Headache can be a tricky health issue. Although both severe headache and migraine are very common — affecting approximately 20 percent of women and 10 percent of men in the United States, according to the American Headache Society — and are usually benign, meaning they cause no lasting medical problems, on rare occasions headaches can be associated with a life-threatening health crisis.
The major question is: How do you know when to be concerned about your headache? What signs can help you distinguish between an ordinary headache caused by stress, one occurring as part of a migraine attack, and one caused by something much more serious, such as stroke or a brain tumor?
Recognizing Headaches With Dangerous Causes
One clue that a headache is a sign of something serious is when it’s significantly worse than the headaches you usually get. Another clue is when the headache is accompanied by other symptoms that are new to you.
“When the headache is the worst headache of your life, or when it is accompanied by fever, neck stiffness, weakness or numbness on one side of the body, difficulty speaking, loss of consciousness, confusion, loss of vision, or any other neurological symptom, it’s serious,” says Alexander Mauskop, MD, the founder and director of the New York Headache Center and a professor of neurology at the State University of New York Downstate Medical Center in Brooklyn.
If in doubt, be safe rather than sorry and call 911 or go to the emergency room, Dr. Mauskop says.
More serious headache causes include the following:
Stroke Can Cause a Headache
It may not always be possible to distinguish the pain of a headache caused by stroke from a tension-type headache or a migraine attack. Usually, a headache caused by stroke happens suddenly and abruptly, while a migraine attack has a slower, more gradual onset, usually stretched over several hours.
In addition, stroke generally causes negative symptoms, indicating loss of neurologic function, such as weakness, numbness, slurred speech, and blindness. Migraine, on the other hand, often produces symptoms such as bright flashing lights, spots, or zigzags in a person’s field of vision and the perception of hearing sounds like buzzing or music.
But some migraine symptoms can resemble those of stroke. For example, a person who has migraine with aura may experience loss of sight for short periods; tingling and numbness in the face, hands, or other areas of the body; and speech and language problems such as being unable to say words, slurring, or mumbling during a migraine attack.
A person with familial or sporadic hemiplegic migraine may have the same symptoms as those that occur in migraine with aura as well as motor, or muscle, weakness on one side of the body.
In very rare cases, a migraine attack can lead to stroke.
A stroke requires immediate treatment for the best chance of recovery, so anyone experiencing symptoms of stroke should get to a hospital emergency department as quickly as possible.
RELATED: What You Need to Know About Migraine and Stroke
Headache From High Blood Pressure Is a Medical Emergency
Headache caused by high blood pressure is serious, since this type of headache only happens when blood pressure is severely elevated to 180/120 millimeters of mercury (mm Hg) or higher, according to the American Heart Association. Normal blood pressure is 120/80 mm Hg. When blood pressure remains extremely elevated and is accompanied by other symptoms, it’s a medical emergency known as a hypertensive crisis.
Even when high blood pressure doesn’t cause headaches, it should be treated. Untreated hypertension can lead to a variety of ailments, including stroke, heart attack, and kidney failure.
Brain Tumors Are Rare but Can Cause Headache
It’s rare that a brain tumor is the cause of a headache, but it does happen, according to Johns Hopkins Medicine. The pain of a brain tumor can be hard to distinguish from a regular headache, though sometimes head pain from a brain tumor is worse early in the morning or when lying down.
A brain tumor can also be accompanied by seizures, forceful vomiting, weakness, double vision, speech impairment, personality changes, and confusion. If a brain tumor is suspected, a thorough evaluation by a doctor is crucial.
Cluster Headache Pain Can Be Unbearable
While technically not life-threatening, cluster headaches cause such severe pain that some people contemplate suicide.
Cluster headaches occur suddenly, sometimes waking people from sleep, and generally last between 15 minutes and 3 hours. The pain of a cluster headache occurs on one side of the head, according to the American Migraine Foundation, and commonly includes a runny nose and a red or tearing eye on the side with the pain.
And unlike migraine, which often makes a person want to avoid physical activity, bright lights, and loud sounds and to take refuge in a dark room, cluster headaches instead make a person feel restless and agitated from the severe pain.
Cluster headaches are so named because they come in clusters — daily for a month or more, for example, and then none for a year. Treatment can be high-flow oxygen through a mask or medication to prevent the headaches in the first place.
RELATED: Is It a Migraine Attack or a Cluster Headache?
Common, Benign Headache Triggers
In most instances, headaches are due to less serious causes. Here are some of the most common:
Stress or Tension-Type Headaches Respond to Self-Care
“Also called tension-type headaches, stress headaches often present with a bandlike sensation around the forehead that worsens as the day progresses,” says Jay Bhatt, MD, a neurologist with Indiana University Health North Hospital and an assistant professor of clinical neurology at Indiana University School of Medicine.
