Headaches are a ubiquitous problem and a common reason for doctor visits. Most headaches are benign, with no serious underlying cause. Often people have a particular pattern of headaches. They might become concerned if there's a change in the frequency or severity of their usual headache. Sudden and severe headaches need to be evaluated in the emergency room. They can be a symptom of a serious condition that might require prompt treatment to prevent disability or death.
Subarachnoid Hemorrhage
Subarachnoid hemorrhage, or SAH, is bleeding under one of the layers of tissue that surround the brain. The classic complaint is of a sudden headache described as the most severe headache the person has ever experienced. Other symptoms often accompany the headache such as neck stiffness, nausea, vomiting and sometimes focal neurological symptoms, such as paralysis of a limb. According to an article published in the "Journal of Neurology, Neurosurgery and Psychiatry," 85 percent of SAHs are caused by rupture of an aneurysm, which is a widened portion of an artery with weaker than normal walls. Mortality rate for this condition is about 50 percent. Aneurysms tend to re-bleed. Neurosurgery with clipping of the aneurysm can prevent recurrence of the bleeding.
Meningitis
Bacterial meningitis, or inflammation of the tissues surrounding the brain, can cause severe headache, along with fever, photophobia and neck stiffness. Headache usually develops over the course of several hours. Sometimes the headache can be very sudden. As "Harrison's Principles of Internal Medicine" explains, bacterial meningitis is a serious illness that can lead to disability and death. Evaluation includes a lumbar puncture to take spinal fluid in order to identify the causative agent. The most common causes of bacterial meningitis are meningococcus, haemophilus influenzae and pneumococcus. Meningococal meningitis is the most rapid of the infections, and if untreated, can lead to death within 24 hours.
Temporal Arteritis
Temporal arteritis is an inflammatory disease of arteries that is common in people over age 50. According to "Harrison's Principles of Internal Medicine," about half of all patients will develop blindness if untreated, due to inflammation of the artery supplying the retina. Symptoms include headache, intermittent jaw pain, fever and weight loss. The headache in this disease usually develops over the course of several hours. Occasionally it is sudden, and has an explosive character. Prompt treatment with steroids can prevent complications such as blindness.
References
- "Journal of Neurology, Neurosurgery and Psychiatry": Acute Headache in the Emergency Department
- "Harrison's Principles of Internal Medicine"; Anthony Fauci et al.; 2008
- "Adams and Victor's Principles of Neurology"; Maurice Victor and Allan Ropper; 2001
