When to worry about a headache
By Dr. Julie Schwartzbard, MD
When did you last wake up with a headache? While painful, for many of us, the occasional headache is so common we hardly even think about it. We just pop a few pain pills, head out the door and go on with our lives.
But then one day, you get a headache that just won’t go away. Maybe it feels more crushing than usual, or is centered in a different spot. That’s when you want to ask the question I hear almost every day as a headache expert:
When should I worry about my headache?
It’s a good, and important question — and here’s the answer.
Call your doctor right away if…
When you suddenly get a serious headache that immediately feels unbearable — and you’ve never had one like it before — call your doctor right away.
Other signs that you should talk to your doctor about your headache include:
- Loss of coordination
- Change in vision, speech or alertness
- Headaches following an injury
- Weakness or numbness on one side of the body
- Neck stiffness
While most people never experience the symptoms above with their headaches, this information can help you recognize the ones that come with big red flags. But you may still be concerned if your headache doesn’t feel quite right.
What other types of headaches should I worry about?
If you’re a regular headache sufferer (I’m sorry!) and you notice changes in the type of headaches you usually get, make an appointment with your doctor to talk it over. For example, changes in the severity or frequency of your headaches, when they happen or when your normal remedy for pain doesn’t seem to help are all reasons to see your doctor.
Some women experience all the different types of headaches. Here are the three most common categories of headaches and what you can typically expect:
1. Tension headaches (stress headaches): You’ve probably experienced this extremely common type of headache. You know the one — it feels like there’s a vice tightening around your head. Or the ones with that dull constant pain vs. the throbbing pain we associate with migraine headaches.
Tension headaches are often caused by stress, so de-stressing is your first order of business. Often you can feel better by resting or using over the counter medications. There’s usually nothing serious to worry about with tension headaches, although you may need to make lifestyle changes for natural relief to keep them from happening over and over again. For women who experience frequent tension type headaches — meaning more than once a week — there are prescription options a headache specialist can offer.
2. Migraine headaches: Women suffer from excruciating migraine headaches much more often than men. Migraine pain usually throbs and can range from mild to crushing — although, surprisingly, there may not be any pain at all. That’s because migraines can present in a variety of ways.
Symptoms can include nausea and an aura before the head pain, as well as extreme sensitivity to light, sound and smell. When it comes to diagnosing a migraine, your doctor will want to know about your family history, as migraines run in families. I have migraines. So do my father, my sisters and my children. When it comes to pediatric migraines, kids often have significant gastrointestinal symptoms that are more predominant than head pain — and sometimes not recognized as migraines.
3. Hormonal headaches: Hormonal fluctuations can trigger headaches and menstrual migraines for women during perimenopause and menopause, even if headaches have never been an issue before. Most hormonal headaches take place when levels of estrogen are out of balance to progesterone levels, often right before menstruation starts.
Other women get hormonal headaches at the end of their periods or during ovulation. If you think your headaches might be related to your hormones, start tracking how your cycle is related to your headache symptoms. That can help you predict — and maybe even prevent — hormonal headaches.
Keeping track of your symptoms to find headache relief
I know how scary headaches can be and how important it is for you to identify the cause of your pain. One way you can help your doctor provide the best prevention and treatment plan is by giving her as much information as you can about your headaches. For example, I try to pull out as much detailed information from my patient as I can during her first visit. For many people, this appointment is the first time they’ve thought about what might be their major triggers, such as what they’ve eaten and how they’ve slept before their headaches come on.
That’s why it’s so helpful for me when my patients keep a headache diary. It’s an irreplaceable tool that helps me determine what kind of headache my patients have — and it often guides me to what should be the next step to help them feel better.
Here’s what your doctor will want to know about each one of your headaches:
- When did the headache start and finish (day/time)?
- How bad was the headache on a scale of 1 to 10 (10 being the most severe)?
- How would you describe the pain?
- How is the pain different from headaches you’ve had before?
- Did you experience any symptoms before the headache?
- Did you experience other symptoms with the headache?
- What were you doing before? Were there any known triggers, such as stress, lack of sleep, eating certain foods?
- What did you do to try to stop the headache?
- How did it work?
- Is this a hormonal headache? Could it be connected to your menstrual cycle?
- How frequently do you get headaches?
Over time, you may discover some patterns you didn’t even realize were happening. And sometimes these patterns can be essential clues that help you prevent your headaches altogether, rather than just trying to catch up and treat them. Now wouldn’t that be great!