Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

When does a headache need to be seen at the hospital?

Chaim Colen, MD
Conditions
September 20, 2010
Share
Tweet
Share

shutterstock_143846479

As a neurosurgeon, I encounter a lot of people who are concerned with ruptured brain aneurysms (blood vessel blisters). Ruptured brain aneurysms typically present with severe headache. I am incessantly asked, “When is a headache more than just a headache? When should I go to the hospital?”

A headache is considered to be pain located anywhere in the region of the upper neck or head.  It is one of the most common locations of pain in the human body and can have many difference causes.  There are three major categories of headaches which include primary headaches, secondary headaches, and cranial neuralgias which can be associated with facial pain.

  • Primary headaches include tension, migraine, and cluster headaches.
  • Secondary headaches are those due to something affecting the underlying structure of the head and neck.  Causes include bleeding in the brain, tumors, meningitis, and encephalitis.
  • The third type of headaches which involve neuralgias and facial pain are usually caused by inflammation of the nerves in the head and neck.

Tension headaches are the most common type of primary headache and are more common in women than men.  Their cause is unknown but thought to be due to the contraction of the muscles covering the skull.  Tension headaches usually occur because of physical or emotional stress placed on the body.  Symptoms of a tension headache include pain which is described as “tightness” that begins in the back of the head and upper neck.  It is usually mild in intensity, bilateral and not associated with vomiting or sensitivity to light.  Usually, these headaches do not impair function.

Migraine headaches are the second most common type of primary headache and are also more common in women than men.  They are associated with unilateral headache, nausea, vomiting, and sensitivity to light.

Cluster headaches are rare primary headaches and occur more commonly in men than women.  The cause of cluster headaches is unknown.  They tend to run in families, which suggest genetics may play a role.  They may be triggered by changes in sleep pattern and by certain medications.  Symptoms of a cluster headache include unilateral pain in the face and head that is sharp in quality and very short in duration.  The pain is usually excruciating and the eyes and nose may become watery.

Secondary headaches include causes such as head and neck trauma, blood vessel problems in the head and neck (ruptured brain aneurysms fall into this category), non-blood vessel problems in the brain, medications, infection, and changes in the body’s normal environment, problems with the structures of the head, and psychiatric disorders.

Headaches are treated differently depending on the type, cause, and nature of the headache.

Tension headaches are usually treated successfully with medications such as aspirin, ibuprofen, acetaminophen and naproxen.  If these fail, supportive treatments should be sought out such as massage, biofeedback, and stress management.  If mild, migraine headaches are usually first treated with non-steroidal anti-inflammatory agents or NSAIDs.  The drugs of choice for migraines are considered to be triptans such as Imitrex, Maxalt, Amerge, Zomig, Axert, Frova, Relpax, and Treximet.  Some other medications used include ergots, anit-nausea medications, butalbital combinations, and opiates.  Cluster headaches are usually treated with inhalation of high concentration of oxygen, injection of triptan medications, injection of lidocaine, ergotamines, and caffeine.  Preventative medications include calcium channel blockers, prednisone, lithium, and valproic acid.

When should a headache be treated?

A patient should seek medical care it for a headache when it is considered the “worst headache of his/her life,” different than a usual headache, starts suddenly or is aggravated by physical exertion.  Medical care should also be sought if the headache is associated with nausea and vomiting, fever, stiff neck, seizures, trauma, changes in vision, changes in speech, changes in behavior, weakness, is getting worse, and/or is disabling.

Why should a headache be treated?

A headache should be treated because it may be caused by something serious or be associated with a worsening condition and if left untreated may even lead to death.  Headaches should also be treated so that it does not become disabling and impair normal function.  Overtreatment should be avoided due to the fact that some medications, once stopped, may cause rebound headaches. So, to answer my simple original question, “When is a headache more than just a headache?” with a simple answer; any headache that presents with neurological deficits and is different than a usual type of headache that you suffer, requires medical attention.

Chaim Colen is a neurosurgeon. He can be reached on Twitter @MyNeurosurgeon.

ADVERTISEMENT

Image credit: Shutterstock.com

Prev

Social anxiety assumptions and their solutions

September 20, 2010 Kevin 0
…
Next

How can anyone deny scientifically sound treatment for breast cancer?

September 20, 2010 Kevin 8
…

Tagged as: Hospital-Based Medicine, Specialist

Post navigation

< Previous Post
Social anxiety assumptions and their solutions
Next Post >
How can anyone deny scientifically sound treatment for breast cancer?

ADVERTISEMENT

More in Conditions

  • Addressing menstrual health inequities in adolescents

    Callia Georgoulis
  • Healing beyond the surface: Why proper chronic wound care matters

    Alvin May, MD
  • Why specialist pain clinics and addiction treatment services require strong primary care

    Olumuyiwa Bamgbade, MD
  • What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

    William J. Bannon IV
  • Facing terminal cancer as a doctor and mother

    Kelly Curtin-Hallinan, DO
  • Why doctors must stop ignoring unintentional weight loss in patients with obesity

    Samantha Malley, FNP-C
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
    • How to advance workforce development through research mentorship and evidence-based management

      Olumuyiwa Bamgbade, MD | Physician
    • The truth about perfection and identity in health care

      Ryan Nadelson, MD | Physician
    • Civil discourse as a leadership competency: the case for curiosity in medicine

      All Levels Leadership | Physician
    • Healing beyond the surface: Why proper chronic wound care matters

      Alvin May, MD | Conditions
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
    • How to advance workforce development through research mentorship and evidence-based management

      Olumuyiwa Bamgbade, MD | Physician
    • The truth about perfection and identity in health care

      Ryan Nadelson, MD | Physician
    • Civil discourse as a leadership competency: the case for curiosity in medicine

      All Levels Leadership | Physician
    • Healing beyond the surface: Why proper chronic wound care matters

      Alvin May, MD | Conditions
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

When does a headache need to be seen at the hospital?
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...