Danger signals in headache patients who should immediately consult a doctor

Presence of following serious danger signals should warn a clinician that a headache may be more serious than migraine:

• Headache that is changing or different from previous headaches may herald a brain tumor superimposed on a longstanding primary headache disorder, such as migraine or tension-type headache.
• Headache with progressive worsening during 24 hours or several days suggest a mass lesion or infectious disease, such as meningitis, abscess, subdural or intracerebral hematoma, or vasculitis.
• Headache precipitated by exertion, bending over, coughing or sneezing may result from transient blockage of CSF flow or increased intracranial pressure.
• Sudden onset of headache during exercise or sex can occur with subarachnoid hemorrhage or could be benign exertional headache.
• Vomiting may result from a brain tumor or other mass lesion with increased intracranial pressure.
• Early morning headache can occur with obstructive sleep apnea and hypertension.
• Any abnormal physical or neurologic finding must be considered suspect, including fever, stiff neck, rash, lymphadenopathy, scalp tenderness, altered sensorium, and focal neurologic signs.
• Any patient who presents with their first or worst headache is cause for alarm (Blumenthal and Rapoport, 2001).

This article was written by Dr. Shahul Ameen, M.D., Senior Resident, Central Institute of Psychiatry, Ranchi, India. Clinical Psychiatry is a part of PsyPlexus, a portal for mental health professionals. You can find the orignal article at his interesting Clinical Psychiatry blog.