When is a headache cause for concern?

March 31, 2014
When to be concerned about a headache

Migraines can be debilitating, but for some people who experience auras with their headaches, they could be a marker for a more serious danger – an increased risk for stroke. 

UC Irvine Health stroke neurologist and headache specialist Dr. Lama Al-Khoury says women who experience an aura with their migraines have been shown to be at particular risk.

Migraines are often described as throbbing or pulsating, but they also can be dull or pressure or sharp. They often occur on half of the head or in a specific location but may involve the whole head, and they sometimes switch from one side to the other.

An aura can be a visual or sensory impairment that can precede or accompany a migraine. Visual auras are more common and are often described as shimmering lights, or as arcs, shapes, colors or patterns. Sometimes visual symptoms can involve dark spots or total or partial loss of vision, Al-Khoury says. Sensory auras can be felt as tingling or numbness that starts small and spreads to a larger area of the face or limb. Other auras may involve difficulty understanding or expressing language, limb weakness on one side or balance difficulties.

What are the common triggers for headache?

What are the common triggers for headache?

Migraines are complex disorders with a wide variety of triggers.

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Migraines and stroke

People who experience auras with their migraines have double the risk of stroke, according to a 2009 study published in the British Medical Journal. Being a female smoker under the age of 45 and on birth control increases the risk of stroke even more.  A newer study also found a significantly higher risk of stroke among women who have migraines with aura.

It is still unclear whether treating and preventing the migraines could result in stroke risk reduction, said Al-Khoury, but affected women should stop smoking and be cautious about using estrogen in the form of birth control or hormone therapy because of estrogen’s effect on blood clotting and coagulation.  Because pregnancy increases the production of estrogen, women who have migraines with aura need to be educated about their elevated risk.

Furthermore, some auras associated with migraines may mimic the symptoms of stroke. Stroke is caused by a blockage in the blood vessels of the brain or by bleeding into the brain. In fact, without proper history and clinical evaluation and tests, it can be difficult to differentiate between stroke and migraine in some patients, Al-Khoury said.

When to see a doctor

People who experience recurring headaches of any type should see a neurologist for a thorough evaluation and examination because an accurate diagnosis is critical to effective treatment, Al-Khoury said.

Episodic tension headaches and sometimes milder forms of migraines may go away with rest, relaxation, and over-the-counter medications, or analgesics. Intense migraine headaches may need special migraine treatments. Frequent headaches – whether tension, migraine or other kind of  primary headache – may require preventive treatments with daily medication.

“Red flags”

Some headaches are considered “red flags” because they could be caused by an underlying, life-endangering condition. If you experience any of these “red flags,” Al-Khoury says, consult a doctor:

  • Sudden, intense headache that peaks to an unbearable intensity over seconds to minutes, often described as “the worst headache of my life.” This is sometimes referred to as thunderclap headache. This may be caused by life-threatening bleeding in the spaces of the brain, and you should go to the emergency room immediately. Call 911.
  • A new headache that is different from any other previous headache, or an increase in frequency or intensity, or poor response to previously effective therapies.
  • Headache that wakes you up at night
  • Increased headache when lying down coughing, sneezing or weight bearing
  • New headache after age 40 if you’ve never had headaches before
  • Headache accompanied by any symptoms such as: weakness in the face, arm or leg; numbness or coordination problems; visual impairment; language or speech problems; vertigo; confusion; altered wakefulness; or seizures. If those symptoms occur call 911.

“Take your headache seriously,” Al-Khoury says. “If you are having headaches, see a headache specialist. We can diagnose your headache and treat it.” 

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