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