When to Worry About a Headache (2024)

Most headaches 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.

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:

• Sinus headaches stem from sinus inflammation/infection and are usually associated with thick nasal green or yellow discharge.
• Post-infectious headaches are usually caused by viruses like the common cold, flu, or COVID-19.
• Cold-stimulus headaches, also known as ice-cream or brain freeze headaches, occur after eating cold foods or exposing the unprotected head to low temperatures.
  
• Cervicogenic headaches are caused by a bone, joint, or soft tissue problem in the neck.

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 strokeoccurs when an artery that supplies blood to the brain becomes clogged.
• Hemorrhagic strokeoccurs 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:

• Reversible cerebral vasoconstriction syndrome (blood vessels in the brain suddenly narrow)
• Cervical artery dissection (formation of a tear in the wall of the carotid or vertebral artery in the neck)
• Pituitary apoplexy (bleeding into or loss of blood supply to the pituitary gland, located in the brain)
  

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.

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 astriptans—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.

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 acorticosteroid 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 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.