What are signs that a headache may be part of a serious health condition?

Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner

The most common symptom of a headache is pain in the head region. The pain can be a sharp, stabbing pain or a dull, aching pain, and can also occur anywhere in the head. Specific types of headaches, such as migraines, may cause other symptoms in conjunction with your headache.

You likely have a migraine. Migraines are moderate to severe headaches that are usually one sided, throbbing and associated with light/sound sensitivity and/or nausea/vomiting. They are often worsened by routine activity (climbing the stairs) and improved with sleep. Other common symptoms of migraine include neck pain or stiffness, dizziness, fogginess and nasal congestion/eye tearing. They last anywhere from 4-72 hours. Migraine is a genetic condition that often runs in families. A migraine can be treated with rest in a cool dark place but often requires additional medication such as caffeine, ibuprofen, acetaminophen, a triptan and sometimes an anti-nausea medication.

Most headaches are not due to serious health conditions. If, however, you experience any neurological changes such as numbness, tingling or muscle weakness with your headaches, these may be indications of a more serious problem. Headaches that are worse than usual, or occur more frequently than usual, may also warrant further investigation. If you notice any fever or chills, neck stiffness, rash or have a headache that results from any head injury, you should receive prompt evaluation. If you have a history of cancer or HIV infection then further evaluation may also be indicated. Any headaches that start suddenly and begin to occur after the age of 50 may also be due to a more serious condition and should be evaluated by a healthcare provider.

Your pain may depend on the type of headache you have.

With a tension headache, you may:

  • Feel like a tight band is squeezing your head
  • Have pain or tension in your neck and shoulders
  • Feel a dull, constant ache somewhere on your head

With a severe headache or a type of headache called a migraine, you may:

  • Feel sick to your stomach, and you may even throw up
  • Have throbbing pain that may be worse on one side of your head
  • Be bothered by light or see flashing lights or spots
  • Be bothered by noise

With a sinus headache you may:

  • Feel pain or pressure in the front of your head or face
  • Have a stuffy or runny nose
  • Have pain when you bend over or first wake up
The following are headache warning signs that require medical evaluation:
  • A headache that's accompanied by fever and a stiff neck might mean: Meningitis, an inflammation of the membranes that cover the brain. A computed tomography (CT) scan and evaluation of spinal fluid (obtained via a spinal tap, in which fluid is drawn from the lower back region of the spine) can confirm or rule out this diagnosis.
  • A headache accompanied by neurological impairment (for example, difficulty speaking or walking, weakness of one side of the body, or double vision) might mean: Brain tumor, stroke, or abscess. Imaging tests, such as a CT or magnetic resonance imaging (MRI) scan, are required to evaluate the situation.
  • A headache that feels like a blow to the head (also known as thunderclap headache) might mean: Bleeding around the brain. A CT scan and a spinal tap are necessary to make a diagnosis.
  • A headache that slowly but relentlessly gets worse over weeks or months might mean: Brain tumor. Evaluation by a CT or MRI scan may be needed.
  • A headache with constant, severe, throbbing pain in the temple region, particularly in people over age 60 might mean: Temporal arteritis. Blood tests and a biopsy are needed to confirm the diagnosis.
  • A headache that occurs frequently, if not daily, especially in the back of the head or neck, is present on awakening, and improves when you get out of bed might mean: High blood pressure. Have your blood pressure measured and schedule follow-ups as necessary.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.