Severe Headaches: When to Worry About a Headache

By Ellen Fan, MD
Medically reviewed
September 1, 2021

Most people have had a headache at some point in their lives. While uncomfortable and unwelcome, headaches are usually not a cause for worry. Most can be treated relatively easily with lifestyle adjustments and over-the-counter (OTC) pain relievers.

Severe headaches, however, should be taken more seriously and may require further evaluation. Not only can they be bothersome, but they can also be a red flag, indicating more serious medical conditions. Paying attention to your symptoms will guide you in deciding when to see a doctor for further evaluation. Here, we’ll discuss the symptoms of severe headaches in adults and children and what they could mean. If you’re uncertain or concerned, seeking medical advice from a healthcare professional can be helpful.

In this article, I will discuss what causes severe headaches, and when to worry about a headache. I’ll also give more detail about headaches in children, and when to worry about them. I’ll explore living with headaches, what can trigger severe headaches, and when to see a doctor. I’ll explain what headache testing is, and talk about how severe headaches are treated. Finally, I’ll discuss some headache prevention tips.

What Causes Severe Headaches

Understanding the common causes of severe headaches is important. You (and your doctor) need to know whether the intense pain you feel is a symptom of something more serious.

There are an estimated 300-plus types of headaches, and about half of the adult population worldwide has had a headache in the last year. In the U.S, severe headaches and migraines affect about 20% of women and 10% of men.

There are two general categories of headaches: primary and secondary. When someone is suffering from a primary headache disorder, headache pain is their main symptom; there is no other medical condition causing their discomfort. When someone has a secondary headache disorder, they are experiencing the pain due to an injury, sinus infection, or other underlying medical condition.

Severe headaches can occur as either primary or secondary headache disorders, depending on what they are and why they develop. Common causes include flares of chronic headache conditions, such as tension headaches and migraine headaches, as well as headaches that occur due to underlying health conditions like:

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When to Worry About a Headache

What is a serious headache? Given that everyone’s threshold for pain is different, how do you know when to worry about a headache?

Most headaches are occasional and go away within a few hours with simple home remedies, lifestyle adjustments, and sometimes OTC headache relief. If you regularly get headaches, you should pay attention to a change in your usual headache pattern, more severe and persistent headaches, and other warning signs, such as:

  • Vomiting
  • Blurred vision
  • Loss of vision
  • Confusion, or changes in thinking
  • Neck pain or stiffness
  • Neurological symptoms like problems talking or walking, or weakness or seizures
  • Painful red eye

You should also pay particular attention if you have:

  • Experienced a recent blow to the head or other head injury
  • Been diagnosed with cancer or are in any other way immunocompromised

In rare cases, people can experience “thunderclap headaches”—sudden, debilitating head pain that strikes without warning and quickly escalates into one of the worst headaches of their lives. Thunderclap headaches can be a sign that you have a subarachnoid hemorrhage or another life-threatening condition. If you are experiencing severe headache symptoms that start suddenly and peak within 60 seconds, or a severe headache that is accompanied by fever, nausea, or a seizure, seek immediate medical attention at your nearest emergency room.

Headaches in Children and When to Worry

It’s less common for children to experience headaches than adults. Mild, uncomplicated headaches should go away with rest, fluids, food, and on occasion, OTC pain medication such as ibuprofen and acetaminophen (Tylenol).  Teenagers are more likely to suffer from headaches than younger children, especially those with stressful home or school situations, or those who have heavy caffeine use, smoke, or drink alcohol.

In children, reasons to seek medical help include:

  • Headache that wakes your child from sleep
  • Headache that becomes more frequent or more intense
  • Headache accompanied by changes in your child’s personality, thinking, vision, numbness, weakness, or seizures
  • Headache that develops after a head injury or fall
  • Severe headache accompanied by vomiting
  • Headache accompanied by fever, pain, or stiff neck

What Can Trigger a Severe Headache?

