When it's more than just a headache: Knowing the symptoms

There are two main types of headaches, primary and secondary. Primary headaches are those not caused by other medical conditions; migraine, tension headaches and cluster headaches are common examples. In migraine headaches and cluster headaches, nerves and blood vessels inside the head send pain signals to the brain. Secondary headaches usually result from another medical condition such as fever, an infection, over use of a medication, high blood pressure, a head injury, stroke, stress, a tumor or a nerve disorder. Distinguishing between primary and secondary headaches can be challenging. But it’s important to differentiate between the two, because occasionally headaches can be caused by or associated with a serious medical condition.

Many of us have a headache from time to time. But do you know how to recognize when it’s more than “just a headache”? What symptoms should you look for?

Primary headaches are the more common type. In this category are migraine headaches, which can be very debilitating and are sometimes accompanied by worrisome symptoms. Even so, they don’t usually indicate a more serious condition. Migraine headaches can occur a couple of times a year or for many days each month. The pain associated with them can range from dull or mild to excruciating. It typically is felt on one side or in one area of the head as a throbbing or pounding.

Besides this head pain, common symptoms of migraine headaches include:

  • Nausea
  • Sensitivity to light and sound (photophobia and phonophobia)
  • Scalp tenderness
  • Facial tenderness
  • Numbness and tingling (paresthesia)
  • Seeing shimmers or sparkles (scintillating scotoma)

If you note any of these symptoms, it’s a good idea to discuss them with your physician, who can help identify the kind of headache you’re having. In addition, the doctor can help you develop a treatment plan to lessen the pain and frequency of any type of headache.

Secondary headaches, unlike primary ones, are associated with another medical condition. They can be benign (such as a headache caused by medication overuse) or ominous (like the “thunderclap” headache that signals a subarachnoid hemorrhage).

Some secondary-headache features that can indicate a serious problem are:

  • A headache that’s the first ever or worst ever
  • A severe headache that comes on abruptly
  • Increased frequency or a change in the character of recurrent headaches
  • Headaches at a very young age or later in life (under 5 or over 50)
  • Abnormalities, such as weakness or vision loss, accompanying a headache
  • Headaches that are associated with seizures, fainting or a medical condition like pregnancy, cancer, HIV or high blood pressure
  • A headache accompanied by fever
  • A headache that comes with exertion or straining, activities known as Valsalva maneuvers


If you have a headache with any of these features, get an evaluation from a physician. Ignoring the symptoms or waiting them out could result in long-term damage. If the symptoms point to a stroke, for example, time is of the essence.

While most headaches aren’t life-threatening, being aware of these warning signs will help you respond properly if an emergency should arise.

During an evaluation, it’s important to establish whether the headaches are primary or secondary. A headache journal is helpful, if you can keep one. Note such specifics as accompanying symptoms and the headaches’ frequency, intensity and duration, along with medication usage and changes in headache patterns. “If there’s any question about whether an evaluation is warranted,” says Steven P. Rider, MD, neurologist at the University of Tennessee Medical Center, “it’s safer to seek help for what might turn out to be a benign headache than to ignore the symptoms of a dangerous headache.”

* This article originally ran in the Spring 2010 issue of Frontiers Magazine.