When to get help for a headache

There are some 200 different kinds of headaches, and about 90 percent are of the non-dangerous type. We’re not talking about how miserably or painful headaches can be, just that most are “not dangerous.” This is about how to recognize when a headache might be dangerous, and when to come in and see the doctor or care provider.155807270

I was an intern working in a big city hospital emergency room one late afternoon autumn day in Georgia, when a tall 40 something year old guy lumbered into my tiny exam room with the worst headache he’d ever had. He was a hiker who spent a lot of time out in the woods with his dog, but who was so miserable he wanted nothing to do with hiking this day.

He was running a 102-degree fever and he hurt everywhere I touched, especially when I bent his head forward. He had a light pink rash especially on the palms and he reported plenty of exposure to ticks lately. To make a long story short, the tests take a week to come back, but we treated him for Rocky Mountain Spotted Fever and later proved that was the case.

What clues are there to know when to do more than just cover up a headache with pain medicines?

In general, people are safe if the headache is associated with a viral syndrome; is something similar to headaches in the past and has been defined already as migraine, tension, or neck arthritis headache; is occurring in a person otherwise healthy; or is accompanied by no other significant new physical or neurological symptom.

On the other hand, people are not so safe if the headache is completely different than any previous headache; is the worst headache ever; strikes suddenly like a thunderclap; is associated with a significant fever, generalized illness, stiff neck, or weight loss; comes with new one-sided face, arm, leg weakness, or vision change; or is a new progressively worsening headache that is happening in someone over 40 years of age.

Of course these are just guidelines. If you have any question, seek professional help.

My woods walker had an unusual and severe headache with a generalized illness, and if not treated early might have resulted in his death. As an intern, I was glad I had been listening during the lecture on the causes of headaches.

By Dr. Richard Holm

Internal Medicine Physician at Avera Brookings Medical Clinic

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