Headaches-know the red flags

Headache is a common complaint for which patients consult a neurologist like me. While headaches can be disabling in themselves they are also the cause of much concern. Many patients are worried that their headache is a sign of a serious condition such as a brain tumor. So in this post I shall discuss what are the red flags one needs to watch out for when it comes to headaches. What are the symptoms and signs that may be a cause for just concern and should warrant a visit to your doctor for evaluation?

–Age of onset of headaches: most primary headaches such as migraine, tension type headaches, cluster headaches start usually in the late teenage years or in the second decade of life. The usual history is of episodic headaches starting from a young age (migraines usually begin in the late teens or the early/mid 20’s). So what is the red flag when it comes to age? If you have never suffered from headaches in your 20s and 30s and suddenly start experiencing headaches in your (40’s, 50s and later years) one should err on the side of caution and seek medical attention.

–character of headache changes: let us assume you suffer from episodic headaches since your 20s. Headaches are unilateral, throbbing in character and associated with light sensitivity (we call this photophobia) and nausea but you were never formally diagnosed with migraine.  You found over the counter ibuprofen helpful and so never sought out medical attention. Now you are in your 50s and the headache character has changed. What do I mean by headache character? Type of headache (now no more unilateral rather the whole head hurts), severity of headache (the pain is either more severe or constant rather than episodic, wakes you up in the middle of the night, you throw up violently when you have the headache episode, it is causing other symptoms–blurring of vision, double vision , problems with balance, memory problems, changes in behavior and so forth. I would advice again to err on the side of caution and do not just assume that this is still migraine, rather seek medical attention and let your doctor reassure you that indeed that is the case.

–headaches which are accompanied by other signs and symptoms: for example-

—————-severe headache and then you pass out/ suffer loss  of consciousness

—————-headache accompanied by visual symptoms (loss of vision, blurring of vision, double vision, pain in the eye–while many of these symptoms may occur along with migraine headaches, I would again advice that you rather err on the side of seeking a timely medical opinion)

—————-headache accompanied by memory and personality changes

—————-headache accompanied by problems with balance, gait and stance

—————-headache accompanied by weakness or numbness on one side of body

—————-headache accompanied by a seizure or vice versa.


Nitin K Sethi, MD

4 thoughts on “Headaches-know the red flags

  1. I have recently been having almost daily headaches and my sleep apnea/daytime sleepiness is worse. My biggest complaint is memory loss is getting worse. Had MRI which showed white spots. What do you think about all this? Donna Rayborn

  2. Hi there. So happy to find your blog. Do you write at length about visual disturbances? I couldn’t search the archives for such very well. I am 30 yrs old and my life changed one afternoon 6 months ago when my vision suddenly changed, no trauma or injury to note. I basically fell into a neurological rabbit hole, and now each day experience my very own set of colors, object movement and depth perception. My visual reality is all my own. I wake each morning happy I can still see, but facing another day of pain. Unbelievable neck pain, throbbing in base of skull, weakness which makes me feel like I’m walking in a world made of rubber. Uninsured and low income in the states, I fought for services. I had a clean CT scan and clean MRA, never and MRI, and a lot of doctors treated me as a hypochondric or heavy drug user. So I left. I am working, hard. I am happy and alive, living in an unfamiliar country, Australia. I am traveling, alone. But I fear I will wake up in a hospital where nobody knows my name.

  3. Hello! My dad has been suffering from headaches, memory loss, and pressure in his head for a fews years now. His speech has changed (slurs a little) and he was recently terminated from employment for the first time in 40 years! He does not like going to the doctor but losing his job prompted him to finally go. They did a CT scan and found “white matter” and scheduled him for an MRI next week. He is only 54 and I have been so worried about what they are going to find. After I google searched what it could be, MS came up which was alarming because his brother died from the symptoms of MS. Does MS cause headaches and pressure. I hate to say this, but he is not as sharp as he use to be either. -Thank you for any feedback!

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