Have you ever experienced a severe headache and started to wonder, “Could this be a symptom of a brain tumor or a stroke?” Well, although there’s a chance for this to happen, it is very remote at best.

When a headache becomes unusually persistent, severe, or recurring it’s common for most people to become alarmed by the possibility of it being a symptom of something more serious. However, only a very small percentage of headaches pose a danger to the person experiencing them. Most headaches are caused by benign conditions such as stress, dehydration or tension, and can be managed with over-the-counter pain relievers or other non-invasive treatments.

Typically, dangerous headaches are secondary to an underlying, life-threatening disorder such as strokes or brain tumors. However, even in those rare instances, the symptoms of these disorders typically include more than just a headache. Additionally, headaches on their own are not particularly severe or painful. Also, it’s likely that the patient is already aware of these disorders.

Life-Threatening Headaches Usually Indicate Secondary Disorders

While most headaches do not cause serious harm, it’s important to recognize when they might signal a more severe underlying condition. Instead of being primary conditions, headaches can sometimes serve as secondary indicators of various serious conditions, which, in rare instances, can lead to death or permanent disability.

You can read this article to know more about the differences between primary and secondary headaches.

For instance, in cases of encephalitis or ischemic stroke , headaches are just one of several symptoms, seldom being the most prominent. However, there are specific instances, such as cerebral venous thrombosis or subarachnoid hemorrhage, where a severe headache is a notable or initial warning sign. Recognizing such distinctive headaches is vital for prompt action and seeking appropriate treatment promptly.

An example of this is the thunderclap headache, a severe, sudden-onset headache that peaks within seconds to minutes. It could indicate a subarachnoid hemorrhage, a ruptured aneurysm or a cerebral venous thrombosis, all of which necessitate urgent medical attention.

Headaches accompanied by neurological symptoms such as weakness, numbness, confusion, or difficulty speaking could signify a stroke, meningitis or brain tumor.

If headaches occur alongside a high fever, they could indicate a serious infection such as meningitis or encephalitis, which can lead to permanent brain damage or death if not promptly treated.

Headaches that develop after a head injury, particularly alongside vomiting, confusion, or loss of consciousness, may indicate a concussion or more severe brain injury. Immediate medical attention is necessary to prevent further damage.

What Potentially Lethal Disorders Are Associated With Headaches As a Symptom?

First, let’s begin with a brief overview of the serious conditions linked to severe headaches, all of which necessitate immediate medical attention:

Clogged arteries or other blockages in blood flow that impede blood from reaching certain areas of the brain (strokes)
Brain tumors or other malignancies of the central nervous system
Excess accumulation of fluid in the brain due to acute interruption of cerebrospinal fluid flow (acute obstructive hydrocephalus), or other toxic factors (carbon monoxide poisoning, altitude sickness, hypoxia, etc.)
Infections of the brain (encephalitis) and other parts of the central nervous system, caused by various microorganisms (meningitis or sepsis)
Other non-infectious encephalopathies of autoimmune or metabolic origin (autoimmune encephalitis, hepatic encephalopathy, posterior reversible encephalopathy syndrome, etc.)
Disorders that cause increased pressure within the brain resembling brain tumors but aren’t (pseudotumor cerebri or idiopathic intracranial hypertension)
Malformations of the blood vessels of the brain (arteriovenous malformations)
Inflammatory disorders of the arteries of the head and neck (temporal arteritis, giant cell arteritis, or other types of vasculitis)
Serious pregnancy disorders such as preeclampsia
Blood vessels rupturing inside the head (aneurysms)
Hemorrhages of the head or neck vessels, or other nearby tissues such as the meninges that cause blood to accumulate or collect (subarachnoid hemorrhage, epidural hematoma, intracerebral hemorrhage)
Head injuries caused by accidents, trauma, or concussions

Each of these conditions presents distinct characteristics and symptoms, emphasizing the need for swift and appropriate medical attention.

When Is Immediate Medical Attention Required For A Headache?

There are some red flags that could signal that the headache a patient is experiencing is secondary to a potentially dangerous disorder, rather than a severe, but still innocuous primary headache. Recognizing these signs can mean the difference between life and death, but at the same time, the patient must always keep in mind that headaches are actually dangerous only in a very small number of cases.

