When a headache needs a doctor urgently

Almost every headache is benign. Tension headaches and migraine between them account for the overwhelming majority, and neither is dangerous even when it is miserable.

A small number are not benign, and the gap between those two groups is where this article lives. The dangerous ones have recognisable features, and knowing them is genuinely useful, more useful than anything else in this category.

This is information, not medical advice. If anything in the first section below applies to you, stop reading and get emergency medical care.

Go to a hospital now

These are emergency features. Not “mention it at your next appointment”, now.

The worst headache of your life, coming on suddenly. A headache that reaches maximum intensity within seconds to a minute, often described as being hit on the head, or as a thunderclap, can indicate bleeding around the brain. This is the single most important pattern in this article. Sudden and severe is the combination that matters; a severe headache that built up over hours is a different thing.

Headache with fever and a stiff neck, particularly with aversion to light, or with a rash. This can be meningitis.

Headache with any new neurological sign:

• Weakness or numbness on one side of the body
• Difficulty speaking, or slurred speech
• Drooping on one side of the face
• Loss or disturbance of vision, or double vision
• Severe unsteadiness, or inability to walk

Headache with confusion, drowsiness, or altered behaviour.

Headache after a head injury, especially if it worsens, or with vomiting, drowsiness, or any period of unconsciousness. And especially if you take blood thinners.

Headache with a seizure.

Headache with persistent vomiting and no other explanation.

A sudden severe headache with a red, painful eye and blurred vision, this can be acute glaucoma, which threatens sight within hours.

Headache in someone who is pregnant or recently delivered, particularly with swelling, visual disturbance or high blood pressure. Pre-eclampsia is a medical emergency.

See a doctor soon, within days

Not emergencies, but they need proper assessment rather than painkillers.

A new type of headache after about age 50. New headaches become less common with age, so a new pattern in an older adult deserves investigation. One specific condition, giant cell arteritis, presents with headache, scalp tenderness, jaw pain on chewing, and can cause permanent vision loss; it needs urgent treatment.

Headaches that are getting progressively worse over weeks, rather than coming and going.

Headache that is worse in the morning, or worse on lying down, coughing, straining or bending forward. This pattern suggests raised pressure inside the skull.

Headache that always occurs on the same side, every time, without variation.

Headache with unexplained weight loss, night sweats, or persistent fever.

Headache in anyone with cancer, HIV, or on immunosuppressive treatment, the threshold for investigation is lower.

Headache with new personality change, memory problems, or clumsiness.

A headache that wakes you from sleep regularly.

Headaches that are increasing in frequency, particularly if you are taking painkillers more often, which leads to the next section.

Medication overuse headache, the one people cause themselves

This deserves its own mention because it is common, under-recognised, and entirely reversible.

Taking painkillers for headache on more days than not can itself cause headache. The pattern: headaches become more frequent, each tablet works less well, so you take more, and the cycle tightens. Combination analgesics containing caffeine and codeine are particularly implicated.

The rough threshold: simple analgesics on more than about 15 days a month, or triptans and combination painkillers on more than about 10, sustained over months.

What to do: do not simply stop on your own, withdrawal headache can be severe. See a doctor, who will plan a withdrawal and often bridge it with preventive treatment.

Why this matters here: someone in this cycle often reaches for supplements next, which does nothing about the cause. The cause is the painkillers.

When it is probably not dangerous

For balance, because most headaches belong here.

Tension headache: a dull, pressing, band-like ache on both sides, mild to moderate, not worsened by activity, no nausea. Associated with stress, poor sleep, and sustained screen posture.

Migraine: usually one-sided, throbbing, moderate to severe, worsened by movement, with nausea and sensitivity to light and sound. Sometimes preceded by visual aura. Attacks last hours to a few days and the person is typically well in between.

The reassuring pattern: a headache you recognise, that follows a familiar course, with no new features, and complete normality between attacks.

One caution even here: if you have had migraine for years and the pattern changes, different site, different character, new neurological features, or far more frequent, that is a new headache and worth reassessment.

What else to check

Several treatable things cause or worsen headache and are easy to miss:

• Blood pressure. Usually silent, but very high pressure causes headache.
• Eye examination. Uncorrected refractive error is a genuine and frequently missed cause, particularly in children and in adults who have gone years without a test.
• Sinus disease, facial pain and pressure, worse on bending, with nasal symptoms.
• Dental problems and jaw joint dysfunction.
• Sleep apnoea, morning headache, snoring, daytime sleepiness.
• Vitamin D and B12 levels, both commonly low in India and both associated with headache in some people.
• Thyroid function.
• Anaemia.
• Dehydration and caffeine withdrawal, mundane, common, and the first things to rule out.

For migraine specifically

If it is established migraine and the red flags are absent, the useful things are:

Keep a diary. Date, duration, severity, what preceded it. Triggers are individual and a diary finds yours in a few weeks far more reliably than a generic list does.

Common triggers: skipped meals, poor or irregular sleep, dehydration, stress, and often the let-down after stress, which is why weekend migraines happen, menstrual cycle, strong smells, flickering light, and for some people specific foods such as aged cheese, chocolate or MSG.

Acute treatment works better taken early. Waiting to see whether it gets bad reduces how well it works.

Preventive treatment exists and is underused. Anyone with frequent attacks should discuss it with a doctor, rather than treating each attack as it comes.

Among supplements, the ones with some evidence in migraine prevention are magnesium and riboflavin. The evidence is modest, not strong, and they are preventives taken daily rather than acute treatments. Coenzyme Q10 has been studied with mixed results. None of these replaces a preventive regimen where one is indicated, and they should be discussed with your doctor.

And the honest note on feverfew and butterbur, both traditionally used: feverfew’s trial evidence is inconsistent, and butterbur, which had the more promising data, carries a genuine concern about hepatotoxicity from unpurified preparations and has been withdrawn in several markets.

What a product can and cannot do here

We manufacture in this category, so this is a practical position rather than a disclaimer.

What is sayable: traditional use of brahmi, jatamansi and shankhpushpi in Ayurvedic formulations for mental calm; the recognised role of magnesium in normal nerve and muscle function; general wellness support.

What is not sayable: that a product treats or prevents migraine or headache. Those are medicinal claims, and in India they fall under the Drugs and Magic Remedies (Objectionable Advertisements) Act.

And the line we insist on in this category: headache products must carry a referral instruction. A sudden severe headache is a potential brain haemorrhage, and the worst conceivable outcome of a wellness label is somebody taking a tablet and waiting.

If you are a brand owner in this space, put the red flags on your website rather than only on the leaflet. It costs nothing and it is the single most valuable thing you can tell a customer with headaches.

The short version

Hospital now: sudden worst-ever headache; headache with fever and stiff neck; headache with weakness, speech or vision change, confusion or seizure; headache after head injury; headache with a red painful eye; headache in pregnancy with swelling or visual change.

Doctor soon: new headache over 50; progressively worsening; worse lying down or in the morning; always the same side; with weight loss or fever; waking you from sleep; or getting more frequent while you take more painkillers.

Probably fine: a headache you recognise, with its usual pattern, and normality in between.

And check the boring things, blood pressure, eyes, sleep, vitamin D, B12, and how many painkillers you are actually taking.

Composition detail: Migro 360.