Headaches one should be worried about.

Severe headache

Having a headache. Don’t worry, chances are that you just have an ordinary headache. Headache is a routine experience for all of us in everyday life. Mild to moderate headaches, that occur once in a while are not a cause of concern.
However, some headaches may not be benign and will require urgent medical attention. In this article, you will come to know about how to differentiate dangerous headaches requiring medical advice from routine headaches.

Worst Headache of My Life

“Worst headache of my life” or “Thunderclap headaches”

A sudden onset, excruciating headache is often described by patients as like “thunderclap” in onset and in severity as “worst headache of my life”. This headache is caused by bleeding into the subarachnoid space of brain from a ruptured cerebral aneurysm. The blood spreads across the subarachnoid space of brain inciting an intense reaction from the covering layers of the brain, causing persistent severe headache. The onset of headache may be associated with vomiting’s, transient loss of consciousness or seizures. Patient has a stiff neck and may also develop low grade fever. The first headache is usually a ‘warning headache’ and usually heralds a more ominous brain haemorrhage. This severity of this headache alone will make you visit the hospital. Urgent medical attention is necessary as there is high re-bleeding rate from a ruptured cerebral aneurysm and is associated with high mortality rate.

Morning headaches with vomiting

A headache that usually wakes you up in the morning, gradually becomes worse and then is followed by vomiting is characteristic of increased intracranial pressure caused by tumours, infections, or obstruction to pathways of circulation of cerebrospinal fluid. This kind of headache involves the entire head, and is worsened with coughing, sneezing,
and bending forwards. Headaches may be the first and only manifestation in 10% of all patients with brain tumours.
This type of headaches are not relieved by over the counter analgesics. Initially the headaches may not be associated with vomiting’s, but as the headaches become more severe with time vomiting’s become a common associated symptom.

Headaches with double vision

Double vision or diplopia is again common with headaches associated with increased intra-cranial pressure from tumours or hydrocephalus. The double vision is caused by weakness of Sixth cranial nerve which helps us in moving our eyeball. The loss of synchrony between the two eyes causes the doubling up of images.

Sudden severe headache with abnormal sensations or limb weakness

A sudden onset severe headache with some neurological deficit like weakness in arm, leg or one side of body, abnormal sensations or facial asymmetry suggests that one might be suffering from a stroke, and needs urgent medical help.

Warning signs in headaches

Here is a list of certain clinical features which should raise alarms if present with headache. One should seek urgent medical attention if these features are present.

  • New onset headaches in middle age or later > 40 years- If headaches start after 40 years, one should get investigated to rule out some underlying problems.
  • Change in frequency, severity or clinical characteristic of usual headaches that patient normally experiences- If a long standing type of headache changes its pattern, becomes more severe, has some new feature to it, or is not getting better with the usual medicines.
  • New or progressive headache that persists for days.
  • Worsening of headache by coughing, sneezing or bending forwards-This may signify raised intra-cranial pressure and need to be investigated.
  • Presence of associated symptoms like fever, malaise, weight loss, or neck stiffness.

Disclaimer- This article is meant for only general public awareness and education. The text can not substitute expert medical advice. Please consult your doctor if you experience these symptoms. 


I am a Neurosurgeon and spine surgeon practising in Gurugram, India. Besides Neurosurgery, I love to read, travel and play tennis.

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