When to worry about and seek care for headaches

While most people experience a headache at some point in their life, certain types of headaches occur with greater frequency or intensity than others, and may require medical intervention. Understanding the different types of headaches and their associated symptoms can help you determine when to seek emergency care and when to schedule an appointment with your healthcare provider.

Types of headaches

There are hundreds of headache varieties, but the most common types requiring immediate or long-term medical intervention include tension headaches, migraines, and cluster headaches.

Tension headaches usually come on slowly and result in a dull, moderate level of pain with a tightening feeling on both sides of the head and sometimes the neck. They are associated with stress and muscle tension, and some people experience them almost daily. Over-the-counter (OTC) or prescription medications can help, along with relaxation exercises like yoga and massage therapy.

Migraine headaches are characterized by concentrated, throbbing pain on one side of the head that may be accompanied by nausea or vomiting, light sensitivity, temporary visual loss or auras, and/or loss of appetite. Migraines can last several hours to several days, though preventive and emergency rescue medications are available for those who regularly experience them. Triggers for migraines differ for each individual, but often include changes in heat or humidity, lack of sleep, stress, bright or flickering lights, loud noises or strong smells, and dietary ingredients in some wine, coffee, chocolate, and prepared foods. The majority of migraine sufferers are women, and migraines tend to run in families.

Cluster headaches involve sudden, severe pain that is primarily felt behind one eye and may result in red, watery eyes, a drooping eyelid, and a runny or blocked nasal passage. They are less common than tension or migraine headaches, but considered the most severe. Pain may last one to three hours and occurs every day or several times a day, in clusters. Cluster headaches frequently are associated with alcohol use or smoking, bright lights, or processed foods that contain nitrates. Lifestyle changes, oxygen therapy, or steroid medications may be recommended treatment for frequent sufferers.

When to seek immediate care

If you have an excruciating headache that does not subside for more than four hours in a 72-hour period, you should seek prompt care. Likewise, if you experience a severe headache that comes on suddenly and is accompanied by any of the following symptoms, go to your hospital emergency room or dial 911 immediately:

• Fainting
• Fever higher than 102 degrees (F)
• Confusion
• Vision difficulty
• Difficulty speaking
• Difficulty walking
• Nausea or vomiting
• Stiff neck
• Headache following an accident or blow to the head

These symptoms in combination with a severe headache may indicate a serious condition, like a brain infection, tumor, or stroke.

When to schedule a visit with your care provider

If your symptoms are not an emergency, but still seem unusual, you should schedule an appointment with your healthcare practitioner. Indications that you need further evaluation include:

• Worsening headaches that do not improve with the use of OTC medications
• Headaches that prevent you from sleeping or participating in normal, daily activities
• Headaches that are more severe or occur more often than usual
• Headaches that cause anxiety
• Severe headaches that first occur after age 50

Your doctor will work with you to develop a plan that treats and prevents debilitating headaches through a combination of lifestyle changes and medications.