Treatment decision6 min read
When does headache require assessment?
The most common concern among people with frequent headaches is the possibility of serious disease. The great majority of headaches are benign, but certain findings require further assessment. That distinction is clarified below.
Signs requiring assessment without delay
A headache reaching maximum intensity within seconds, unlike any experienced before, requires urgent assessment. This picture can suggest a vascular event.
Headache with fever, neck stiffness and altered consciousness is not suitable for watchful waiting. This triad raises the possibility of infection.
Headache starting after head trauma, or worsening after it, should be assessed without delay if accompanied by vomiting or drowsiness.
Situations requiring a planned medical review
A first headache after the age of fifty requires medical review even if benign, as the differential list differs in this age group.
Headache that steadily worsens, increases with coughing or straining, or is worst in the mornings requires planned assessment.
If accompanied by visual change, double vision, speech disturbance or weakness on one side, the picture is treated as a neurological finding rather than a headache.
When physiotherapy is appropriate
Absent the warning signs above, it is appropriate to look for a neck component in bilateral, pressure-type headaches recurring over months.
Pain that changes with neck movement, increases after long screen work and eases at weekends belongs to this group. That pattern directs assessment to the neck.
Reproducing the familiar pain on examination is the strongest indication a physiotherapy programme is appropriate. Without that finding, other sources are investigated.
Key points
- The great majority of headaches are benign.
- Pain peaking within seconds requires urgent assessment.
- Headache with fever and neck stiffness is not suitable for waiting.
- A first headache after fifty requires medical review.
- Reproducing familiar pain on examination indicates a neck origin.
Frequently asked questions
Is an MRI needed for headache?
In people without warning signs and with a normal examination, imaging is usually unnecessary and does not change treatment. Where warning signs are present, the imaging decision is taken without delay.
Is frequent headache a sign of a brain tumour?
The vast majority of frequent headaches are tension-type or migraine. Tumour-related headache is rare and usually presents with a steadily worsening course alongside neurological findings.
Does blood pressure cause headache?
Mild and moderate hypertension usually does not cause headache. Pain can occur at very high readings, so blood pressure measurement is a routine part of assessing persistent headache.
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.