Headache (also called cephalgia), like the common cold or low back pain, is extremely common. Nearly all human beings, at some point in their life, will experience a headache. The question is, when should you be concerned about a headache and seek medical attention. The most common forms of headache are muscle tension headaches, migraine headaches, and the headache associated with excessive alcohol consumption. These are benign headaches and people who have them typically experience them on a regular basis.

The headache to be concerned about is the one that is distinctly unusual, particularly a very severe headache that has a sudden or abrupt onset which the patient has never experienced in the past. This type of onset could be a symptom of bleeding within the brain. A common cause would be a ruptured aneurysm. That headache is distinctly unusual and again the hallmark is extremely abrupt onset often associated with a temporary loss of consciousness, nausea and vomiting, a stiff neck, and photophobia (light sensitivity). Any individual experiencing symptoms such as these should proceed immediately to the emergency room to be evaluated. Their medical evaluation will include a CT scan of the brain and possibly a lumbar puncture.

A headache due to a tumor within the head typically has a more gradual onset. It initially can be intermittent and then become more constant. Often the headache associated with tumor is worse when a patient is lying down. Certainly, any headache associated with any neurologic symptoms–weakness, numbness, speech disturbance, or visual change–should be evaluated by a physician.

It is important to understand that only a small minority of headaches are due to something potentially life-threatening, such as a ruptured aneurysm, other intracranial hemorrhage, or tumor. The vast majority of headaches are benign, may recur with some frequency, and are not associated with serious conditions. The headache that is distinctly unusual in its intensity or severity, particularly it if comes on extremely abruptly, should be evaluated by a physician.

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