Headaches: Tension - Managing Tension-Type Headaches

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Headache Symptoms that Could Indicate Serious Underlying Disorders

Headaches indicating a serious underlying problem, such as cerebrovascular disorder or malignant hypertension, are uncommon. (It should again be emphasized that a headache is not a common first or only symptom of a brain tumor.) People with existing chronic headaches, however, might miss a more serious condition believing it to be one of their usual headaches. Such patients should immediately call a doctor if the quality of a headache or accompanying symptoms has changed. Everyone should call a doctor for any of the following symptoms:

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• Sudden, severe headache that persists or increases in intensity over the following hours, sometimes accompanied by nausea, vomiting, or altered mental states (possible hemorrhagic stroke)
• Sudden, very severe headache, worse than any headache ever experienced (possible indication of hemorrhage or a ruptured aneurysm)
• Chronic or severe headaches that begin after age 50
• Headaches accompanied by other symptoms, such as memory loss, confusion, loss of balance, changes in speech or vision, or loss of strength in or numbness or tingling in arms or legs (possibility of small stroke in the base of the skull)
• Headaches after head injury, especially if drowsiness or nausea are present (possibility of hemorrhage)
• Headaches accompanied by fever, stiff neck, nausea, and vomiting (possibility of spinal meningitis)
• Headaches that increase with coughing or straining (possibility of brain swelling)
• A throbbing pain around or behind the eyes or in the forehead accompanied by redness in the eye and perceptions of halos or rings around lights (possibility of acute glaucoma)
• A one-sided headache in the temple in elderly people; the artery in the temple may be firm and knotty and without a pulse; the scalp may be tender (possibility of temporal arteritis, which can cause blindness or even stroke if not treated).
• Sudden onset and then persistent, throbbing pain around the eye possibly spreading to the ear or neck unrelieved by pain medication (possibility of blood clot in one of the sinus veins of the brain)

Review Date: 11/15/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).