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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.

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

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 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, or 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.

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