Central Nervous System Disorders
Once diagnosed, most chronic head pain is treatable with medication and/or lifestyle changes. But rarely, head pain is a symptom of a serious neurological problem, especially if it comes on suddenly and severely without a prior headache history. Inflammation of the nerves or blood vessels connected to the brain, hemorrhage in or around the brain, changes in cerebrospinal fluid (CSF) pressure, development of a brain lesion or mass (either benign or malignant), head injury, and central nervous system infection can all produce headache.
Other neurological disorders and diseases that have headache as a symptom include multiple sclerosis, trigeminal neuralgia, and pseudotumor cerebri (also known as idiopathic intracranial hypertension).
Remember, brain tumors are extremely rare — affecting only 7 in 100,000 people, in the U.S. population each year. Most head pain is caused by more benign, and easily treatable, health conditions.
Only 8 percent of patients with brain tumor have headache as a first symptom, but up to 70 percent of diagnosed brain tumor patients will eventually experience regular headache as a symptom. Headache is usually associated with increased intracranial pressure caused by the tumor mass, but head pain may be mild in the case of a slow-growing tumor. Sometimes these headaches are at their worst in the morning and lessen in intensity throughout the day. They are frequently accompanied by nausea and vomiting, and they may get worse when bending over or coughing.
When It's an Emergency
Sometimes, severe head pain that comes on rapidly and without warning is a sign of a medical crisis. Headache is a defining feature of several brain and cardiovascular emergencies, including stroke, meningitis, and subarachnoid hemorrhage.
Red flags for headache emergencies include:
A headache that develops suddenly and dramatically in a person with no prior headache history
Severe and sudden headache that is different from normal headache symptoms in someone with a history of headache
A “thunderclap” headache — a sudden and severe headache that appears without warning and might be described as “the worst headache you've ever had”
Headache accompanied by fever and/or neck stiffness (which could point to meningitis)
Headache accompanied by neurological signs such as vertigo, visual disturbance, speech difficulty, and balance problems