Worst Headache of Your Life

Head and neck pain may be more than just a headache.

Headaches are a common reason for a visit to a health care practitioner. Almost everyone suffers headaches occasionally. Some people have more serious types of headaches requiring specialized medical treatment. On rare occasions, a headache may be a symptom of a life-threatening problem. The "worst headache of your life" may be a symptom of a medical emergency. People with this symptom should be evaluated right away.

There are many types and causes of headaches. Some of them include:

• Tension headaches
• Migraine headaches
• Meningitis or an infection of the fluid surrounding the brain and spinal cord
• Tumors
• Temporal or giant cell arteritis, an inflammation or swelling of blood vessels in the head
• Head injury with or without bleeding within the skull
• Exposure to certain toxic substances, such as carbon monoxide (this exposure tends to occur in the winter months because of defective heating systems and may affect an entire family)
• Aneurysm in the brain
• Subarachnoid hemorrhage

Some of the symptoms of the different types of headaches include (not every type of headache will produce all of the symptoms):

• A throbbing, sharp, or aching pain in the head or upper neck
• Visual changes, fever, nausea, and vomiting
• A headache that involves one or both sides of the head
• A "prodrome" (a group of symptoms) preceding a migraine headache
• Rapid onset of headache

Contact a health care practitioner or emergency department under the following circumstances:

• You are experiencing the worst headache of your life, especially if you rarely suffer from headaches. Having the worst headache of your life, especially if you rarely suffer from headaches, makes it an emergent situation.
• A headache is associated with a fever. If the headache and fever are accompanied by a stiff neck, go to an emergency department immediately for evaluation.
• When more than one family member has a headache at the same time, especially in the winter in cold climates where carbon monoxide exposure could be a possibility
• Any headache that is clearly out of the ordinary for you
• People already diagnosed with migraine whose home care plans have failed to produce acceptable pain relief, or if the intense headache differs in character from your usual migraine headache

Go to a hospital emergency department immediately under the following circumstances:

• The worst headache of your life, especially if it starts like a "thunderclap" (very suddenly)
• A headache following a head injury
• A headache with loss of vision or numbness or weakness of your arms or legs
• Someone diagnosed with migraine headache but it does not improve significantly with home-care
• Any headache with unusual associated symptoms, especially in people who rarely suffer from headaches
• A headache with a fever (not obviously caused by the flu), especially if it is associated with a stiff neck
• Any other headache that you feel may be an emergency medical condition

• The doctor will ask you questions about your headache and other medical problems and will do a physical examination.
• Blood or urine tests may be ordered.
• Specialized imaging tests, such as a CT scan or an MRI may be performed under certain circumstances, either as an emergency procedure or on a more routine basis. Regular X-rays are rarely helpful.
• Certain types of headaches may require the doctor to do a lumbar puncture or spinal tap. This test involves the removal of a sample of cerebrospinal fluid (the fluid around the brain and spinal cord) to examine for signs of infection, bleeding, or other physiological problems. Lumbar puncture is a safe test, but unfortunately, the removal of spinal fluid may make the patient's headache transiently worse.
• In some cases referral to a specialist may be necessary, depending on the results of specific tests; for example, a referral to a neurosurgeon is usually ordered if bleeding in the brain is found.

Treatment of the headache depends on the specific diagnosis. It is important for the patient to keep their primary care doctor updated on visits to the emergency department so that the doctor is aware of any changes that may need to be made to the patient's treatment plan, especially if they are managing chronic migraine headaches.

• Headaches that are not life-threatening, such as tension, mild, cluster, or migraine headaches may be treated with a variety of pain medications.
• More serious headaches will require specific treatments prescribed by the doctor, possibly with the involvement of a specialist.

Self-Care at Home

• Most affected individuals usually may take an over-the-counter (OTC) headache medication, such as acetaminophen (Tylenol) to reduce the headache pain; taking ibuprofen (Advil) or other nonsteroidal anti-inflammatory drugs (NSAIDs) is not advised because if the headache is due to bleeding in the brain, the medication may make it worse. If the headache is truly the worst headache of your life you should go to an emergency department immediately.
• Some tension headaches are relieved if the person removes themselves from the situation causing stress.
• A cool, wet towel over the forehead may reduce symptoms.
• A person with chronic migraine headaches should discuss a treatment plan with their healthcare practitioner. If the affected individual continues to visit the emergency department, repeated CT scans may be performed, resulting in unnecessary radiation exposure, and no follow-up plan for the patient for a potentially treatable condition.

Most headaches are not serious and will resolve with or without treatment. Headaches of a more serious nature, migraines, for example, should be evaluated by a doctor or an appropriate medical specialist.

Some headaches have a more dire prognosis, especially if they are left untreated. For example, headaches caused by brain infection or bleeding may result in severe disabilities or death if left untreated. Even with treatment, in some individuals, the prognosis can still be poor if the infection is treated at a later stage, or if there is a large amount of bleeding into the brain.