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thunderclap headache

28 February 2023

Signs of an “Emergency Headache”

This month the National Neurosciences Advisory Group in the UK published a paper of recommendations for headache and facial pain diagnosis and treatment. Part of the purpose of the document was to help doctors recognize emergency situations.

Today we’ll take a look at that part of the paper as a reminder of certain signs to look for if you are someone you love is experiencing new or changed symptoms. This is just a summary, you can view the full paper below.

New Headache

New or changed symptoms are always a reason to get to a doctor as soon as possible. But there are certain symptoms that could especially be signs of an emergency:

A new headache late in your pregnancy, or soon after the birth of your baby.
You’re over 50 years old – your doctor may want to test for inflammation (ESR test)
Neurological symptoms such as problems speaking, hearing, or seeing, or even feeling (numbness, pins and needles…). If these symptoms are getting worse, that’s another urgent sign.
Seizures
Unusual changes in personality or trouble thinking. “Unusual” because we’re assuming this is not a known mental or physical illness. This is something that needs to be noticed by someone else.

Other New Facial Pain

Jaw pain in patients taking bisphosphonates (a group of medications designed to increase bone density)
New pain in your temple, especially if you’re over 50

Other Headaches/Facial Pain

Any headache with a change in consciousness, drowsiness, or fainting
Thunderclap headache (headaches that appear suddenly and are at “full power” in 60 seconds or less)
Headache or facial pain with other symptoms such as fever, vomiting, visual problems, etc.
Headache or facial pain when you already have related medical problems or a history of them
Red eyes with headache (especially in seniors)
Trigeminal Neuralgia – sudden severe facial pain (like an electric shock)
Facial pain with a nosebleed, thick coloured nasal discharge, continuous change in your sense of smell, hearing loss on the same side as the pain

This might sound confusing, but it really can be summarized for the most part in new or changed headache, facial pain, or accompanying symptoms.

But whereas some mild changes or progressions might mean booking an appointment, when the symptoms are sudden and show signs of neurological problems and serious illness, going to emergency right away is important. There are also symptoms that may be ongoing that should be watched carefully and continuously.

These symptoms are also an important reminder to be aware of your friends and family. You may notice certain things before they do, and you can help them get the treatment they need.

Headaches are common, but they’re not “normal”. And at times they can be an important warning that immediate treatment is needed. Don’t ignore them.

To read the full report, go to Optimal clinical pathway for adults with headache and facial pain and download the pdf version.

4 October 2010

Aneurysm and Headache: 9 Ways to Know if I’m in Danger

James Information, Tips 7

When many people think of an aneurysm (or aneurism), they think of a severe headache and severe danger. Although aneurysms aren’t always like that, it is important to be aware of how headache and aneurysm can relate.

An aneurysm is an abnormal ballooning or widening of an artery. That means they can actually happen in many parts of the body, though some locations are more likely than others. Though no one is certain what causes all aneurysms, there are cases when they may be caused by a defect in the artery wall. High blood pressure, high cholesterol, smoking, drug abuse, and pregnancy are all common risk factors.

Sometimes aneurysms don’t cause any symptoms at all, but simply show up when you’re being tested for something else. At times your doctor won’t even recommend you have it treated.

An Angiograph of a Brain Aneurysm
Photo courtesy of Lucien Monfils

The most common type of aneurysm related to headache is the brain aneurysm. The bulge in a blood vessel in the brain may grow, leak, or rupture.

If the aneurysm is small, or even large, there may be no symptoms at all. If an aneurysm like this is discovered, you’ll need to talk to your doctor about whether or not treatment is needed.

If there are symptoms, they might include:

Pain – usually above or behind an eye
A drooping eyelid (which may also be a symptom of cluster headache)
A dilated pupil
Change in vision (ie double vision)
Numbness or weakness on one side of the face

You need to see your doctor if you’re experiencing these symptoms.

If the aneurysm begins to leak, or ruptures, that’s when it becomes an emergency (if it ruptures you need to get to a doctor NOW). But how do you tell?

Sudden, severe headache. This may happen with a leak (which usually becomes a rupture) or an actual rupture. If you have a sudden headache, perhaps the worst you’ve ever had, get to a doctor right away.
Nausea (also common in migraine, of course)
Sensitivity to light (another very common migraine symptom)
Stiff neck
Blurred or double vision
Drooping eyelid (again, a common cluster symptom)
Seizure
Unconsciousness
Confusion

Important: You do not have to have all these symptoms to have a ruptured aneurysm. But if you have a sudden, severe, headache, or if you have a combination of a couple of these symptoms or more, make sure your doctor is aware – and see her right away if these are new symptoms.

Your doctor will need to know about your cardiovascular health in general, any family history of aneurysms, and your use of drugs/alcohol/tobacco. Then tests will be ordered, such as a CT scan, MRI, ultrasound and/or angiogram. Depending on the type of aneurysm and other factors, you may need surgery, medication, or other therapies.

There are other conditions that may cause some similar symptoms – such as the so-called ophthalmoplegic migraine, sex headache or orgasm headache, or another type of "thunderclap headache" not caused by aneurysm. And of course we’ve talked about similarities with migraine and cluster.

Although unruptured aneurysms in general are fairly common, thankfully ruptured aneurysms are rare, and fatalities from brain aneurysms are even rarer (about 1 in 25,000 each year in the United States). Hopefully being aware of the risks and symptoms will help us get that number a lot lower.