When Should You Worry About a Headache?

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You get a splitting headache. It happens. You shouldn’t worry that it’s life-threatening, right?

Probably. Yet it could be—so take heed, and consider Game of Thrones actress Emilia Clarke.

One minute she was working out with a trainer in a trendy London neighborhood. The next, the 24-year-old was assailed by a piercing headache, accompanied by vomiting. She’d suffered a life-threatening rupture of a blood vessel in the space surrounding her brain.

The good news is that such horrific headaches—called subarachnoid hemorrhages (SAH)—are rare, striking only one in 10,000 people. The bad news is that those who do suffer need immediate medical attention and brain surgery.

“Surprisingly, headaches are not caused by the brain itself,” says Dr. James Grotta, Neurologist, Memorial Hermann Medical Group, Director of Stroke Research, Clinical Institute for Research and Innovation, Memorial Hermann-Texas Medical Center and Director, Mobile Stroke Unit Consortium. “The blood vessels and the lining around the brain are sensitive to pain. Things that affect bones of the neck and spine also may cause headaches by irritating vessels.”

What else do you need to know? Dr. Grotta gives us the 411 on which symptoms signal an emergency, merit a doctor’s visit—or just require patience and pain relievers.

Q: When Should You Be Alarmed?
A: If you get the worst headache of your life, clearly different from any you’ve had before, and it’s sudden, you must be checked out immediately, Dr. Grotta says. “The same goes for any headache that you’d rate as 9 or 10 on a scale of 1 to 10.”

Such headaches could be due to a torn artery (subarachnoid hemorrhage).

Also worrisome are extreme headaches accompanied by a stiff neck, fever and possibly lethargy, nausea or loss of appetite. They may be due to meningitis, an inflammation of the meninges—membranes that coat the brain and spinal cord.

Annually, some 200,000 Americans are diagnosed with meningitis, which is due to a viral or bacterial infection transmitted via airborne droplets. The disease may improve on its own or require antibiotics. Vaccines may thwart some types of meningitis.

Also be evaluated if your headaches persist, worsen or otherwise change in character and pattern. “In rare cases—emphasis on rare—you may have a brain tumor,” Dr. Grotta says.

Q: When Should You See Your Doctor?
A: “Any headache that impairs your quality of life or prevents you from functioning at work or school should be evaluated,” Dr. Grotta says. “Treatments can bring relief.”

Q: What Are Other Causes of Headaches?
A: Big indicators are the intensity and location of your discomfort.

Headaches may be due to an infection of the sinuses within the bone behind your eyes. The pain isn’t severe but may be chronic, Dr. Grotta says. Antibiotics can attack germs, when needed. Nasal antihistamine sprays, decongestants and topical nasal corticosteroids can ease discomfort.

Tenderness in your temple—AKA temporal arteritis—stems from an auto-immune attack on blood vessel walls. Pain strikes twice as many women as men, usually after age 50. Though not intense, these headaches should be heeded—and treated with steroids to suppress your immune response.

Over-the-counter meds are not enough. “NSAIDs (nonsteroidal anti-inflammatory drugs) or other over-the-counter medicine may mask pain, but doesn’t treat the underlying disease,” Dr. Grotta says.

Swollen vessels curb blood flow to your eyes, which can cause permanent vision loss.

When you hurt or experience stiffness at the base of your head or neck which worsens with movement, you may have arthritis. Anti-inflammatories can help.

Stress can make muscles spasm or tighten, resulting in tension headaches. “These feel like a band of pain around the head,” Dr. Grotta says. “They wax and wane in severity.”

Anti-inflammatories, muscle relaxants and stress reduction can help.

Soreness and numbness at jaw joints is known as TMJ, short for temporomandipular joint. It often can be eased by relaxation techniques, over-the-counter pain relievers, anti-inflammatory drugs or muscle relaxants.

Four of five people who get cluster headaches, lower in the face, are men. Neurochemical irritation within vessel walls leads to this pain, which can be treated with hypertension-lowering calcium channel blockers or other drugs. Quitting alcohol use and smoking may prevent future clusters.

Q: Why Do Some People Get Migraines?
A: Migraine throbbing tends to be on one side and may make you nauseous or sensitive to light and sound.

The onus most likely falls on hypersensitive pain receptors in the lining of blood vessels in your scalp, Dr. Grotta says.

Estrogen fluctuations may trigger misery, and explain why women are more likely to have migraines than men. “Migraines tend to run in families, but not always,” he says. “As with tension headaches, migraines often are due in part—not entirely—to fatigue, anxiety, depression, smoking, drinking and poor posture.”

Unlike many headaches, migraines affect multiple parts of the body. It pays to keep a migraine journal noting frequency, stress levels and what you’ve eaten before an attack, as well as what improves your symptoms.

According to Dr. Grotta, not only can migraines be disabling, leading to hours or days of being unable to work, but there’s a link to stroke risk. “Migraines, smoking and birth control hormones are a bad combination,” he says.

Treatment should be discussed with your primary care physician, as some drugs may raise stroke risk by further hardening arteries.

“The first line of treatment is analgesics and NSAIDs, which help half of sufferers,” says Dr. Grotta.

Other medicines that lessen or prevent suffering include Botox® injections to block nerve signals to muscles, the anticonvulsant Topamax® and new drugs that target an inflammation-aggravating protein called calcitonin gene-related peptide (CGRP).

A healthier lifestyle of rest, exercise and a diet high in fruits and vegetables while low in alcohol, caffeine, preservatives and nitrites also may thwart or lessen migraines.

 

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