Red flags and receiving URGENT medical help.

Headaches can present differently and have various associated symptoms.  They can be one sided or occur in both, present at the top, sides or back or front of the head and have you feel dull, achy, sharp, pressure, band-like or throbbing pain of different intensity and duration.   Some patients experience nausea, vomiting, altered sensation, noise sensitivity, light sensitivity, dizziness, visual disturbances,  and numerous other serious symptoms.

Firstly, rest assured that a clear majority of headaches are benign and non-life threatening.  But there exists a small subset of secondary headaches that can have a very serious cause.  Below are some of the common red flags I look for to refer for urgent or immediate medical care.  This list is for reference use only.  Always consult your medical doctor or chiropractor for a proper diagnosis and course of action.

  1. First or worst headache of patient’s life
  2. Focal neurologic signs not migraine related (eg loss of limb function)
  3. Headache with change in personality, mental status, or level of consciousness.
  4. Headache beginning after age 50
  5. Headache triggered by cough or exertion or while engaged in sexual intercourse.
  6. Headaches with systemic signs like fever, rashes or stiff neck
  7. New onset of severe headache in pregnancy or post-partum
  8. Headache after direct trauma to the head or neck
  9. Sudden onset (maximum intensity within seconds to minutes)
  10. Rapid onset with strenuous exercise.
  11. Tenderness at the temple and the artery
  12. Change in pattern of usual headaches.
  13. New headaches in patients suffering from cancer, lyme disease or HIV infection.

Source:  Hainder et al.  2013. American Family Physician.  “Approach to acute Headaches in Adults”

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As per the Canadian Heart and Stroke Association, Learn the signs of stroke.  If you or a loved one ever experience a sudden severe onset of a headache, THINK FAST.

  • F-ACE:   is it drooping?
  • A-rms: can you raise both?
  • S-peech: is it slurred or jumbled?
  • T-ime: call 9-1-1 right away.