By Dr. Shradha Maheshwari, Neurosurgeon, Minimally Invasive Brain & Spine Surgeon, SL Raheja Fortis Hospital
Ajay, a 29-year-old corporate professional, was wheeled into our emergency department in an almost unconscious state on a Friday evening. His panicked relatives told us, “Doctor, my son has not been responding since afternoon. All he had was a headache for the last few days.”
Ajay had been experiencing headaches for over a week, which he attributed to work-related stress and managed with self-medication. That day, however, he complained of a severe headache and subsequently lost consciousness.
He was diagnosed with a brain aneurysm, an abnormal ballooning of a blood vessel, which had ruptured and caused bleeding in the brain. He was treated with endovascular coiling and, after a difficult 25-day hospital stay, recovered and was able to return home.
Cases like Ajay’s remind us that while headaches are extremely common, there are times when they should not be ignored.
So, are all headaches dangerous? Certainly not.
Headaches are among the most common health complaints. Some people experience them occasionally, while others suffer from them more frequently. They are often self-treated or attributed to stress, lack of sleep or migraine. While these are common causes, the spectrum of headaches is much broader.
Even when headaches have an underlying medical cause, timely evaluation can help identify the problem and guide appropriate treatment. The important thing is knowing when a headache warrants further attention.
Red Flags to Keep in Mind
1. A change in the nature of your headache
A headache that suddenly feels different from the ones you usually experience deserves attention.
2. A change in frequency or duration
If headaches are becoming more frequent, lasting longer than usual or beginning to interfere with your everyday activities, they should be evaluated.
3. New associated symptoms
Visual disturbances or vomiting that were not previously associated with your headaches should not be ignored.
4. Neurological symptoms
Symptoms such as tingling or numbness in a part of the body, weakness in the limbs or other new neurological changes along with a headache require medical evaluation.
5. A new or unusual headache
A new headache, particularly when accompanied by any of the above symptoms, may require further investigation.
When is a Headache an Emergency?
The “worst headache of your life”
A sudden and extremely severe headache, often described as a “thunderclap headache,” requires urgent medical attention as it can sometimes be associated with bleeding in the brain.
Headache with neurological symptoms
A headache accompanied by visual disturbances, numbness or weakness in the limbs can be associated with neurological conditions, including stroke, and requires prompt medical evaluation.
Headache with fever and neck stiffness
This combination can be associated with meningitis, an infection involving the protective layers surrounding the brain and spinal cord. Early medical attention is important.
A worsening headache after a head injury
A headache that progressively worsens following a head injury should be evaluated, as it can sometimes indicate bleeding or swelling within the brain.
Headache with seizures
A headache accompanied by seizures warrants prompt medical evaluation to determine the underlying cause.
Most headaches are not a sign of a serious neurological condition. However, recognising a change in pattern or accompanying warning signs can make an important difference.
Rather than becoming anxious about every headache, the key is to understand your usual pattern, recognise when something feels different and seek timely medical advice when warning signs appear.
That awareness can help us recognise when a headache is not just a headache.
Dr. Shradha Maheshwari is a neurosurgeon with more than 15 years of experience and has performed over 10,000 complex neurosurgical procedures. She is among the few practising female neurosurgeons in Mumbai and the city’s first female spine surgeon.
She completed her MBBS from Dr. D. Y. Patil Medical College, Mumbai, and her DNB in Neurosurgery at Lilavati Hospital & Research Centre, where she trained under Dr. P. S. Ramani and Prof. Atul Goel. She has also worked at leading institutions including KEM Hospital, Nair Hospital and LTMG Hospital.
Dr. Maheshwari has completed fellowships in Endoscopic and Minimally Invasive Neuro and Spinal Surgery. Her key areas of interest include skull base surgery, spinal surgery and paediatric neurosurgery. She also pioneered the Department of Neuro & Spinal Surgery at Dr. R. N. Cooper Hospital, Mumbai, and currently heads the department.
An active academician and researcher, she has authored more than 25 publications and contributed three chapters to international medical textbooks. She has also served as international faculty at medical programmes in several countries and actively supports greater representation of women in neurosurgery.