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.
Conditions that cause headaches
The four conditions we emergency medicine doctors worry about most when we see
a patient in the emergency room 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 accompanied by a fever. Meningitis usually
includes neck pain or stiffness. Other meningitis symptoms may include confusion, lethargy
and seizures.
Brain tumors
Brain tumors may cause pain as they grow, increasing pressure on the
structures of your 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 your body or seizures. It is often these symptoms, rather than
headaches, that will lead you to seek medical attention.
Hemorrhagic stroke
Contrary to what many people believe, most strokes do not
involve a headache. The type of stroke that does involve 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. A bleeding stroke is most common if you are older and have a history of high blood pressure or head
trauma, or if you take blood thinners.
Aneurysm
An aneurysm is an enlargement of an artery caused by a
weakening of the artery wall. You can have an aneurysm for many years
without having any symptoms. If the blood vessel wall becomes so weak that it ruptures, it
causes bleeding in the brain, resulting in a sudden, severe headache. Other
symptoms, such as 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 by a medical professional.