By Claire Fletcher, M.D., Family Medicine with Obstetrics
Headaches are one of the most common concerns of patients that come to the clinic and one of the most complex. The most prevalent headaches are tension-type and migraine. These types of headaches are rarely dangerous but can be debilitating and may require medicine to treat. They are called “primary” headaches. Primary headaches have no clear underlying reversible cause. Secondary headaches result from an underlying problem and can signify that something dangerous is going on in your body. It is important to know when you should see a doctor about a headache because it may save your life, or dramatically improve its quality.
Tension-type headaches are the most common. The pain is classically dull, “band-like” around the front of the head, mild to moderate, and not throbbing. They can be treated with over-the-counter medicines if needed, though you should ask your medical provider which medications are safe for you. If you get frequent tension headaches or they are severe enough to make you miss work or school, talk to your primary care provider (PCP).
Migraine headaches are the second most common type of headache. Anyone can get them, although they tend to occur more frequently in women and girls. Unfortunately, it is often a family trait. Migraines are usually moderate to severe and are associated with vision changes, nausea, and sensitivity to light and sound. If you get migraines, talk to your PCP about options for treatment and prevention, and make sure that you aren’t taking medications that might be making them worse. Unlike standard migraines, ocular migraines are often not as painful, and the onset period is compared to looking through a kaleidoscope. You should let a provider know if your typical migraines are suddenly different.
Red Flag Headaches
Other forms of headaches are more rare but potentially serious. The following red flags will help you decide whether to go to the ER:
- Severe and sudden in onset (“worst headache of your life”)
- Headache after hitting your head
- Pain gets worse over time
- Headache after a loss of consciousness
- Headache associated with weakness, decreased wakefulness, confusion, speech difficulties, loss of balance, or loss of vision
- Headache with fever, neck stiffness, confusion, or rash
- Headache with one-sided neck pain, eye pain, eye swelling, or vision loss
- Headache with very high blood pressure
If you are over the age of 50, have a history of cancer, or notice the headache is worse when lying down or coughing, you should talk to your PCP about your symptoms right away. Likewise, if you get headaches associated with high blood pressure, your PCP can adjust your blood pressure medicine, so don’t delay making a clinic appointment.
Headaches are painful to experience and sometimes tricky to evaluate. When in doubt, it is always safest to talk to your provider if you have a new headache, a headache that is getting worse, or headaches that keep you from living your life to the fullest.