Environmental issues, lifestyle factors, and medical conditions can all trigger headaches. Here are a few common triggers that you should try to avoid. 

  • Alcohol and caffeine: For some, alcoholic or caffeinated drinks can trigger headache symptoms. For heavy coffee or tea drinkers, caffeine withdrawal can cause headaches. 
  • Dental or jaw issues: People who clench their jaw, grind their teeth, or who have other untreated dental concerns may experience headaches as a result.
  • Food and food additives: For some people, certain foods can trigger headache symptoms. Aged cheese, processed or salty food, monosodium glutamate (MSG), and aspartame may cause headaches.
  • Illness: People who have a cold, the flu, meningitis, the coronavirus (COVID-19), or other diseases may experience a secondary headache.
  • Lights, sounds, and smells: Bright lights, loud sounds, and strong smells can bring on a headache in those sensitive to sensory stimulation.
  • Medication: People can experience headaches as a side effect of certain medications. Talk to your doctor about your medications if you suspect that one of the prescription drugs or supplements that you’re taking may be contributing to your pain.
  • Physical exertion: Patients who exert themselves with intense physical exercise or sexual intercourse can sometimes experience a headache as a result. 
  • Seasonal allergies: Those who suffer from seasonal allergies may experience sinus headaches along with their allergy symptoms during a portion of the year.
  • Hormonal changes: Many women have headaches when they experience changes in their estrogen and progesterone levels. Researchers have found a link between menstrual periods, pregnancy, menopause, and worsening headaches. The use of hormonal contraceptives, including birth control pills, can also alter headache patterns. 
  • Sleep challenges: Getting too much or too little sleep can trigger a headache.
  • Smoking: People who smoke or who experience second-hand smoke are at risk for frequent headaches. Nicotine affects the blood vessels in your brain, making it more likely that you will experience headaches.
  • Stress: Patients who are undergoing significant physical or emotional stress may experience headaches as a side effect.
  • Weather patterns: For people sensitive to barometric pressure, changing weather patterns can lead to a headache.

If you are suffering from frequent headaches and aren’t sure why, your doctor might suggest that you keep a headache diary to find out more about the factors that are contributing to and triggering your pain. 

When to See a Doctor

Severe headaches can be a symptom of underlying medical conditions that require urgent attention and treatment, such as high blood pressure. They can also signify a serious, life-threatening illness or medical emergency that may need medical care. It is important to be aware of these serious medical conditions:

  • Infection: Headaches accompanied by fever, confusion, neck pain and stiffness, and decreased alertness can indicate an infection in the brain or spinal cord.
  • Bleeding: Neurological symptoms such as problems with walking or talking, one-sided weakness, or seizures can be a sign of a stroke, bleeding, or a tumor in the brain.
  • Concussion: Headaches that occur after a head injury, particularly when accompanied by a loss of consciousness, vomiting, confusion, or difficulty with balance, coordination, or concentration, can be a sign of concussion.
  • Dehydration or heat stroke: Headaches in extreme heat, especially accompanied by weakness/dizziness, confusion, nausea/vomiting, elevated heart rate, or problems breathing, could be a sign of severe dehydration or heat stroke.
  • Pregnancy complications: Headaches late in the second or third trimester of pregnancy can signify preeclampsia, a severe, life-threatening medical condition. Preeclampsia can cause high blood pressure, brain injury, damage to the kidney or liver, and other serious problems. Any symptoms of preeclampsia require immediate medical attention to prevent serious complications for both mother and baby.

You should talk to your doctor in the following situations to help determine if your severe headache is a cause for concern and whether you should explore medical treatment:

  • Any unusual or sudden severe headache, especially one that wakes you from sleep
  • A significant change in your typical headache patterns
  • Headaches accompanied by eye pain or vision changes
  • Post-concussion headache that does not improve with ibuprofen (Advil, Motrin) or acetaminophen (Tylenol)
  • Headaches in patients with cancer or impaired immune systems

Headache Testing

Diagnosis is the key to treating severe headaches. To get to the bottom of what’s causing your intense head pain, your doctor will start by asking about your symptoms, obtain a general medical history, and will then conduct a physical exam. The physical exam may involve examining your eyes, heart, lungs, muscles, and nerves, as well as your blood pressure and other vital signs. Often, this may be enough to determine whether your severe headache is a cause for concern. Sometimes, your doctor may recommend some treatment, such as lifestyle changes or medications (OTC or prescribed), and then have you return for follow-up.

