Headache (cont.)

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When should I seek medical care for a headache?

A patient should seek medical care if their headache is:

  • The "worst headache of your life." This is the wording often used in textbooks as a cue for medical practitioners to consider the diagnosis of a subarachnoid hemorrhage due to a ruptured cerebral aneurysm. The amount of pain will often be taken in context with the appearance of the patient and other associated signs and symptoms. Too often, patients are prompted to use this expression by a health care professional and do not routinely volunteer the phrase.
  • Different than their usual headaches
  • Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity
  • Associated with persistent nausea and vomiting
  • Associated with fever or stiff neck. A stiff neck may be due to meningitis or blood from a ruptured aneurysm. However, most patients who complain of a stiff neck have muscle spasm and inflammation as the cause.
  • Associated with seizures
  • Associated with recent head trauma or a fall
  • Associated with changes in vision, speech, or behavior
  • Associated with weakness or change in sensation on one side of their body that may be a sign of stroke.
  • Not responding to treatment and is getting worse
  • Requires more than the recommended dose of over-the-counter medications for pain
  • Disabling and interfering with work and quality of life

Medically reviewed by Jon Glass, MD; American board of Psychiatry and Neurology

REFERENCES:

Beithon, J., et al. "Health Care Guideline Diagnosis and Treatment of Headache." 10th Edition. 2011.

Olesen, J., et al. "The International Classification of Headache Disorders." 2nd Edition. International Headache Society (IHS). May 2005.

Steiner, T. J., et al. "Guidelines for All Healthcare Professionals in the Diagnosis and Management of Migraine, Tension-Type, Cluster and Medication-Overuse Headache." 3rd Edition. British Association for the Study of Headache. 18 Jan. 2007.

Previous contributing author and editor: Dennis Lee, MD and Harley I. Kornblum, MD, PhD


Medically Reviewed by a Doctor on 7/15/2014

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