Headaches, like the majority of conditions that revolve around pain, can be very tricky to categorize. A headache that is 'terrible' to one person, might feel mild to someone else. However, speaking generally, according to Mark Morocco, a clinical professor and ER doctor at the University of California Los Angeles Medical Center, you need to see your primary care physician if your headache status changes. That means if you have never had headaches, but now you seem to have them all the time, your doctor should be made aware of the change. Or, if the intensity of your regular migraines has suddenly increased, that's also something worthy of your doctor's attention.
Even in these situations, the chances are good that your headaches are of the non-threatening variety. "People are always worried about brain tumors," Morocco says. However, headaches are not actually among the symptoms that experts usually associate with tumors. On the other hand, there are some warning signs that your headaches is a true medical emergency. Here's what you should look out for:
If a severe headache comes on suddenly - "Like someone flipping a light switch or hitting you with a hammer" - Morocco says that's something you should take very seriously. It could be a subarachnoid hemorrhage, or bleeding in the brain caused by a leaking aneurysm. "That's a dangerous headache, and you need to call 9-1-1 or have someone take you to the hospital," Morocco says.
To be absolutely clear, this isn't a sharp pain that recedes in seconds or a few minutes. "It won't go away quickly," he adds. "But you don't want to make the mistake of taking heavy pain pills and going to sleep."
2. Your Headache Changes Its Tune
If you experience migraines or tension headaches, an especially severe headache isn't necessarily something you need to worry about. According to Morocco, "one way to think about it is, if the quality of your headaches were a song, is this the same song but with the volume turned up higher?" If the answer to this question is yes, that's a reassuring sign.
What Morocco worries about is if the song changes, meaning your headache feels both severe and different from what you usually experience. If this is the case, you should get yourself to the ER as this could be an aneurysm or some other urgent medical situation.
A bad headache accompanied by a fever is concerning. "This could indicate an infection of the brain - something like meningitis," Morocco says. It could also be a warning sign of encephalitis, or inflammation of the brain. Especially if your bad headache and fever are accompanied by an altered mental state - like forgetting your kids' names - you should head to the ER.
4. The Ache Is Behind or Around Your Eye
According to Morocco, "if you have a headache with eye pain, and especially if you have a change in your vision, that's an emergency." The big concern here is acute glaucoma, or a buildup of pressure in your eye that cuts off its blood flow and can lead to blindness. "What we see a lot is a person goes to a movie, and when the lights go down and the pupil dilates, that change in pressure leads to the headache and the other symptoms," he says.
5. You Bumped Your Head - AND You're on Blood Thinners
If you knock your head and are on blood thinners, a headache could indicate a subdural hematoma, or a kind of slow bleed inside your brain that - thanks to those thinners - doesn't clot. This condition can be deadly, so you should get to an ER as soon as possible.
7. Your Headache Is Contagious
If people around you - your family or coworkers for example - are complaining about headaches at the same time you're experiencing an unusual ache, that could be a sign of CO2 poisoning. If you step outside and your headache lightens, warn everyone else, open windows and doors, and have the place inspected for a CO2 leak.