Headaches can range from benign to life-threatening, and it is important to take them seriously. Symptoms such as headache with fever and stiff neck, thunderclap headache, headache after a head injury, headache with loss of vision or numbness in the arms or legs, or headache with fever (not caused by the flu) are urgent medical conditions. Migraines tend to run in families, and children whose parents have migraines are up to four times more likely to develop them as well. Researchers believe that migraines occur when unstable nerve cells overreact to several factors.
Nerve cells send impulses to blood vessels and cause chemical changes in the brain. While scans and other imaging tests may be important to rule out other diseases, they do not help diagnose migraines, cluster headaches, or tension headaches. A CT scan or MRI may be used if your provider thinks your headaches are related to a problem in the central nervous system. Both tests produce cross-sectional images of the brain that may show abnormal areas or problems. X-rays of the skull are usually not done.
An EEG (electroencephalogram) may not be needed unless you have ever passed out during a headache. For frequent or severe headaches, your healthcare provider may recommend prescription pain medications. Triptans and other types of medicines can stop a migraine attack if taken at the first signs of an approaching headache. Medicines for high blood pressure, seizures, and depression can sometimes prevent migraines. Sinus headaches are also considered headaches. This type of headache is the result of inflammation caused by infection of the sinuses.
Swelling puts pressure on the brain and surrounding areas, leading to headache. If you have the typical severe headache or migraine, and you don't have any new symptoms, the chances that these tests will be helpful are extremely low and you have the right to refuse them. Most patients with headache in the emergency department had primary headaches, with migraine being the most common diagnosis. General practitioners, internal medicine physicians, cardiologists, and neurologists work together to provide a multidisciplinary approach for these patients; therefore, not all headache patients were seen and treated by neurologists or a headache specialist. Drug overuse headache (MOH) is a common and well-described condition that develops in patients with underlying primary headache syndromes. Of the headaches classified as primary, a large majority (almost 90%) are migraines, tension or cluster headaches. The consensus of the European Headache Federation reports the reasons and cases of headache that may require technical investigation, as well as the required tests. Consideration should be given to using CT imaging of the head in patients who have symptoms of “red flag”, have a new onset headache or changes in the nature of their headache. For many patients, an emergency room visit for headache or migraine occurs after a long period of severe headache that lasts for days or weeks.
Most people who go to an emergency room for severe headache or migraine don't get lasting results from medications given in the emergency room, so it's very important to have a good long-term plan and relationship with an outpatient doctor who treats their headache disorder. If you have any type of headache all the time, it's important to talk to your primary care doctor so they can help you create a treatment plan or refer you to a specialist.
