Headache is an extremely common symptom that can be caused by migraine, but also tumors, infections and other illnesses. There are more than 200 causes of headache in the International Classification Of Headache Disorders! (our Bible for headache diagnosis). 

https://ichd-3.org/

The vast majority of headaches are from a benign origin, like migraine and tension-type. It means that the process leading to the headache will not cause lesions to the brain or induce permanent damage. But in some situations, the headache must be investigated. 

Here is a list of situations and symptoms where you should probably seek medical advice. 

  1. You have a history of cancer (even if treated or in remission). Cancer is associated with blood clots and of course brain metastasis.
  1. Your immune system is deficient. You take immunosuppressant medications or you have a disease lowering your immunity. 
  1. You have been losing weight, had fever or other unexplained signs of illness. 
  1. You have any new neurological symptoms. That would include problems with vision, ability to walk, coordination, speech, vision, sensation, memory and focus. 

Note: If you are know to have typical auras, then no need to worry everytime you have one. But if you have new neurological symptoms, see a physician.

  1. You have had a headache that was sudden and severe. We call these «thunderclap» and they should be immediately investigated. Go to the Emergency now. That could be a bleeding in the brain. 
  1. You have headache that are progressing since a few days or weeks with no explanation.
  1. You have new headaches and you are 50 years old or older. In this age bracket, the risk of having a headache that is not benign is higher. 
  1. You have a headache different than your usual ones. Yes, if you have migraines you can still have a different type of headache!
  1. Your headache is clearly worse when lying down (the pressure in your head might be elevated)
  1. Your headache is clearly worse when sitting or standing up (the pressure in your headache might be too low). 
  1. You are pregnant or just gave birth. Some serious health issues like venous thrombosis and eclampsia may occur during those times. 

What if I have had tests but a cause is not found?

Remember that headache medicine is complex. Testing will exclude most causes of dangerous headaches, but sometimes a clear diagnosis is not found. This is a stressful situation, but it does happen. In some cases, once the appropriate testing has been done, if the headache persists, it may be necessary to watch and wait.

My imaging is normal, do I only have migraine?

If in the end your diagnosis is migraine, then fine, you don’t have a brain tumor, but of course you should be properly treated. Some physicians may discard migraine as a benign problem, but migraine can be disabling. There are many options to improve your life if you live with migraine (See this post)

My doctor did not prescribe any imaging. Should I worry?

If you do not have any danger clues or red flags, if your examination is normal and if you have typical migraine symptoms, then imaging may not be required.  https://www.choosingwisely.org/patient-resources/imaging-tests-for-headaches/

Post#109

 Print This Post Print This Post