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When a headache is more than just a headache

While headaches are rarely serious, there are some that require immediate medical attention. In fact, about four percent of Emergency Department (ED) visits are related to headaches. If you come to the ED with a headache, our goal is to treat your pain and make sure there are no underlying serious conditions.

Here are the four conditions we worry about most when we see a patient in the ED with a headache.  

Meningitis
Meningitis is an infection or inflammation of the outer lining of the brain (the meninges). It can have multiple causes, the most serious of which is bacterial meningitis. It often starts with a headache that gets worse over a few hours or days and is accompanied by a fever. It usually includes neck pain or stiffness. Other symptoms may include confusion, lethargy and seizure.

Tumor
Brain tumors may cause pain as they grow. The growing tumor increases pressure on the structures of the brain. Symptoms come on gradually and include nausea or vomiting, night sweats, and nighttime and early morning headaches (when you lay flat, the pressure in your brain increases). Symptoms may progress to weakness in one area of the body or seizures. It is often these symptoms, rather than headaches, that will lead to a person seeking medical attention for a brain tumor. 

Hemorrhagic stroke
Contrary to what many people believe, most strokes do not involve a headache. The type of stroke that does occur with a headache is called a hemorrhagic (or bleeding) stroke. They are caused by a leaky blood vessel or trauma, and they account for about 15 percent of all strokes. They are most common in older people with a history of high blood pressure or head trauma, or in people on blood thinners.

Aneurysm
An aneurysm is an enlargement of an artery caused by a weakening of the artery wall. People may have an aneurysm for many years without symptoms. If the blood vessel wall becomes so weak that it ruptures, it causes bleeding in the brain. This will cause a sudden, severe headache. Other symptoms, like vomiting, seizure or coma may also occur.

If you come to the ED with a headache, we can often rule out serious conditions without extensive tests. But depending on your symptoms and medical history, a CT scan or spinal tap may be necessary. If you have any cause for concern about a headache, it is best to be evaluated.

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