Taber Andrew Bain via Flickr

Taber Andrew Bain via Flickr

You will get a headache at one point or another. That’s the inconvenient truth.  99.9% of the time, your headache is harmless and will resolve without medical intervention other than getting some sleep and taking an over the counter pain reliever.

The problem with headaches is that they could be a harbinger for some life threatening illnesses like a brain tumor or an aneurysm rupture. Scary right?

The good thing is that the life threatening headaches typically leave clues. I will go over 5 of those clues and what they could imply.

So what should you look for when trying to decide if the headache you have is ER worthy or if an aspirin would do?

1. Is this the “worst headache of your life”?

If it feels that way, run don’t walk to the closest emergency room. “Worst headache of your life” typically points to a leakage of blood into a walled-off fluid filled area covering the brain and the spinal cord called the meninges.

This condition is known as Sub-Arachnoid Hemorrhage (SAH) and this is the kind of bleed that occurs with an aneurysm rupture.  This is a medical emergency.

These types of headaches typically get worse with any bearing down like when having a bowel movement.

2. Do you have a fever with neck stiffness accompanying the headache?

If so get to the emergency room ASAP! Headaches, neck stiffness and fever points to meningitis; an infection of the meninges (the walled-off fluid filled area covering the brain and spinal cord).

3. Did that headache come after a fall or a blow to the head?

Call the ambulance for this one, need I say more? There might be some bleeding in the skull or brain from the impact to the head. Younger folks typically develop Epidural Hematoma– bleeding between the skull and the brain.

If the bleeding is brisk, it could cause a lot of pressure to the brain and things could go “south” very quickly. The brain surgeons are on speed dial for these.

Older adults typically develop a different kind of brain bleed after a fall called Sub-dural Hematoma. This variant of bleed occurs under the lining of the skull.

Since we lose brain volume as we age (yep, brain cells disappear as we get older!) there’s a lot more wiggle room for the bleeding to slowly build up so the Sub-dural bleeds are typically not as deadly as the Epidural bleeds

4. Headache with vision loss or double vision earns you a ride to the ER.

Often times, migraines could cause temporary vision loss or vision defects but resolves when the migraine wears off. Even if you have experienced what is known as “ocular migraines” , play it safe by getting the sudden vision loss + headaches checked out in the emergency room setting.

5. A new headache.

If the headache is different from what you are accustomed to, you don’t necessarily have to dash to the emergency room but get it check out if it persist longer than you are accustomed to.

Any one of these headaches should get you going to the emergency room in a hurry!

About the author

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Dr. Bola

Family physician. Works for the "man" by day, wife & mom 24/7.
Loves the work of translating "medicalese" to plain english.


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