Headaches are a normal part of adult life. Daily stressors like work, family, menstrual cycles and just forgetting to drink water can contribute to headaches. From a mild throbbing in the temples to a full-blown migraine, headaches can vary in severity from annoying inconvenience to crippling hindrance.

It may be easy in your busy life to simply take some ibuprofen and carry on. But what if there’s a deeper issue behind your headache? Here’s what you should watch for, and when to be concerned.

How do I know when a headache is more than a headache?

Jennifer Rasmussen-Winkler, MD (vascular neurologist on the medical staff at Baylor Scott & White Medical Center – McKinney) gives guidance on finding help for a common migraine that turns into something more unbearable, or potentially serious.

“If you have never had a headache before and start having them, you should seek care with your physician to confirm it is nothing potentially serious,” Dr. Rasmussen-Winkler says. If you have a sudden onset severe ‘worst headache of my life’ headache, then you need to seek emergency care.”

According to Rashedul Hasan, MD, (medical director of the Comprehensive Stroke Program on the medical staff at Baylor Scott & White Medical Center – Plano) any headache which is out of the ordinary in terms of severity (more intense), duration (longer than expected), or nature should be immediately addressed.

“A headache that is associated with severe nausea, vomiting, decreased alertness, or that wakes you up from sleep is of great concern,” Dr. Hasan says. “Brain aneurysm usually presents with the ‘worst headache of my life,’ associated with nausea, vomiting, decreased consciousness, or alertness.”

Migraine Vs. Stroke. Vs. Aneurysm

Migraines are a very common form of headache. They typically start as a throbbing headache over one eye that starts slowly and worsens over the next couple of hours. Some people experience “auras” which can include flashing visual lights, increased sense of smell and dizziness. If you experience this for the first time, it’s recommended that you get evaluated to confirm you have migraines.

William Fox, MD (site medical director at Baylor Scott & White Medical Center – Centennial Emergency Department, Emergency Medicine Physician on the Medical Staff at BSWMC Centennial) gives guidance on knowing when your migraine is serious enough to make a trip to the ER.

“People with a history of migraines know the quality, timing and other characteristics of their ‘usual’ migraines, and also know what treatments have improved their symptoms in the past,” Dr. Fox says. “If someone’s headache is different from their past migraines or does not improve with their usual treatments, an evaluation may be warranted.”

Strokes result from blood supply to the brain being interrupted, preventing oxygen flow to brain tissue. About 85% of strokes are caused by blood clots in the brain.

“The patient usually presents with at least one of the following symptoms,” Dr. Hasan says. “One-sided arm or leg weakness, loss of sensation, face droop on one side, difficulty talking or understanding, sudden balance problem, or loss of vision on either eye.”

Dr. Hasan implored people to be familiar with the acronym B.E.F.A.S.T, established by the American Stroke Association, when they watch for stroke symptoms:

B – Balance problems
E – Eye problems
F – Face droop
A – Arm drift
S – Speech difficulty
T – Time to call 911

Brain aneurysms are bulges in blood vessels in the brain, indicating a weakness that can result in a leak or rupture.

“Sudden onset headaches that reach maximal intensity within one hour is the conventional indication of aneurysm rupture,” Dr. Fox says. “These headaches are described as ‘the worst headache of my life’ or a ‘thunderclap headache.’ Some aneurysm ruptures may be associated with passing out, vomiting, or neck stiffness.”

Don’t need to visit the ER, but have a headache you still want to treat? Each doctor advises that home remedies for headaches work best earlier in the course of the headache than later. If you know you have a tendency for headaches, taking a non-steroidal anti-inflammatory drug (NSAID) when it starts to develop instead of when it has become nagging is best. In addition, a regular sleep routine helps improve headaches. Please check with your doctor about the safety of taking an NSAID.

Physicians provide clinical services as members of the medical staff at one of Baylor Scott & White Health’s subsidiary, community or affiliated medical centers and do not provide clinical services as employees or agents of those medical centers or Baylor Scott & White Health. ©️2022 Baylor Scott & White Health.