When should you worry about headaches

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When to Worry About Headaches

Headaches are a common ailment, but certain types and symptoms can indicate more serious health issues. Understanding when to worry about a headache can help in seeking timely medical intervention.

Unique or Different Headaches

A headache that is unique or different from previous headaches should raise concern. This is especially true if it is associated with symptoms like meningismus, focal neurologic symptoms (e.g., oculoparesis, cranial nerve palsies, hemiparesis), or loss of consciousness, particularly if the onset is recent and acute.

Headaches in Older Adults

For individuals over 50, new types of headaches warrant testing for temporal arteritis, a treatable but potentially devastating condition. Temporal arteritis can present with a slower, subacute course but may also produce focal neurologic deficits.

Headaches During Pregnancy

Pregnancy increases the risk of secondary headache disorders due to physiological changes. Red flags for secondary headaches in pregnancy include severe pain, systemic features like elevated blood pressure, and abnormal lab tests (e.g., thrombocytopenia, elevated liver function tests, proteinuria). These symptoms can indicate conditions such as hypertensive disorders, vascular problems, or infections .

Severe Acute Headaches

Severe acute headaches require immediate medical evaluation to rule out conditions like subarachnoid hemorrhage and bacterial meningitis. Temporal arteritis should be excluded in older patients with recurrent headaches of recent onset.

Pediatric Headaches

In children, headaches are often benign but can sometimes indicate serious conditions like brain tumors, central nervous system infections, or hydrocephalus. Red flags include abnormal neurological exams, headaches that wake the child from sleep, recent and progressive severe headaches, and new headaches in immunocompromised children .

Non-Benign Headaches

Non-benign headaches can be caused by conditions such as cervical artery dissection, cerebral venous thrombosis, pseudotumor cerebri, hypertensive encephalopathy, acute angle glaucoma, hydrocephalus, giant cell arteritis, meningitis, and subarachnoid hemorrhage. These conditions require prompt diagnosis and treatment.

Diagnostic and Treatment Approaches

A thorough history and physical examination are crucial in identifying potentially dangerous headaches. Neuroimaging studies or lumbar puncture may be necessary for severe cases. For pregnant women, non-pharmacological treatments are preferred, but medication may be considered if necessary.

Conclusion

While most headaches are benign, certain symptoms and patient demographics necessitate a higher index of suspicion for serious underlying conditions. Recognizing red flags and seeking appropriate medical evaluation can prevent potentially life-threatening complications.