In a Health Alert published October 17, 2012 by Johns Hopkins, Peter Goadsby, M.D., Ph.D., a neurologist who is director of the Headache Center at the University of California at San Francisco, lists some of the signs and symptoms that may indicate a headache could be dangerous.
“Most of the time, a headache is just a headache — perhaps severe and disabling, but typically not dangerous. But, rarely, a headache can come on as the result of something dangerous,” Dr. Goadsby explains.
He provides a mnemonic (HPAIN) as a way of organizing and remembering what he calls potential “red flag” events or “danger signals” that indicate your headache could be dangerous, and you should immediately seek medical help.
“I don’t want you to self-diagnose but to understand that if and when any of these danger signals do occur, you should seek medical assistance promptly,” says Dr. Goadsby.
What are the Signs that a Headache May be Dangerous?
Here are the signs and symptoms listed by Dr. Goadsby, organized according to his mnemonic, HPAIN:
- H = YOU, THE HOST. According to Dr. Goadsby, “If you have an underlying medical problem and then suddenly have a headache you’ve never experienced before, it could be a dangerous complication due to medication or the underlying disease process.” Here are some of the underlying medical conditions he lists:
- You are over 50 years old
- You have cancer, HIV, heart disease or diabetes
- You at risk for other illness
- You on immunosuppressant drug therapy
- You smoke
- P = PATTERN. “Is this the same old headache, or a change to what you are used to?” Dr. Goadsby asks. Any rapid escalation in headaches, abrupt and severe onset, or new and unusual type of headache, could be a serious sign of danger, according to Dr. Goadsby. Here are some dangerous patterns that Dr. Goadsby lists:
- Your headaches are escalating rapidly,
- You developed one that just won’t quit
- You have experienced an abrupt onset of the headache
- This is a new and unusual headache,
- A thunderclap that has been felt in the head followed by the worst pain in your life
- A = ASSOCIATED SIGNS OR SYMPTOMS. “Is this more than just a headache? Does it come with anything else,” Dr. Goadsby asks. As examples of other potentially dangerous associated signs and symptoms, he lists:
- Stiff neck,
- Chills or weight loss.
If these signs or symptoms accompany your headache, according to Dr. Goadsby, “You may have viral or bacterial meningitis, an infection of the membranes that cover the brain. Contact your doctor; this can be fatal if not treated immediately.“
- I = INCREASE IN PAIN ASSOCIATED WITH UNUSUAL EVENTS. “We are looking for any unusual features here,” says Dr. Goadsby. As examples, he asks, “Did it come up the first time after recent intercourse? Does sleep bring it on or make it worse? Did it begin after a head injury? Is this pain provoked by lifting, coughing, standing or yelling?” “Speak with your doctor about these concerns,” Dr. Goadsby advises.
- N = NEUROLOGICAL SIGNS OR SYMPTOMS. Following are some neurological signs or symptoms listed by Dr. Goadsby:
- Difficulty with speech, or
- Has there been a seizure?
If any of these neurological symptoms accompany your headache, “You may have suffered a stroke or have a tumor or abscess,” according to Dr. Goadsby. “Call 911 or get to the nearest hospital emergency department,” he urges in these cases.
If you have any of these conditions, a sudden headache could signify a potentially dangerous complication. Don’t ignore this; contact your doctor immediately to discuss the headache,” Dr. Goadsby cautions.
“A headache that comes on in a matter of seconds and causes other problems may be due to a ruptured brain aneurysm that is now bleeding into your brain. Call 911 or get to the nearest hospital emergency department immediately,” Dr. Goadsby warns.
Clearly, the information provided by Dr. Goadsby is intended as a preliminary checklist, and is not intended to be comprehensive or exhaustive. If you have a symptom that is not listed above, you should not assume that just because it is not listed above, it may not be dangerous. Consult your doctor about your symptoms and medical condition.
The Johns Hopkins Health Alert, “What Are the Signs That a Headache Could Be Dangerous?” was published online by Johns Hopkins on October 17, 2012.
Johns Hopkins offers a related Special Report on “How to Manage Migraine Headaches,” which can be purchased online from Johns Hopkins for $29.95.
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