Headache Danger Signs: Which Symptoms Call For Emergency Care? : Shots

A woman with a temperature stays home, wrapped in a scarf while drinking hot tea.

Of all of the aches and pains I spend my days investigating as a household physician, none appear to be as anxiety-provoking as a headache. And that is typically true, each for sufferers questioning, “Might this be one thing harmful?” and for clinicians attempting to get to the basis of ache that may be completely unexplained and but utterly debilitating.

Considerations about complications in my follow have picked up over the previous 12 months as we have seen them as a symptom in acute COVID-19 infections and amongst long-haulers — and extra lately when information broke in regards to the (very, only a few) mind clots linked to the Johnson & Johnson vaccine.

Although we’re all one Google search away from assuming a worst-case situation when a headache strikes, the chances are overwhelmingly in our favor right here. Analysis exhibits that the overwhelming majority of complications are what’s recognized medically as “major,” that means they don’t seem to be the results of another underlying situation. In different phrases, your headache is unlikely to be attributable to a critical or life-threatening drawback.

Harmful complications additionally are inclined to have some distinctive options and patterns – and they are often laborious to disregard. Here is an outline of these crimson flag signs, and whenever you want same-day or emergency care:

The worst headache, very quickly flat

You might have been advised to be cautious of a sudden headache, however simply how sudden does it need to be to be a crimson flag? It is lots faster than you’d assume.

We’re speaking by way of seconds – the headache comes on quick with an depth that stops you in your tracks, feels downright insufferable, and the ache peaks inside lower than a minute or so (though the headache might proceed for longer). That is referred to as a thunderclap headache, and sufferers have a tendency to explain it as explosive, or “the worst headache I’ve ever had.”

Mia Minen, a neurologist and chief of headache analysis at NYU Langone Well being, says it is like “the snap of the finger: 10 out of 10 ache.”

That stands out from a typical headache that tends to creep up over a number of minutes or an hour, linger some time and worsen as time wears on. Though different non-life-threatening headache syndromes similar to migraine or cluster complications may nonetheless usher in the identical ache depth, these have a tendency to construct extra progressively or might even be preceded by an aura (sensory signs similar to tingling or spots in your imaginative and prescient).

Thunderclap complications are an indication of one thing critical till confirmed in any other case, given their hyperlink to mind bleeds — issues similar to ruptured aneurysms or different hemorrhages, although they are often associated to different lots or lesions within the mind as properly.

Don’t delay medical care with a headache similar to this – it is an emergency, so name 911 or have somebody show you how to to an emergency room. That’s true for folks of any age, with or with no historical past of complications, and whether or not or not it is accompanied by different signs similar to vomiting or passing out.

Nervous system signs

My sufferers and their households will let you know I typically belabor the identical checklist of stroke signs that all of us have to be prepared to acknowledge early. If a headache accompanies one in all these signs, do not cease to consider the timing or severity, or actually something in any respect concerning that headache – simply name 911.

The checklist of signs to look at for consists of: abrupt weak spot total or in an arm or a leg, new numbness, modifications in speech, confusion or hassle understanding and expressing ideas clearly, facial droop or sudden hassle strolling. It is also important you get speedy take care of modifications in consciousness similar to issue waking up, being in a stupor, passing out or having a seizure.

Adjustments from movement

This subsequent group of signs deserve same-day consideration by your major care supplier. If you do not have one, or cannot get a immediate appointment, go to an pressing care clinic.

Probably the most essential questions they are going to ask you in regards to the headache is what’s making the ache higher or worse. Take discover if the ache sharpens intensely with day-to-day actions — issues similar to bending over, rolling over in mattress and even bearing down whenever you’re having a bowel motion.

And alongside the identical traces, it might not be an atypical headache if the ache will get a lot worse when mendacity flat and higher with sitting or standing. We name {that a} “postural” headache, and it may be an indication of lots placing stress on the mind or spinal twine, and has been recognized to occur with blood-clotting occasions within the mind. This sort also can current as a brand new morning headache that is extreme and may include vomiting.

There is a acquainted various to this: a headache that will get subtly worse standing up and is best mendacity down. This may be an indicator of dehydration (or low blood stress, typically attributable to dehydration and medicines, amongst different issues). It is actually no totally different than a hangover headache, although I hear complaints of this on a regular basis from sufferers who admit they reside off dehydrating drinks similar to espresso or soda. Thankfully there is a fast repair: Drink extra water.

But when such a ache sample is especially pronounced with a dramatic improve in ache whenever you arise, or you may’t moderately attribute it to being just a little dehydrated (i.e., thirsty, with dry lips and scant or darker urine), it is essential to get checked out.

Stiff neck

One other signal to look at for: Together with the beginning of your headache, your neck feels so stiff that it is troublesome, even painful, to maneuver. This could possibly be an indication that one thing’s brewing within the mind, spinal twine or the fluid surrounding it – meningitis being the massive one, and that is value a same-day medical examination, even when there isn’t any different signal of an infection, similar to fever.

Deviation out of your patterns

Do not get too targeted on the ache degree of your headache, cautions Peter Goadsby, a UCLA neurologist and president of the American Headache Society.

As an alternative of fixating on ache severity, take into consideration whether or not any characteristic of your headache is out of the atypical for you. Examine the headache with others you have had over the course of the previous few days, weeks or months.

“Folks have a standard false impression that if it feels actually dangerous, you are going to die or one thing dreadful is at all times taking place, and that is simply incorrect,” Goadsby says. He notes frequent headache problems – similar to migraine, his specialty – may cause horrible ache however aren’t essentially suspicious.

It might be useful to ask your self, “Is that this new for me?” If the reply is sure, it is essential to comply with up together with your physician.

New headache options could possibly be a change within the timing of headache, ache in a single space that by no means switches sides, a brand new or totally different aura beforehand or signs similar to nausea or vomiting that you have by no means had earlier than. And the identical is true for complications that get progressively worse over time, do not reply to medicines, or any kind of headache that retains coming again for somebody who hasn’t had hassle with them prior to now.

Even so, simply bear in mind ache degree can nonetheless sign an emergency when you get that thunderclap-style headache talked about above, which Goadsby likens to “a baseball bat to the again of the pinnacle.”

Belief your intestine

For medical doctors, maybe an important issue after we’re investigating a headache is nothing to do with the headache itself however as an alternative the particular person experiencing it.

What looks like an harmless headache in a wholesome particular person could possibly be one thing important for folks with persistent sicknesses similar to HIV, most cancers or perhaps a historical past of most cancers — if that is your state of affairs, you must have a decrease threshold to succeed in out to a physician with any kind of headache that is new. Likewise, it is OK to be extra guarded about complications when you’re pregnant, over age 50, have disabilities or have suffered latest trauma similar to a fall or concussion.

As with most issues within the human physique, it would not assist to be too inflexible whenever you’re enthusiastic about what’s “critical sufficient” to fret about. When a headache provides you the sensation that one thing’s not proper, belief your intestine — both get speedy, pressing care or write down all the main points in a headache log, take it to your physician and begin asking questions.

Kristen Kendrick is a board-certified household doctor in Washington, D.C., and a well being and media fellow at NPR and Georgetown College Faculty of Medication.


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