Red Flags for Painful Conditions
By Bernard Abrams, MD,
October 31, 2010: Pain.com is initiating a series of informational articles on painful conditions that merit urgent attention. These articles should alert you to the possibility that a serious condition involving pain exists. These articles are not intended to substitute for consultation with your family physician or a specialist. In case, you see any condition listed, which may affect, you or someone you know, you are urged to take appropriate immediate steps to secure help through your physician, emergency room or 911 access.
Red flags that headaches may have serious implications.
Headaches are one of the most common conditions that bring patients to physicians or other health care providers. Familiar headaches include migraine, tension type headaches, headaches associated with influenza or other systemic infections and headaches, associated with certain medications. However, under certain circumstances, headaches may represent a serious or life-threatening emergency. These may be characterized as:
- Sudden onset headache “first, worst”
- Subacute (a condition that does not come on quickly or catastrophically but has been present for some time, generally days to months) headaches with increasing frequency or severity
- Headache associated with systemic illness (fever, rash, neck stiffness)
- Chronic daily headache
- Headache with neurological symptoms or signs other than typical visual or sensorial aura, or headache always on the same side.
- Headache associated with vigorous vomiting (projectile), mental changes such as memory impairment, word finding difficulty or other speech and language problems, personality change or seizures.
While headaches, which have become chronic and familiar to the sufferer, such as episodic migraine headaches, obviously have to start at some time, the “first, worst headache” demands immediate attention. If the patient has never had a headache before, especially a patient over the age of 35, special concern is raised for the occurrence of possible bleeding within the brain known as subarachnoid hemorrhage or intracerebral hemorrhage. If the patient has had headaches for some period of time, whether intermittent or continuous, sudden escalation of the intensity of the headache may portend hemorrhage within the brain or a mass within the brain. Immediate medical attention and imaging of the brain is highly recommended.
Headaches which begin insidiously as mild or infrequent and increase in severity and frequency may indicate a serious problem within the brain. This is especially so in patients who are over the age of 50, have had a previous history of malignancy, or have a compromise of their immune system due to diabetes mellitus, HIV infection, chemotherapy or other conditions which may reduce their capability of dealing with infection.
Headaches which are associated with systemic manifestations such as fever, rash, lethargy, abnormal bruisability, or stiff neck indicate the possibility of meningitis related illness or other systemic condition which requires immediate attention.
Headaches, which occur more than 15 days a month over a period of more than one month, are referred to as “chronic daily headache”. While many of these headaches will be attributable to withdrawal from medication and are known as analgesic (pain medication) rebound headaches, a complete medical investigation of the headaches is certainly warranted.
Headaches which have any neurological symptoms such as loss of vision, loss of sensation on one side of the body, weakness on one side of the body, confusion, or difficulty with speech, warrant further observation. On occasion, these headaches may be recurrent and associated with a diagnosis of migraine with aura. However, if these type headaches are of new onset, especially in a patient over the age of 35 or they have occurred for the first time, medical investigation is urgently required, as these type headaches, may be a manifestation of tumors of the brain or blood vessel abnormalities.
Headaches associated with loss of consciousness, confusion, personality changes, or memory loss may be indicative of an ongoing process in the brain such as a brain tumor, chronic blood clot, or chronic infection.
While most headaches are not indicative of a serious or life-threatening condition, attention to the symptoms and signs listed above suggest the need for immediate medical attention and may prevent serious outcomes.”