Seven red flag symptoms that mean your headache could be serious

Most people have an occasional headache and will normally grin and bear it, or pop a few painkillers and wait for it to dry. But what if your headache is more than a dull ache and the pain persists? Does it mean you have a serious brain disease?

Probably not, say medical experts. While it’s easy to panic if your headache really hurts and the pain won’t go away, most headaches are still nothing to worry about, doctors say. But that doesn’t mean they’re never a sign of something more troubling—you just have to know what to look for to spot the rare occasions when your head actually needs examining.

“Headache is the most prevalent symptom in the general population, with 97% of people experiencing headaches at some point,” says consultant neurologist Dr Fayyaz Ahmed, trustee of the International Headache Society. “The good news is that the vast majority – nearly 99% – are benign, meaning they do not have a serious underlying cause. Only 1% or even less are serious.”

And Dr Ben Turner, consultant neurologist at London Bridge Hospital, part of HCA Healthcare UK, confirms: “Headaches are usually unpleasant but harmless and only occasionally serious.

“The worst headaches are sudden onset, severe, unrelenting and not relieved by rest or lying down. If they are associated with additional features such as fever and cognitive problems, then they are more concerning.”

Turner emphasizes that this is a general guideline and points out: “Each individual case must be considered and any doubts should be addressed with formal medical advice.”

What are the different types of headaches?

The two major categories of headaches are secondary and primary headaches. Turner says secondary headaches can be caused by bleeding or tumors in the brain, and also by something less sinister, like 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.

Tension headache

“Sometimes people have a headache that feels like their head is being squeezed or they have pressure inside their head,” explains Ahmed, who is also a professor of neurology at Hull York Medical School. “This is often called a tension headache and does not have nausea, vomiting, or sensitivity to light, sound, or smell.”

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

The NHS says drink plenty of water – headaches can be a symptom of dehydration – plenty of rest and relaxation can help relieve some headaches.

Migraine

The second type of primary headache is migraine. The Migraine Trust says migraine attacks can last from four to 72 hours and have a wide variety of symptoms, often including a severe throbbing headache that is usually, but not always, on one side of the head.

Ahmed says: “If you don’t have a severe headache, then the most likely headache you have is a migraine. This is more common in women (22%) than men (8%). In migraine, you have a moderate to severe, one-sided or both-sided, throbbing or throbbing headache (feels like your heart is beating in your head), with nausea and/or vomiting, and sensitivity to light, sound, and smell. Most migraine sufferers would prefer to go lie down in a dark, quiet room and avoid physical activity.”

A third of migraine patients have symptoms suggestive of a stroke, such as flashing lights, zigzag lines, blurred vision, pins and needles, and weakness in the arms or legs that last less than an hour and come on gradually, he explains Ahmed. “This is called the aura and it resolves in about an hour, followed by headaches,” he says. “It often raises the alarm of a stroke, but unlike a stroke, the symptoms develop gradually over minutes and resolve within minutes.”

There are many treatments for migraines, Turner points out, adding, “Migraines are usually underdiagnosed and many people suffer needlessly. There are now many dedicated treatments that can transform people’s lives.”

7 headache symptoms that should be checked

Ahmed says, “There are red flag symptoms that mean the chance of a serious underlying cause is high and you need to see your doctor and be referred.”

The most common red flags that suggest a headache needs to be checked out are…

1. Sudden onset

The sudden onset of a severe headache can be cause for concern, Turner says—an example would be if the headache is at its peak in less than a minute or two. Ahmed describes them as flash headaches and explains: “This is a sudden onset of headache, like someone hitting your head with a cricket bat.”

2. Sore throat and fever

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

3. Possible stroke symptoms

If you have a headache along with symptoms such as double vision, vision loss, altered consciousness, weakness in a limb, or seizures, these could be signs of a stroke and should be checked out even if they are short-lived. Ahmed says, “Headaches associated with vision loss, weakness, slurred speech, or any other focal symptoms that persist for more than an hour require medical attention.”

4. Headaches that wake you up at night

Turner says that if a headache wakes a patient at night or worsens when lying down or in the morning, it may be associated with increased pressure in the head. This increased intracranial pressure, or intracranial hypertension (IH), can occur suddenly after a severe head injury or stroke, according to the NHS, or, rarely, it can be a persistent, long-term problem with no clear cause.

5. Headaches caused by exertion

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

6. The change from normal

If a pre-existing benign headache changes characteristics, it’s worth checking that out, too, Ahmed says.

7. Headaches in the elderly and those with pre-existing medical conditions

The new onset of headaches in people over 50 or those taking steroids, or who have had cancer or HIV could be a red flag, warns Ahmed.

Turner adds, “The older the patient, the more likely a headache is associated with a more serious condition.”