There are many different types of headaches. Headache emergencies require immediate medical care while others are not life threatening. You can still be seen in an emergent setting for any headache to treat the pain, but some headaches will require further investigation to rule out a more serious problem. We will discuss four headaches that require immediate attention, but keep in mind there are more than just four headache emergencies.
Meningitis and Encephalitis
Meningitis and encephalitis are two types of infectious headaches that require emergent care. Key symptoms that can appear with these kinds of headaches are rash, stiff neck, and fever. If you have these symptoms it is critical that you be seen immediately. More severe symptoms can be associated with these types of headaches and can include altered mental status, lethargy and even coma. Diagnosis of these types of headaches requires a CT scan and lumbar puncture. Treatment of bacterial meningitis will require IV antibiotic therapy and supportive care.
Subarachnoid hemorrhage (SAH) is an emergent headache that often presents as the worst headache of your life, often with rapid onset. These are also called thunderclap headaches, because one minute you don’t have a headache and the next minute you have a severe headache. Fainting can also accompany this kind of headache. Its cause is due to bleeding in the brain and can lead to coma and death and requires imaging studies of the brain and emergent care. Keep in mind not all SAH present classically; many will present as moderate HA for instance. We advise patients to get emergent imaging of the brain when you have the worst HA of your life, your headaches increase in frequency or severity, are associated with neurological deficits, you have associated fever and or rash, or trauma has occurred.
Trauma Related Headaches
All trauma related headaches should be evaluated by an emergency physician. Head trauma, which is particularly ominous for increased risk of intracranial bleed, is any trauma which results in loss of consciousness. However, keep in mind that any trauma which results in headache, especially if associated with nausea and vomiting, requires immediate evaluation.
Temporal Arteritis is a type of headache that occurs in the temporal region of the head and is associated with an inflammatory process. This can lead to complications with vision, including permanent loss. Giant-cell arthritis is another name this malady and is an inflammatory disease of the blood vessels most commonly involving large and medium arteries of the head. The most serious complication is occlusion or blockage of the ophthalmic artery, which is a branch of the internal carotid. It can create a medical emergency which can cause irreversible blood supply loss and blindness if not treated promptly. Temporal arthritis is treated with steroids which help reduce inflammation and prevent blockages.