Although the discomfort that stress headaches cause is very real, they are generally not serious, says Dr. Bhatt, adding that they "can be treated with a variety of lifestyle modifications or medications.” Aerobic exercise, biofeedback, relaxation training, and meditation are all possible ways to reduce stress and limit head pain from this type of headache.
Over-the-counter medications such as aspirin, ibuprofen (Advil, Motrin), or acetaminophen (Tylenol) can be used for pain relief in a tension headache, according to MedlinePlus.
Allergies Can Cause Headache
Headache can be a symptom of allergies if the sinuses become inflamed or infected as a result. Allergy-related headaches typically include a feeling of pressure in the forehead, face, or behind the eyes, along with typical allergy complaints such as sneezing, nasal congestion, and itching.
Treatment for allergy headaches may include over-the-counter medications for pain relief, along with treatment of the underlying allergy. Your doctor may recommend or prescribe an allergy drug and help you identify triggers to avoid, such as pollen, dust mites, pet dander, mold spores, certain foods, and other common allergens.
Although sinus inflammation can cause pain in the face and head, often what people believe to be a sinus headache is actually a migraine attack, according to the American Academy of Allergy, Asthma & Immunology. If you’re experiencing this type of pain frequently, discuss it with your doctor. Getting a correct diagnosis can lead to more effective treatment.
Perimenopause May Worsen Migraine
“Migraine usually improves after the menopause transition; about 70 percent of women stop having migraine at this time,” says MaryAnn Mays, MD, a neurologist and headache specialist at the Cleveland Clinic.
But perimenopause can be a very difficult time because hormones are changing and fluctuating so much, adds Dr. Mays. Perimenopause is the period, ranging from months to years, when a woman’s body is transitioning to menopause.
If you develop migraine during perimenopause, or if it gets worse, your doctor might put you on low-dose estrogen on days surrounding your period or prescribe certain types of birth control that may help with hormone fluctuations, according to theNorth American Menopause Society.
RELATED: The Link Between Migraine Attacks and Menopause
A Woman’s Menstrual Cycle May Trigger Migraine Attacks
Often, migraine attacks coincide with a woman’s menstrual cycle. In fact, as many as 60 percent of women with migraine have attacks related to their menstrual cycle, according to the National Headache Foundation.
Migraine attacks can be triggered by changes in estrogen levels, and estrogen dips around the time that a woman starts her monthly period, according to Nada Hindiyeh, MD, a headache specialist and researcher at Stanford Health Care in Palo Alto, California.
“They can be pretty severe, they can last several days, and they can be quite debilitating,” says Dr. Hindiyeh.
Certain types of birth control pills, pain relievers, and migraine-specific medications may help with these headaches, she says. There’s also evidence that a magnesium supplement may help improve migraine, says Hindiyeh.
A meta-analysis published in Pain Physician, for example, found that oral magnesium significantly alleviated the frequency and intensity of migraine.
RELATED: 7 Top Remedies for Menstrual Migraine
Smoking Can Lead to Headache or Migraine
Nicotine changes the blood vessels in the brain, and cigarette smoke can irritate the nerves in the nose and throat — both of which can lead to migraine attacks or headaches.
Some people complain of headaches while they're trying to kick the habit, but “nicotine gum usually helps," says Ricardo Jorge Komotar, MD, a professor of clinical neurosurgery at the University of Miami Miller School of Medicine and the director of surgical neuro-oncology at the University of Miami Hospital.
The health benefits of quitting smoking still clearly outweigh this possible discomfort.
Taking Too Much Pain Medication Can Cause Headaches
Frequent use of medication for chronic headaches can actually lead to more headaches. Medication-overuse headache (MOH) is a chronic daily headache that happens when acute medications for headache or migraine are used more than two or three days per week, according to the American Migraine Foundation.
These headaches have been linked with over-the-counter pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen (Aleve), and combination pain relievers that contain aspirin and caffeine.
Prescription drugs are also associated with MOH, including triptans, ergotamines, and opioids, according to the American Migraine Foundation.
The best treatment for this type of headache is to stop taking the frequently used medication. People who develop MOH should work with their doctor to identify bridge therapy and lifestyle modifications to help with pain relief while stopping the medication and moving forward afterward.
Both Caffeine and Caffeine Withdrawal Can Lead to Head Pain
The relationship between caffeine and headaches can be complicated. Some people drink a cup of coffee or take medication with caffeine to help with a headache, but for others, the stimulant can trigger an attack.
“Caffeine use is a common trigger for headaches and for caffeine withdrawal headaches,” notes Bhatt. “These are often severe, continuous headaches that don’t improve with heavy-duty pain medications but dramatically respond to reinstitution of caffeine use.”
If you are prone to caffeine-withdrawal headaches, talk with your doctor about gradually weaning yourself off caffeine over a month to see whether headache pain decreases.
Additional reporting by Becky Upham.