If there are any concerning findings on your history or physical exam, your doctor may also recommend one or more of the following exams or imaging tests:

  • Full eye exam
  • Blood test
  • CT scan of the brain
  • MRI scan of the brain
  • Spinal fluid test (lumbar puncture)

How Are Severe Headaches Treated?

Healthcare professionals may treat headaches differently, depending on the individual, their health history, and whether they are suffering from a primary headache disorder or another condition.

Standard treatment options for severe headaches include: 

  • Taking a non-steroidal anti-inflammatory drug (NSAID): Over-the-counter medications like ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and acetylsalicylic acid (Aspirin) are considered the first-line defense against both primary and secondary headache.
  • Taking a prescription drug: Your doctor can suggest several medications to help improve headache symptoms. Triptans like sumatriptan (Imitrex) and zolmitriptan (Zomig), a nasal spray called dihydroergotamine (Migranal), lasmiditan (Reyvow), ubrogepant (Ubrelvy), erenumab (Aimovig), and anti-nausea drugs such as metoclopramide (Reglan) are all commonly used to combat severe headaches.
  • Drinking fluids: Patients with headaches should carefully increase their intake of water and other fluids to ensure they aren’t suffering from dehydration.
  • Using a hot or cold compress: Many patients place a hot or cold compress on their forehead, face, neck, or shoulders to help relieve significant head pain.
  • Resting in a dark, quiet room: Some people find relief from severe headaches and migraine pain when they lay down in a dark room for a few hours.

If you seek medical attention for your headache and your doctor determines that heat stroke or severe dehydration have caused your serious headaches, they may treat you with intravenous fluids. 

If the cause is high blood pressure, your doctor will likely prescribe a daily blood pressure medication. If your headache improves with treatment of the underlying condition, this helps determine what is causing your headache.

When headaches are difficult to treat or require additional expertise, your doctor may refer you to a neurologist.

Prevention Tips

It’s important to talk to your doctor about persistent or worsening headaches so they can rule out any underlying medical conditions causing your pain. However, if your headaches only occur intermittently and are not generally a cause for concern, there are steps you can take to reduce head pain and prevent it from recurring. 

  • Eating well: Maintaining a healthy, balanced diet can help reduce your headaches.
  • Exercise: Low-impact physical activity can reduce muscle tension and prevent headaches.
  • Prescription drugs: Your doctor may be able to recommend medications that can help you fend off severe headaches. Some people have found success using antidepressants, anti-seizure medications, botulinum toxin (Botox), and drugs that lower blood pressure to prevent headaches from occurring more regularly.
  • Sleep: Getting eight hours of uninterrupted sleep time is essential to your health and can help reduce headaches.
  • Stress relief: Practicing deep breathing exercises, meditation, acupuncture and other lifestyle habits can help you manage stress and keep you from experiencing headaches.

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How K Health Can Help

Sure, headaches are common. But if you or your child is suffering from severe headaches, it’s vital to find out whether further evaluation or treatment is needed. Using K Health’s virtual tools will help you quickly determine whether the symptoms surrounding your severe headache pain may indicate a more serious underlying condition.

Our doctors are here to provide insight that may lead you to make more informed decisions about getting the proper medical attention and treatment sooner rather than later.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Ellen Fan, MD

Dr. Fan has a Bachelors of Arts degree in Human Biology and a Doctorate in Medicine from Stanford University. In addition to her work with K Health, Dr. Fan is a primary care physician in Indianapolis, Indiana.

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