Headache symptoms can actually vary quite a bit depending on the underlying cause of the headache. Different headaches may have different characteristics to the headache itself as well as different associated symptoms that go along with the headache.
While the different types of headaches cannot always be distinguished solely based on these headache symptoms, a close examination of a patient with headaches can help to point the way to the correct diagnosis to explain their underlying cause.
We will discuss both differences in the character of headaches that can help distinguish them and then associated symptoms which may be present along with the headache.
Character of the Headache
Interestingly, the specific character and location of a headache is only sometimes directly related to the underlying cause. For example, benign tension headaches can present in various ways. They can involve only one area of the head or the whole head. They are generally dull or pounding in nature. However, in some specific examples, the specific nature of the headache can help point you toward the diagnosis.
For example, a sudden, sharp, stabbing headache can be indicative of a subarachnoid hemorrhage, bleeding into the space around the brain, most commonly caused by the rupture of a brain aneurysm. These headache symptoms can also be accompanied by neck pain and stiffness, nausea and vomiting and a depressed level of consciousness (such as lethargy or coma).
A sharp, stabbing pain behind one eye is a specific type of headache called a cluster headache. It can be associated with other symptoms such as redness and swelling of the area of the eye on that side.
A headache that is worse when lying down and/or sleeping, so that it wakes you from sleep or is worst in the morning, can be associated with diseases that cause an increase in pressure inside the head. Brain tumors can cause these types of headache symptoms, as can hydrocephalus of any type.
Associated SymptomsNausea and Vomiting
: Nausea is actually a very common symptom to accompany a headache. It is classically associated with migraine headaches but can be associated with other types of headaches as well. Patients with the flu or an alcohol hangover can have both a headache and nausea. More seriously, nausea and vomiting can occur with headaches caused by subarachnoid hemorrhage, meningitis, or a brain tumor.
Photophobia: Photophobia is the avoidance of bright lights. Bright lights are irritating. This can occur with migraine headaches but also with headaches caused by irritation of the membranes covering the brain, most notably subarachnoid hemorrhage or meningitis.
Neck Stiffness and/or Pain: Neck stiffness and/or pain can be caused by anything that irritates the membranes covering the brain, the meninges. It is therefore also referred to as meningismus. This neck stiffness, or nuchal rigidity, is most classically associated with meningitis but can occur, although less severely, with subarachnoid hemorrhage and migraine.
Swelling or redness of the eye and area around the eye: Most causes of headache do not cause a visible change on the outside of the patient's head or face. However, with cluster headaches a red, swollen eye and skin around the eye on that side can accompany the stabbing pain behind the eye.
Scotoma: Scotoma is the loss of vision in a part of the visual field. It is often associated with migraine headaches and is temporary, the vision returning to normal after the headache resolves. However, true visual changes or visual field loss can also be associated with more serious underlying brain pathology such as a brain tumor.
Fever: High fever with a new headache can be a very concerning sign. Although both can occur together in the setting of a flu, meningitis typically also presents with high fever and a headache. Patients with meningitis will often have other signs such as neck stiffness and/or pain and a deteriorating level of consciousness.
Depressed or Deteriorating Level of Consciousness: Most benign causes of headache symptoms, including tension headaches, migraine and cluster headaches, do not have an impact on the patient's level of consciousness. If a patient with headache becomes less responsive, either lethargic, stuporous or even comatose, it is very concerning for a life-threatening cause of headache such as subarachnoid hemorrhage or meningitis. Less commonly, a brain tumor can present with depressed consciousness with a headache although it tends to evolve at a much slower rate in most cases. In any case, deteriorating level of consciousness is a concerning symptom that should be evaluated immediately.
Seizure or other Neurological Symptoms: New seizures in an adult patient is very concerning for a brain tumor or other pathology in or around the brain. Brain tumors can also cause other neurological symptoms such as loss of vision or muscle weakness or numbness in one part of the body. A headache accompanied by any of these types of symptoms is concerning and should be worked up by an appropriate medical professional.
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This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.