When should you consult a doctor about your
headaches? When evaluating a patient for headache in
general, we look for certain warning signs or red flags in the history, and on the physical
examination. Typical red flags that would make me as a
neurologist worry would include things such as the headache being associated with fever
or stiffness of the neck or body pains or joint aches which would make me think that
the headache is a manifestation of some other illness like an infection such as meningitis
in worrisome condition. Other indications would be if the headache
were associated with some neurologic defects, numbness on one side of the body, weakness
on one side of the body, difficulty with speech or understanding what is being said to the
patient or difficulty in vision or eyesight. Again, that would make me worry of a neurologic
complication. The headache might be the manifestation of
a stroke or were still a brain tumor. Also, how did the headaches occur? Headaches that have their onset with coughing,
straining, exercise like weightlifting or sexual activity could be a worrisome indication. It might mean that in fact the headache is
a manifestation of a bleed into the brain, hemorrhagic stroke, or an aneurysm that is
ruptured. Alternatively those same things causing headache
could be the result of a brain tumor in the back of the head that interferes with the
pathways of the cerebrospinal fluid. Also at what age did the headache begin? Headaches that start after age 50 for the
first time are worrisome. As we get older, we are more likely to have
other medical conditions, brain tumors, inflammations of the arteries, a condition known as Giant-cell
arteritis, which causes headaches only after the age of 50 with associated jaw pain, tenderness
of the scalp, and as untreated blindness. Brain tumors are also more likely or metastasis
from other tumors to the brain are more likely after the age of 50. So the age of onset is a red flag for us. Also lastly, a change in the pattern of headaches,
so even if you had a longstanding history of headaches, but the headache should coming
to me with now are different than your usual headaches. They have a different quality to the pain. They have a different location. That would make want to investigate further. And then the last reason which is not necessarily
a dangerous reason, but a red flag being the headaches are interfering with your life. You are having trouble going to work, going
to school, taking care of your family, they are so frequent or so disabling that you just
cannot function normally, you need to go to your physician to get appropriate treatment
for these headaches.
