Serious Causes of Head Pain
It is important for patients and clinicians to be aware of any headache features that could have possible sinister causes. These need to be investigated immediately and patients with the following features should seek medical opinion with their doctor or consultant straight away.
Do you have any of these signs and symptoms?
Signs and Symptoms | Possible Significance |
---|---|
Abrupt onset of severe headache particularly if precipitated by physical exertion (cough valsalva manoeuvre, sneeze, straining effort), sexual activity or repetitive neck movement | Thunderclap headache – possible aneurysm |
Headache associated with rash, fever, photophobia, vomiting, neck stiffness | Possible signs of meningitis or encephalitis |
Associated with recent significant head trauma | Possible SAH |
Malignant hypertension BP > 200/120 (patient may have home monitor) | Possible serious risk of vascular accident, temporal arteritis, systemic failure |
New headache (2-3 weeks) associated with distal spinal pain | Possible slow leaking aneurysm |
Where there is a change in regular pattern in the patient’s headaches; worsening head pain or new additional features, nausea, autonomic features | Possible secondary headache |
The patient has worsening headache over many days or months (seizure) | Possible intracranial mass |
Recent onset of headache (<3/12) in adult life (>50 years) | 50 years is a guideline; consider >40 years |
Night time headache or head pain that is worse first thing am headaches and lessens during the day | Hypertension, intracranial mass |
Associated neurologic signs or symptoms including concentration, alertness, changes in behaviour patterns | |
Systemic symptoms such as fever, jaw claudication, weight loss, myalgia | Possible giant cell arteritis |
New (<3/12) headache with history of cancer or other significant systemic illness (HIV) | Possible secondary tumour (intracranial infection) |
Headache with family history of aneurysm or other vascular anomalies | Possible vascular pathology |
Onset of migraine or ‘cluster’ headache for the first time during pregnancy | Vascular complications |
Warning: Please ensure that you have consulted a doctor regarding your headache or migraine. Most headaches and migraines are non-life threatening however it is advisable to seek the opinion of your GP or Neurologist if you develop sudden or severe symptoms, especially if these are different from previous attacks.