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When is a Headache Serious?

Headache symptoms often have a dramatic quality that naturally arouses a degree of fear and anxiety about the possibility of a sinister cause. For this reason, many patients will have had some form of brain imaging. Fortunately, in the vast majority of cases, these scans are a conservative measure to reassure both the patient and the clinician. For example, in one study CT scanning of 11,200 consecutive patients whose sole presenting symptom was headache, only 1 tumour was found. This is obviously quite reassuring.

Thankfully, there are almost always other features that should alert us to the possibility of a serious headache. These are our “Red Flags”.

We have 5 key questions that help us exclude the possibility of a sinister cause.

1. Are headaches a new symptom for you?

2. Do you have any other new symptoms that are noticeable even when you don’t have a headache such as changes to your balance, vision, sensation or strength?

3. Do your headaches worsen sharply when coughing, straining or bending forward?

4. Have your headaches suddenly changed in character, frequency or intensity for no reason?

5. Have you or your partner noticed any changes in your personality, memory or ability to think clearly?

If you answer yes to any of these questions it is important to have these assessed by a medical practitioner.

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