I waited for hours in an emergency last night with this terrible headache, but eventually gave up and left. Should I have kept waiting for the hospital?
This is a surprisingly common scenario I encounter as a general practitioner. If you are wondering how bad your headache must be to get to the hospital, here is the advice I give my patients.
Go to the hospital now
Let’s start with when you definitely are ought to go to the hospital for a bad headache.
Serious and acute causes of headaches include infection, bleeding, blood clots and tumors. Do not hesitate to go directly to the hospital (via ambulance or with a trusted driver) if you notice any of the following:
- suddenly the worst headache you have ever had occurred
- headaches that are aggravated by exercise or intercourse
- neck stiffness (new since the headache started)
- high fever that is not lowered with over-the-counter painkillers
- headache after trauma to your head or neck
- personality changes and / or strange behaviors
- weakness / numbness on one side of your body.
Three specific situations are also urgent:
- pregnant or newly pregnant women who suddenly develop a severe headache
- people who are immunocompromised (such as someone living with HIV or on strong immunosuppressive drugs)
- individuals who have received any COVID-19 vaccine within the previous four to 42 days and who have persistent headaches despite taking simple painkillers.
If you are reading this and identify with any of the above, stop reading now and go straight to the hospital.
For most headaches, do not go to the hospital
Fortunately, most headaches are less severe and can be managed without a hospital trip. But they can still take a serious toll.
As you read this, 15% of Australians are taking painkillers for headaches.
But just because you do not have to drive to the hospital, does not mean you should not get help, especially if you experience regular headaches.
When to see a doctor – and what they will ask you
Start by making a long time for a doctor to discuss your headache and nothing else. Give it the time and attention it deserves.
It is helpful to take a record of your headaches for your doctor’s visit: a “headache diary”.
The most important tool doctors have for diagnosing headaches is your history. You may feel like they are asking a lot of questions, but that is because there are so many possible causes. Carry on with your GP while trying to give you the most accurate diagnosis.
Here are the kinds of questions a doctor may ask or ask themselves while assessing you:
Is the pain caused by something straightforward?
Possible common causes include dehydration, strain on the eyes / neck, grinding of teeth, lack of sleep or caffeine withdrawal. Even taking regular painkillers can cause “overuse of medication” headaches; the cure may be the cause.
Where in your head is the pain?
Sometimes the site of the pain gives a clue. For example, about 35% of headaches are “tension headaches” that feel like a tight band around both sides of your head. Another 4% are “cluster headaches”, which start behind one eye (which can turn red and watery) and are often associated with a stuffy nose.
Do you have other symptoms that accompany the headache?
A migraine episode can precede an “aura” (such as flashes of light) and often includes symptoms such as nausea or vomiting, extreme sensitivity to noise and light, and blurred vision.
Fever, a changed sense of smell, fatigue and pressure in your ears are features associated with acute sinusitis.
Is there a pattern to your headache?
Certain headaches, such as migraine episodes or tension headaches, may have triggers that trigger them, including certain foods, lack of sleep, particular odors, or emotional stress.
Hormonal headaches come with menstrual cycles. Once an association is noticed, you may be able to prevent and treat headaches early.
Do you have other medical conditions?
In rare cases, very high blood pressure (a hypertensive crisis) can cause headaches. However, high blood pressure during headaches is usually just your natural reaction to pain.
It is important to get a chronic and recurrent headache diagnosed correctly by a doctor. Your GP may refer you to another specialist (such as a neurologist or ear, nose and throat surgeon) depending on how complicated your situation looks.
Headaches rarely require diagnostic tests, but if your doctor is concerned, they may arrange for a CT scan, MRI scan, or lumbar puncture.
Even if you are sent for further testing, a specific cause may not be found. If so, your doctor’s goal will be to help you deal with your headaches and reduce their impact on your life.
Why migraines are a particular pain
Migraines deserve special mention here as they can be so disabling and poorly understood.
Many people self-diagnose “migraine” incorrectly. But it’s a bad headache does not the same as a migraine attack, and some migraine attacks do not even include headaches!
If you think you have migraine attacks, get them diagnosed and treated properly.
Why headaches can be so costly for all of us
If you can avoid going to the hospital unnecessarily when you have a headache, you will benefit yourself and Australia’s healthcare system.
Every time you go to an emergency department, it costs you hours of your life, and the community averages $ 561.
Seeing your GP is obviously more time efficient and instead costs the community between $ 38 and $ 75.
If headaches interfere with your life, please prioritize your health. See a doctor, get a management plan for them – and save yourself a painful long wait in case of an emergency.
Natasha Yates, Assistant Professor, General Practice, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.