Seek emergency care if: Headache medication does not relieve chronic or excruciating pain. Head pain prevents eating or drinking, making one susceptible to dehydration or malnutrition. You experience major side effects to medication, such as severe drowsiness, sedation or nausea and vomiting.
Call 999 or go to the Emergency Department if:
You have an extremely painful headache and: Sudden problems speaking or remembering things. Loss of vision. You're feeling drowsy or confused.
Your headache comes on suddenly and is explosive or violent. Your headache is "the worst ever," even if you regularly get headaches. You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache. Your headache gets worse over 24 hours.
ER doctors can treat migraines with:
Sumatriptan for rapid migraine relief. Fluids via IV to prevent or alleviate dehydration.
If your headache persists for longer than 72 hours, you should see a doctor as soon as possible. The same is true for headaches that come and go but continuously occur in the same spot.
Going to sleep with an untreated migraine is commonly a mistake as it may worsen during the night and become difficult to treat in the morning. If a migraineur is sleep deprived, he or she can expect more migraines, while those who oversleep may wake with attacks that are very resistant to therapy.
What causes a persistent headache? A persistent headache can result from an injury or a structural problem in the spine, such as arthritis. It can also affect people who have migraine or have had a stroke. The overuse of pain relief drugs can also cause an ongoing headache.
Cluster Headaches
These headaches are the most severe. You could have intense burning or piercing pain behind or around one eye. It can be throbbing or constant. The pain can be so bad that most people with cluster headaches can't sit still and will often pace during an attack.
A thunderclap headache is a rare type of headache that's extremely painful and comes on suddenly. It can be a sign of blood vessel issues or bleeding in your brain.
Headaches that get steadily worse. Changes in personality or mental function. Headaches that are accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures.
The good news is that 90 percent of headaches are "benign." That means they aren't harmful or dangerous to you. The bad news is that 10 percent of headaches are a sign of a serious condition which requires an emergency evaluation.
Symptoms of a ruptured brain aneurysm usually begin with a sudden agonising headache. It's been likened to being hit on the head, resulting in a blinding pain unlike anything experienced before. Other symptoms of a ruptured brain aneurysm also tend to come on suddenly and may include: feeling or being sick.
Don't hesitate to go straight to hospital (via ambulance, or with a trusted driver) if you notice one or more of the following: sudden onset of the worst headache you've ever had. headache that worsens with exercise or sexual intercourse. neck stiffness (new since the headache started)
Seek immediate medical attention if you're experiencing the worst headache you've ever had, lose vision or consciousness, have uncontrollable vomiting, or if your headache lasts more than 72 hours with less than 4 hours pain-free.
The bottom line
While migraines can be painful and disrupt your life, you should be able to treat most attacks at home and avoid an ER visit. But it's important to listen to your body. If the pain is severe and accompanied by new symptoms, then it's time to head to the emergency room.
Depending on where you feel pain, the headache location usually determines what kind of headache you have: Tension headache: Both sides of your head or a band around your head. Migraine headache or hormonal headache: One side of your head. Cluster headache: One side of your head, specifically in or around your eye.
If this doesn't help, or if your migraines become more frequent or severe, ask your doctor about a stronger prescription drug. Common options include triptans, such as rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig).
Crash migraine
Migraine headaches may have an abrupt onset; these are termed "crash" migraine headaches and are similar to a "thunderclap" headache. Cluster headache also may be sudden and excruciating, but it lasts only 15-180 minutes and is recognized easily if the patient has had previous attacks.
The pain is usually like a dull ache, but it can also be sharp. You may have a throbbing (pounding) headache, or the pain might be constant. The pain might get worse when you bend over, shake your head or move around. Other dehydration symptoms usually occur along with headache pain.
Taking OTC pain relievers too often, or at a higher dose than advised, could cause more problems. Once the drug wears off, withdrawal symptoms start. This leads to more head pain and the need for more medicine. Doctors call this a rebound headache.
Tension-type headache, hemicrania continua, and the trigeminal autonomic cephalalgias SUNCT and SUNA may also occur in the night. Idiopathic intracranial hypertension (pseudotumor cerebri) headache may be worse when lying down and can disrupt sleep.
Just remember to keep your nap to 20 minutes or so: That's enough time to help you feel refreshed, but not so much that you wake up groggy—and in worse pain than before. “Sleep and pain have a two-way relationship,” says Dr Nayantara Santhi. “Poor sleep can intensify the pain and conversely, pain can worsen sleep.
The Difference Between Headaches and Migraines
The easiest way to distinguish a headache from a migraine is by the severity. Unlike headaches, which range from dull to acute pain, migraines are often so debilitating that the acronym POUND is sometimes used to summarize key migraine signs and symptoms.
One of the most obvious signs of a ruptured aneurysm is intense head pain, typically described as the worst headache of your life. Additional symptoms of a ruptured aneurysm include: Nausea and vomiting. Double or blurred vision.