Understanding Headaches and What Matters
Ask an Expert. Emergency Physician Dr. Jehangir Meer explains how headaches are evaluated and which patterns raise concern
What is the first thing going through your mind when a patient comes in with a headache?
The first question is whether the patient has a prior history of headaches and whether this feels like a similar pattern.
From there, we look for red flags, meaning warning signs that may suggest a more serious underlying problem. These include a sudden “thunderclap” headache, which is a headache that reaches maximum intensity within seconds, associated neurologic symptoms such as weakness or vision changes, pregnancy, use of birth control pills, recent trauma, or use of blood thinners, also called anticoagulants.
What do most patients get completely wrong about headaches?
One common misconception is that the severity of a headache always correlates with how dangerous it is. While severe pain can sometimes indicate a serious issue, that is not always the case.
Patients may also expect imaging such as a CT scan or MRI, even when it is not medically indicated. These tests are used selectively and are not needed for most headaches.
There can also be an expectation for strong pain medications, though this has become less common over time.
When do you know it is something serious?
We become more concerned when certain patterns are present.
These include a severe headache in someone without a history of chronic headaches, recent trauma, or use of blood thinners. Associated neurologic symptoms, such as changes in speech, vision, balance, strength, or sensation, are especially concerning.
Another important combination is fever with altered mental status, meaning confusion or changes in awareness, with or without neck stiffness. These can point to more serious underlying conditions.
THE BOTTOM LINE
Most headaches are not dangerous, but certain patterns and associated symptoms should not be ignored. Evaluation focuses on identifying red flags and determining when further testing is needed.
About the Expert
Dr. Jehangir Meer is a Board-Certified Emergency Physician.
This article is for educational purposes only and is not a substitute for medical advice from your own healthcare provider.