Warning signs that a headache needs urgent medical evaluation

Full analysis

Brian Grosberg lists specific red flags that should prompt a person to seek medical evaluation rather than assume they have a primary headache: a new headache or a clear change in an existing headache pattern; headache accompanied by fever, rash, or inability to flex the neck comfortably; unintended weight loss; neurologic symptoms such as weakness, numbness, speech difficulty, double vision, or balance problems; headache triggered by cough, exertion, sexual activity, or posture; and any new headache in someone over age 50, which raises concern for conditions such as temporal arteritis (inflammation of arteries near the temple, though the pain can occur anywhere in the head or face). A sudden thunderclap headache that reaches peak intensity within seconds to a minute is also a warning sign and can indicate a cerebrospinal fluid (CSF) leak or other serious vascular event. Grosberg notes that CSF leaks are easy to miss and may only declare themselves through a postural pattern — headache that worsens when upright and improves when lying down.