Search Blog

Straight, No Chaser: When Your Headache is Life-Threatening

By Jeffrey Sterling, MD April 23, 2019


All headaches are not created equal. Earlier we discussed migraines, but there’s a lot more to headaches than those. In fact, when you come to an emergency room with a history of migraines and tell us you’re having a migraine, we aren’t thinking about migraines first. The ER is all about the life-threats.

The lead picture suggests items to avoid if you’d like to improve your prognosis for headaches in general and especially certain ones like brain aneurysms. In other words, alcohol, cocaine and cigarettes increase  your risk for life-threatening causes of headaches.

Secondary headaches are those related to some other illness or condition that produces headaches as a symptom. These are much more common causes of headaches than migraines. They’re even more important because they could represent life-threatening conditions. So we’ll put aside the headaches caused by things like panic attacks and hyperventilation, influenza, dental pain, sinusitis, ear infections, eye strain, dehydration, hangovers, hunger and “brain-freeze.” (Yes, “ice-cream headaches” are a real thing!) Today we’ll point you to some conditions about which you should be concerned. (I’m intentionally leaving out especially uncommon ones and otherwise esoteric conditions. I wouldn’t want to encourage any hypochondriacs out there.)

  • AVM (arteriovenous malformation): an abnormal formation of blood vessels inside your brain
  • Concussions and post-concussive syndrome
  • Brain aneurysm: a ballooning of one of your brain’s arteries that can steal blood away from needed areas


  • Brain tumor
  • Carbon monoxide poisoning: from breathing exhaust fumes
  • Encephalitis/Meningitis: inflammation and/or infection of different components of your brain
  • Subarachnoid and other intracranial hemorrhage: bleeding inside various parts of the brain


  • Stroke
  • Temporal arteritis: inflammation of an important forehead artery with potentially devastating consequences to your sight

Given that I’ve blogged on several of these already (you can always enter the term in the search box on the right for more details), I’m going to focus on the symptoms that may suggest your headache is different enough to get evaluated for a possible life-threat.
Consider this a “headache plus this symptom = go to the emergency room” list.

  • Altered mental status
  • Confusion
  • Difficulty standing or walking (different from baseline)
  • Fainting after a headache
  • High fever, greater than 102 F to 104 F (39 C to 40 C)
  • Nausea or vomiting that’s not hangover related
  • Numbness, weakness or paralysis on one side of your body
  • Slurred speech
  • Stiff neck
  • Vision disturbances (blurred or inability to see)
  • Worse headache of your life

Unfortunately, defenses go down in (and when evaluating) those with a history of headaches. This places you at additional risk. Even if you have had headaches before, if you have new symptoms or something seems different about a new episode, the decision to get evaluated could save your life.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Leave a Reply

Your email address will not be published. Required fields are marked *