Headaches: when are they harmless, and when do they need urgent assessment?

Headaches are very common and usually are not related to a life-threatening illness. Migraine and tension-type headaches can recur and significantly affect daily life. However, certain signs suggest that a headache may be a symptom of another condition requiring more prompt medical assessment.

Pain intensity is not the only factor

The doctor needs to know when the pain began, how quickly it peaked, where it occurs, how long it lasts and which symptoms accompany it. Changes in its pattern and similarities to previous episodes are equally important.

Migraine often causes throbbing, moderate or severe pain, nausea and sensitivity to light or sound. Some patients have an aura before the pain, such as temporary visual or sensory disturbances. Tension-type headaches are more often pressing, affect both sides and do not worsen with ordinary movement. A symptom description alone, however, is not a basis for self-diagnosis.

A headache diary helps your doctor

Record the onset, duration and intensity of pain, accompanying symptoms, menstrual cycle day, sleep, meals and medication. Note how many days a month you use painkillers. Using acute medication too often can itself maintain or worsen chronic headaches.

A diary helps identify patterns and assess treatment results. It also reduces the risk of forgetting important information during the consultation.

When is a neurology consultation needed?

A routine neurology consultation is appropriate if headaches recur, disrupt work or sleep, become more frequent, change character or no longer respond to self-care. A neurologist performs a neurological examination and decides whether further tests are needed. Brain imaging is not automatically necessary for every patient; the decision depends on symptoms and examination findings.

Prepare a medication list, previous test results and a headache diary. If possible, also note relevant family conditions and previous head injuries.

What should you avoid?

Do not regularly increase painkiller doses without medical advice or assume that severe pain is always migraine. Do not delay seeking help if headaches are accompanied by neurological symptoms or a rapid deterioration in your general condition.

When should you book a consultation?

Consider a consultation if:

· headaches recur several times a month;

· they become more frequent or their usual pattern changes;

· you need painkillers increasingly often;

· you have temporary visual, sensory or speech symptoms that have not previously been assessed.

When not to wait

Call 113 if a headache starts suddenly and becomes extremely severe within seconds or minutes, or is accompanied by altered consciousness, seizures, facial drooping, weakness on one side, speech difficulties, high fever with neck stiffness or a recent severe head injury.