A headache may require urgent medical attention when:

The intensity of the headache is unusually severe or it keeps becoming worse over the course of 24 hours.
The headache appears suddenly, in an explosive fashion, or reaches a peak of intensity in a very short time frame (seconds or minutes).
It is strong enough to wake up the patient from sleep.
It becomes worse in the morning or when the patient wakes up.
Pain becomes much worse as the patient lies flat.
It is associated with neck stiffness, especially when other symptoms of an infection are present (such as fever).
It is associated with acute confusion, altered mental status, severe mood swings, or aggression.
The patient never experienced this kind of headache before during their lives (new onset), and it’s severe enough to prevent them to perform their daily activities.
The headache is described as “thundering” or “like a thunderclap,” or is associated with a booming, pounding, or thundering sound or sensation inside the head of the patient.
The headache develops acutely in close association with physical exertion or other physical activities such as running, lifting a weight, making exercises, having a sexual intercourse, etc.
It is associated with projectile vomiting, vomiting without nausea, or weight loss.
Pain is associated with an increasing feeling of pressure in the back of the head
It is associated with gradually worsening or progressive weakness or numbness on one or both sides of the body, limbs or face.
It is associated with one or more neurological symptoms such as movement disorders, loss of balance, disorientation, blurred or loss of vision, slurred speech, confusion, seizures, or memory loss.
The duration of the headache is unusually persistent, or lasts more than a day or two.
The headache appeared in close temporal correlation with a head, neck or spine injury, concussion or trauma.

Conclusion

While headaches are, for the most part, a common yet harmless disorder, regardless of their perceived severity, it’s essential to recognize when they are just a symptom of some much serious underlying condition.

Understanding the red flags and potential dangers associated with potential life-threatening headaches is important to know when to seek prompt medical attention.

Article edited and fact checked by our editorial team.

About the author:

Dr. Claudio Butticè, Pharm.D., is a former Pharmacy Director who worked for several large public hospitals in Southern Italy, as well as for the humanitarian NGO Emergency. He is now an accomplished book author who has written on topics such as medicine, technology, world poverty, human rights, and science for publishers such as SAGE Publishing, Bloomsbury Publishing, and Mission Bell Media. His latest books are “Universal Health Care” (2019) and “What You Need to Know about Headaches” (2022). A data analyst and freelance journalist as well, many of his articles have been published in magazines such as Cracked, The Elephant, Digital Journal, The Ring of Fire, and Business Insider. Dr. Butticè also published pharmacology and psychology papers on several clinical journals, and works as a medical consultant and advisor for many companies across the globe.

References:

Butticè, C. (2022). What you need to know about headaches. Santa Barbara: ABC-CLIO, LLC.
Headache Classification Committee of the International Headache Society (IHS). (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1-211. DOI: 10.1177/0333102417738202
Ferrante, E., Tassorelli, C., Rossi, P., Lisotto, C., & Nappi, G. (2011). Focus on the management of thunderclap headache: from nosography to treatment. The Journal Of Headache And Pain, 12(2), 251-258. doi: 10.1007/s10194-011-0302-z
International Classification of Orofacial Pain, 1st edition (ICOP). (2020). Cephalalgia: an international journal of headache, 40(2), 129–221. https://doi.org/10.1177/0333102419893823
American Association of Neurological Surgeons. Brain Tumors – Classifications, Symptoms, Diagnosis and Treatments. aans.org. Retrieved from: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Brain-Tumors
Sandoe CH, Lay C. Secondary Headaches During Pregnancy: When to Worry. Curr Neurol Neurosci Rep. 2019 Apr 22;19(6):27. doi: 10.1007/s11910-019-0944-9. PMID: 31011857.
Friedman SA, Masters-Israilov A, Robbins MS. Secondary Headache Disorders: Approach, Workup, and Special Considerations for Select Populations. Semin Neurol. 2022 Aug;42(4):418-427. doi: 10.1055/s-0042-1757753. Epub 2022 Oct 11. PMID: 36220127.

How To Tell When a Headache Could Be Life-Threatening