history of cancer or a weakened immune system (e.g., HIV/AIDS).
  • You are age 65 and over and are experiencing a new type of headache.
  • Your headaches are accompanied by painkiller overuse (indicative of possible medication overuse headache).


Treatment

The treatment of headaches depend on the type and severity.

Primary Headaches

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

For example, tension-type headaches can often be treated with over-the-counter (OTC) pain relievers like Tylenol (acetaminophen) or the nonsteroidal anti-inflammatory drug (NSAID) Advil (ibuprofen). Soaking in a warm bath or drinking a caffeinated beverage may also be helpful.

Likewise, mild to moderate migraines are often treated with NSAIDs. A class of oral drugs known as triptans—for example, Imitrex (sumatriptan)—is used to treat moderate to severe migraines. For those who cannot tolerate triptans, Reyvow (lasmiditan) may be tried.

Napping in a quiet, dark room and applying a cold compress to the forehead can also be effective in helping to soothe a migraine.

For cluster headaches, oxygen therapy (inhaling high flow oxygen), Imitrex (sumatriptan) injection, and Zomig (zolmitriptan) nasal spray may be used as an acute treatment.

Talk With Your Doctor

Before taking any medication for your headache, talk with your healthcare professional. If you are on a blood thinner or have kidney, liver, or ulcer disease, your doctor will want you to avoid certain OTC drugs or take a lower dose.

Secondary Headaches

The treatment of secondary headaches requires addressing the underlying condition.

For example, a sinus headache may be treated with OTC pain relievers like Tylenol or ibuprofen. Your doctor may also recommend saline nasal sprays and/or a corticosteroid nasal spray to reduce sinus inflammation. In rare cases of bacterial sinusitis, an antibiotic may be prescribed.

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

Prevention

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

Primary Headaches

Lifestyle modifications and pharmacologic and non-pharmacologic therapies can help prevent primary headaches.

Migraines, for example, may be prevented by avoiding triggering foods, sounds, and smells, sticking to a regular sleep routine, and engaging in certain therapies like acupuncture. For patients with chronic migraine, Botox or taking a preventive medication may be recommended.

For patients with cluster headaches, a preventive medication, like Calan (verapamil), may be advised. Adopting certain lifestyle behaviors like smoking cessation is also usually recommended.

Secondary Headaches

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

For example, a stroke may be prevented by ensuring that risk factors like high blood pressure and high cholesterol are under control.

Likewise, a post-traumatic headache may be prevented by wearing a helmet during potentially high-impact sports or recreational activities.

Headaches that result from viral infections like the cold or flu can be prevented by washing your hands frequently and getting vaccinated, when applicable.

Summary

Most headaches are not anything 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 features like fever, neurologic deficit, pregnancy, older age, or a weakened immune system require prompt medical attention.

A Word From Verywell

No doubt, headaches can be burdensome and stressful to deal with. If you have been diagnosed with a headache disorder, remain committed to finding ways that help you obtain the relief you deserve. During your headache journey, don't hesitate to reach out to loved ones or a support group for emotional guidance and comfort.

Frequently Asked Questions

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

    Headaches in the morning have multiple possible causes. They may be a primary headache like a migraine or tension-type headache. They may also arise from a hangover, caffeine withdrawal, or an underlying health problem like sleep apnea.

  • What is a tension headache?

    A tension headache (also called a tension-type headache) is the most common form of headache. It causes pressure or a tightening sensation around the head or neck and can last from 30 minutes to seven days.

  • What does a COVID headache feel like?

    There are different descriptions of headaches reported in patients with COVID-19. A typical one is a moderate-severe headache located on both sides of the head, forehead, or around the eyes, that is throbbing or pressing in nature.

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By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.