Although headaches are common and often nothing to worry about, sometimes they’re a sign of something more serious like a stroke or an aneurysm.

The continuous head pain known as headache comes in many different forms.

From common types like tension and cluster headaches to rarer ocular or vestibular migraine, it’s estimated that as much as 99% of the population has experience headache at some point.

It’s understandable to fear the worst when your head hurts. But most headaches are the kind without a dangerous underlying cause. Even so, learning more about certain red flags can help you know when to be concerned about a headache.

There are signs that indicate when to worry about a headache. Knowing what to watch for can help you decide when to seek medical advice.

Severe and sudden onset

Sometimes described as the worst pain you’ve ever felt, an agonizing headache that comes on suddenly requires immediate medical attention.

A ruptured aneurysm can cause this type of headache, along with additional symptoms like:

  • nausea
  • double vision
  • seizures
  • light sensitivity
  • loss of consciousness
  • cardiac arrest

Accompanying fever or stiff neck

Headache with a fever or stiff neck can indicate the presence of infection affecting the brain or spinal cord. This infection leads to a type of inflammation:

  • meningitis: inflammation of the membranes surrounding the spinal cord and brain
  • encephalitis: inflammation of the brain
  • myelitis: inflammation of the spinal cord
  • encephalomyelitis: inflammation in both the brain and spinal cord

Untreated brain or spinal cord infections can lead to complications like permanent brain and nerve damage.

Prompt treatment increases the chance of a full recovery. Treatment consists of medication like an antibiotic or antiviral, depending on the type of infection present.

A history of neoplasms

A neoplasm, or tumor, is an atypical mass of tissue. Neoplasms can be malignant (cancerous) or benign (not cancerous). A history of neoplasms, either in yourself or your family, increases the chance of new tumors occurring.

Usually, there are other symptoms besides headache. It’s possible to have a brain neoplasm with headache as the only symptom, but this occurs in only 1% of instances.

Additional symptoms to watch for include:

  • memory issues
  • confusion
  • fainting
  • focal neurological symptoms (functional brain or nerve deficit)
  • seizure

Tumors can be benign and still cause these symptoms. According to 2019 research, headaches associated with brain tumors are also worsened with activity that increases intracranial pressure, such as:

  • bending over
  • vomiting
  • coughing

Change to previous headache pattern

If you have a history of recurring headaches, you might not worry about another episode of head pain even if it’s different than you’re used to. Maybe the pain intensity has changed, or it’s in a different area of your head.

Changes to your previous headache type or pattern may be cause for concern because people with primary headache disorders can still develop conditions that cause secondary headaches.

Triggered by position

If your headache intensifies or fades based on your body position, this is a sign of a potentially serious condition involving your cerebrospinal fluid (CSF). 2022 research suggests that positional headaches due to CSF Leak worsens with standing up and is improved with laying down.

Positional headaches, also called orthostatic headaches, can occur if you have a CSF leak or pressure change.

Brought on by coughing

A painful and lasting headache that occurs after you’ve been coughing may be another reason to see your doctor. According to a 2021 study, coughing headaches are linked to tension headache and migraine.

Mild coughing headaches are often not a cause for concern, but if yours occurs with signs like a loss of balance, dizziness, or fainting it may indicate the presence of another condition such as:

Neurological symptoms to watch out for

Neurological symptoms relate to the brain, spinal cord, and peripheral nerves. When they accompany a headache, it’s often because of an underlying cause that needs medical treatment.

See your doctor if your headache occurs with symptoms like:

  • vision changes
  • fainting
  • confusion
  • weakness
  • loss of balance
  • numbness or tingling

Early signs of a stroke

A stroke may cause sudden onset of any of the following:

  • weakness or numbness, often on one side of the body
  • confusion
  • trouble with speech or understanding language
  • vision trouble in one or both eyes
  • loss of balance or dizziness
  • coordination loss or trouble walking
  • severe headache with no apparent cause

The F.A.S.T. test can help you check for signs of stroke. If any are present, call 9-1-1 immediately.

F – face: unusual asymmetry or drooping on one side

A – arms: inability to raise both arms without one drifting downward

S – speech: strange or slurred speech

T – time: according to the Centers for Disease Control and Prevention (CDC), the most effective stroke treatments are available only within the first 3 hours of the initial symptoms.

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Headaches can be painful and debilitating, but an estimated 90% are the result of a type of primary headache disorder, which is the type of headache without a known pathological cause. Common examples of primary headaches are:

  • migraine
  • cluster headaches
  • tension headaches

Secondary headaches are headaches that are due to another underlying medical condition. Common secondary headaches include:

  • vascular disease
  • trauma
  • infection

Headache as the result of a mental health issue is also considered secondary.

Physical injury is a common cause of secondary headaches. A cervicogenic headache from muscle injury or a concussion headache are examples.

A concussion can cause continuing issues if you don’t get enough post-accident rest, so it’s important to note that this type of injury can occur even without a direct impact to the head.

The American Association of Neurological Surgeons (AANS) indicates that rapid acceleration-deceleration events like blast injuries or whiplash without head impact can cause concussions.

Headaches after an injury

Mild cervicogenic or concussion headaches can self-resolve with rest and home care. But some post-injury headaches are more serious.

Seek medical help if your post-injury symptoms include:

  • persistent and worsening headache
  • vomiting
  • convulsions or seizures
  • decreased coordination
  • weakness or numbness
  • behavioral changes
  • slurred speech
  • uneven pupil size
  • confusion
  • mood changes
  • loss of consciousness or excessive drowsiness

These signs may indicate potential post-injury complications like blood clots in the brain.

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Your primary care doctor may be able to recommend treatment that helps your headaches.

If not, they can refer you to a neurologist. This is a specialist with expertise in conditions affecting the brain, spinal cord, and peripheral nerves. Neurologists can look for headache causes using tools like neurological exams and imaging tests.

Most headaches are the primary type. This means there isn’t a known pathological cause, and they’re usually not cause for concern.

Secondary headaches may have a known cause that’s not serious, like a cervicogenic headache from whiplash. Other secondary headaches have serious causes that need prompt medical attention, like a stroke or brain tumor.

If necessary, your primary care doctor can refer you to a neurologist for more testing and treatment options.