Severe Headaches: When to Worry About a Headache

By Ellen Fan, MD
Medically reviewed
January 15, 2020

Most people have had a headache at some point in their lives. While uncomfortable and unwelcome, headaches are usually not a cause for worry. The majority of them can be treated relatively easily with lifestyle adjustments and/or over-the-counter (OTC) headache medicine.

However, severe headaches are worth paying attention to. Not only can they be bothersome, but they can also be a sign of more serious health concerns. Paying attention to your symptoms will guide you in deciding when to see a doctor for further evaluation. Here, we’ll discuss the symptoms of severe headaches in adults and children, and what they could mean. If you’re uncertain or concerned, a consultation with a medical professional can be helpful.

What Causes Severe Headaches

Understanding the causes of severe headaches is important. You–and your doctor–need to know whether the intense pain you feel is a symptom of something more serious.

There are an estimated 300+ types of headaches, and about half of the adult population worldwide has had a headache in the last year. In the U.S, severe headaches and migraines affect about one out of five women, and one out of ten men.

Severe headaches can be caused by anything from flares of chronic headache conditions, such as tension headaches and migraines, to more concerning conditions.  These conditions can include, but are not limited to:

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When to Worry About a Headache

What is considered a serious headache? Given that everyone’s threshold for pain is different, how do you know when to worry about a headache?

Most headaches are occasional and tend to go away within a few hours with simple home remedies, lifestyle adjustments, and sometimes OTC headache relief. However, you should pay attention to a change in your usual headache pattern, more severe and persistent headaches, and other new symptoms, such as:

  • Vomiting
  • Vision changes
  • Confusion, or changes in thinking
  • Neck pain or stiffness
  • Neurological symptoms like problems talking or walking, or weakness or seizures
  • Painful red eye

You should also pay particular attention if you are more at risk for problems, such as:

  • Recent blow to head or accident
  • You have already been diagnosed with cancer or a condition that causes weakened immune system

Headaches in Children and When to Worry

Just like with adults, it’s common for children to have headaches. And just like adults, common headaches usually come and go, and will often disappear on their own, or with some rest, fluids, food, and on occasion, OTC headache medication.  Teenagers especially are more likely to suffer from headaches Especially those with stressful home or school situations, lack of exercise, or caffeine, smoking, or alcohol use.

In children, reasons to seek the advice of your doctor would include:

  • Headache that wakes your child from sleep
  • Headache that becomes more frequent or more intense in pain
  • Headache with changes in your child’s personality, thinking or vision, or weakness or seizures
  • Headache that develops after a head injury or fall
  • Severe headache and vomiting
  • Headache accompanied by fever and neck pain or stiffness

Living with Headaches

If you suffer from chronic headaches, there are measures that you can take when they flare, including:

  • Drink plenty of water/fluids
  • Rest in a dark, quiet room
  • Put a cool cloth on your forehead
  • Take all headache medications, whether prescribed or OTC, as instructed
  • Keep a headache diary to record triggers and patterns, which may help manage the onset of symptoms

To help prevent chronic headaches from flaring, drinking adequate fluids daily, eating regular meals, getting sufficient sleep every night, and stress management are important. Incorporating relaxation techniques into your daily lifestyle routine may help minimize head pain, as well as yoga, biofeedback, meditation or acupuncture.

Sometimes, your doctor may prescribe daily medications to prevent headache flares, or recommend that you keep a headache diary to find out what in your environment may trigger your headaches. Common triggers include stress, lack of sleep, alcohol, and certain foods, like processed meats and cheeses. Avoiding these triggers may keep headaches away.

When to See a Doctor

Severe headaches can be a symptom of something that requires ongoing attention and treatment, like high blood pressure. However, it can also be a sign of a serious, life-threatening illness or medical emergency that may need immediate attention. It is important to recognize the following health emergency scenarios:

  • Headaches and fever, confusion, neck pain and/or stiffness, and/or decreased alertness could be a sign of an infection in the brain or spinal cord.
  • Presence of neurological symptoms, like problems walking or talking, weakness, or seizures which can be a sign of a bleed or tumor in the brain.
  • Headaches after a head injury, with loss of consciousness, vomiting, confusion, or difficulty with balance, coordination, or concentration.
  • Headache in the setting of extreme heat or dehydration, especially when there is also weakness/dizziness, nausea/vomiting, or elevated heart rate or problems breathing.
  • Headache in pregnant women in their third trimester can be a sign of preeclampsia, although some women can get it as early as 20 weeks. Preeclampsia may cause high blood pressure and damage to the kidney or liver, brain injury, and/or other serious problems. Preeclampsia headaches require medical attention to prevent serious complications for both the mother and the baby.

You should talk to your doctor in the following situations to help determine if your severe headache is a cause for concern and to help with your headache pain:

  • An unusual or sudden severe headache, especially one that wakes you from sleep
  • A significant change in headache patterns
  • Headaches accompanied by eye pain or vision changes
  • Post-concussion headache
  • Headaches in patients with cancer or impaired immune systems

Headache Testing

Diagnosis is key to treating severe headaches. To get to the bottom of what’s causing your intense head pain, your doctor will start off by asking about your symptoms and general medical history, and then conduct a physical exam.  The physical exam may involve an examination of your eyes, your heart and lungs, your muscles, and your nerves, as well as a review of your blood pressure and other vital signs. Often this may be enough to determine whether your severe headache is a cause for concern. Sometimes, your doctor may recommend some treatment, such as lifestyle changes or medications (OTC or prescribed), and then have you return for follow-up.

On occasion, your doctor may also recommend one or more of the following exams or imaging tests:

  • Full eye exam
  • Blood test
  • CT scan of the brain
  • MRI scan of the brain
  • Spinal fluid test (lumbar puncture)

It’s worth noting that in cases of severe tension headaches, migraines, and cluster headaches, results from imaging scans, like CTs and MRIs, may be normal. However, these tests can be helpful when your doctor is concerned about checking for another cause for your severe headaches.

If your doctor determines that heatstroke or severe dehydration are the causes of your serious headaches, you may be treated with intravenous fluids. If the cause is high blood pressure, your doctor will likely prescribe a daily blood pressure medication. If your headache improves with treatment of the underlying condition, this helps determine what is causing your headache.

When headaches are difficult to treat or require additional expertise, your doctor may refer you to a specialist, like a neurologist.

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How K Health Can Help

Sure, headaches are common. But if you find yourself or your child suffering from severe headaches, it’s vital to find out whether further evaluation or treatment are needed. Using K Health’s virtual diagnosis tool will help you quickly determine whether the symptoms surrounding your severe headache pain may indicate a more serious underlying condition. Our doctors are here to provide insight that may lead you to making more informed decisions about getting the right medical attention and treatment sooner rather than later.

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Ellen Fan, MD

Dr. Fan has a Bachelors of Arts degree in Human Biology and a Doctorate in Medicine from Stanford University. In addition to her work with K Health, Dr. Fan is a primary care physician in Indianapolis, Indiana.

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