Headache and Migraine Specialists

Headache &
Migraine Specialists

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Call us on 0844 264 0305

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.

Serious Causes of Head Pain. Thunderclap Headache Caused by Physical Exertion, Sexual Activity or Repetitive Neck Movement. Headache Associated with Distal Spinal Pain. Night Time Headache, Migraine or Cluster Headache for the First Time During Pregnancy. Headache with Family History of Aneurysm or other Vascular Anomalies.

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Headache & Migraine Specialists, 49 Brookside, Hertford, Hertfordshire, SG13 7LJ
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