Changes in Headache Symptoms: When to be Concerned

Headache is a serious condition, and changes in symptoms may indicate the presence of complications. Brian Plato, DO, discusses what to look for and how to address it.

Headache disorders can be a difficult health issue to address. They can be further complicated, however, by changes in headache or symptoms. In some cases, these changes are associated with other health issues that need to be addressed.

“As a provider, I’m concerned when a patient with a stable history of headache has a sudden change in the features of their headaches,” says Brian Plato, DO, medical director of headache medicine at Norton Neuroscience Institute in Kentucky. “This could be in terms of where it hurts, how it hurts, if they have a sudden onset headache or if they have other associated neurological symptoms or other systemic symptoms, such as fever or weight loss.”

Patients need to be on the lookout for certain changes in the features of their headaches. If any symptoms develop that differ from a patient’s usual experiences, they need to seek medical attention.

What to watch for

Dr. Plato says there are several symptoms that may suggest there is something happening beyond what a given headache patient may consider “normal” based on their headache history.

“Most patients who seek medical attention for headache have a diagnosis of migraine, so many times I am looking for red flags that are not migrainous in nature, or other red flag symptoms, including things like sudden onset headache or certain systemic symptoms,” he says.

Some changes that should concern patients include new onset headache, especially if it is very sudden in nature, according to Dr. Plato. He also notes “thunderclap headache,” or headache that reaches maximal intensity in under one minute, as being “of great concern.”

“A significant change in the pattern of headache may also be significant,” he says. “Maybe someone has had consistent headaches for the last several years that occurred infrequently, then, all of a sudden, they have a new or a different type of headache that’s occurring much more frequently.”

Red flags

There are a few red flags that Dr. Plato and other professionals look for in patients that may indicate something else is going on beyond a primary headache disorder. Things that should be viewed as significant red flags in the history of a patient with headache include:

  • Neurological symptoms that are new or accompany headache
  • Sudden onset of headache
  • Positional components—it feels better when they lay down and worse when they’re upright, for example
  • New onset of headache in pregnancy
  • Progressive changes in headache, where headaches are continually worsening

Changes in other headache-associated symptoms or the development of other neurological symptoms should also be of concern. They include:

  • Significant vision changes
  • Weakness
  • Numbness
  • Trouble speaking or concentrating

What to do

If a patient notices a sudden, drastic change in headache—particularly if they have a thunderclap headache—Dr. Plato recommends seeking immediate medical attention. He notes, however, that if there is a slower change in the pattern of headache, patients should be in contact with whoever they’re seeing for the management of their headaches, be it a primary care provider, a neurologist or a headache specialist.

Regardless of what changes may be taking place, it is critical for patients to be on the lookout for these symptoms. Catching them as soon as they begin is key to addressing whatever underlying problem may have developed.

For more information on migraine diagnosis and treatment, visit our doctor-verified resource library. To find a headache specialist in your area who can diagnose you and create an effective treatment plan, use our Find a Doctor tool.