Is it really just a headache? Although a bad migraine might make you wish for the end of everything, headaches are not usually life threatening. However, a severe headache can signal something much more serious, requiring emergency attention such as stroke or aneurysm. These are not terribly common, but it's worth watching for a headache that feels markedly different from normal—even if normal is agonizing. Here are a few signs to watch for.
1. Worst headache you've ever had. One of the first things medical students learn is that when people use this sort of language about a headache, they must be seen immediately. Called a "thunderclap headache," this sudden, excruciating pain, which reaches maximum intensity within seconds to a minute, may signal the rupture of a brain aneurysm, when a blood vessel in the brain tears, cutting off the blood supply to a part of it. Brain aneurysms can be treated, but only if you get to the ER within hours of an attack.
2. You have neurological symptoms. A headache coupled with confusion, dizziness, memory loss, slurred speech, loss of balance, weakness on one side of the body, seizures or blurred or double vision may signal a stroke or brain tumor , so always demand prompt medical action. If you experience these symptoms, visit the nearest medical institution immediately.
3. You've had bad headaches before, but this one is totally different. Any major change in the type or pattern of your headaches should be checked out right away. This could signal a number of conditions ranging from life-threatening (stroke, tumor or meningitis) to less serious "rebound" headaches caused by too much pain medication. Consult your Neurologist for proper medical action.
4. You are on your senior years and this is your first-ever acute headache. Throbbing migraines since college may be incapacitating, but they're not as worrisome as a first-time headache in an older adult, which, if severe, could signal a stroke or brain tumor.
5. Your headache started after you hit your head. Even if it was a moderate bump and you didn't black out, you should get to the ER because your head pain may stem from a concussion. Although most such injuries are not serious, concussions with bruising or bleeding on the brain can lead to vision loss, balancing problems, confusion and even death.
6. You have cancer or HIV/AIDS and develop a new headache. Any new headache in a patient with HIV/AIDS could mean a brain infection such as meningitis, which should be evaluated promptly by a doctor. A new headache in a cancer patient doesn't necessarily demand a trip to the ER but should be seen promptly by the patient's own doctor.
As a general rule, for non-severe headaches, your family doctor is a great place to start. However, if the recommended treatments are not working well or you have unusual symptoms, you may need a neurologist who specializes in disorders of the nervous system. Neurologists do not perform surgery. If one of their patients requires surgery, they refer them to a neurosurgeon.
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