Headaches are a shared experience impacting people across all walks of life. Those experiencing them move along and manage the best they can, tapping formal and informal supports, trying a spectrum of remedies, and taking one day at a time.
However, there exists an elusive, complex, and problematic level of headache … the severe headache. This is a whole different ball game warranting further discussion since severe headaches can and do have a significant impact on those experiencing them.
This article dives into several Migraine World Summit interviews with renowned headache experts. They will explain what severe headaches are, their causes, and, most importantly, when and how to get help. Khalil Gibran once said, “Your pain is the breaking of the shell that encloses your understanding.” This touches deeply on managing a severe headache, where the struggle may bring insight and resilience. This information aims to help people living with and managing severe headache conditions feel more informed, empowered, and safe.
Common Causes of Severe Headache

What is a severe headache? Differing definitions and assumptions exist. It may be surprising to know severe headaches do not often occur in isolation, nor are they the main instigator. Also, many health conditions and headache variations fall under the severe headache spectrum (i.e. primary and secondary headache). Below are medical diagnoses where severe headache is a foundational component:
Common Diagnoses Featuring Severe Headache
Migraine Headache | This presents as throbbing pain, usually on one side of the head, often with nausea, vomiting, and sensitivity to light, smells and sound. |
Cluster Headache | This headache type brings severe, burning, or piercing pain, usually around one eye, in clusters or cycles. |
Sinus Headache | Sinus inflammation causes deep, constant pain in the forehead, cheekbones, or nose bridge. |
Tension Headache | This tight, band-like head pain is often linked to stress or muscle strain. |
Thunderclap Headache | This sudden, severe headache peaks within seconds to minutes and is often a sign of a more serious condition (e.g., subarachnoid hemorrhage). |
Medication Overuse Headache | Frequent use of headache medication leads to daily/chronic headaches. Find more information on this in the next section. |
Brain Tumor | A rare and growing tumor results in severe headache and other neurological symptoms. |
Brain Injury/Post-Traumatic Headache | This severe headache follows a head injury or concussion. |
Aneurysm | Bulging blood vessels in the brain cause sudden, severe head pain if they leak or rupture. |
Infections | Infections such as meningitis, encephalitis, or an abscess can cause severe headache, fever, and neck stiffness. |
Stroke | Severe headache and nerve, spinal cord, or brain function problems can be symptoms. |
Cervicogenic Headache | Cervical spine/neck issues cause severe pain in the head and neck area. |
Temporal Arteritis | Inflammation of blood vessels in the scalp leads to severe headache with tenderness in the temple(s). |
Trigeminal Neuralgia | Irritation of the trigeminal nerve causes severe facial pain, sometimes perceived as a severe headache. |
Hypertension | Extremely high blood pressure can often lead to what is described as pulsating head pain. |
Carbon Monoxide Poisoning | Exposure to carbon monoxide gas can cause severe, throbbing head pain, with symptoms like dizziness and confusion. |
Hangover | Severe headaches can occur after excessive alcohol consumption. |
Eyestrain | Prolonged use of digital screens or uncorrected vision problems can lead to severe head pain. |
Dehydration | Severe head pain can come from losing fluids in the body to the point of bodily function impairment. |
Avoiding Medication Overuse Headache
As mentioned in the table above, overuse of medications, especially over-the-counter or prescription pain relievers, can lead to a headache returning as the medication wears off, creating a cycle of dependency and constant head pain. These are commonly referred to as rebound headaches.
During the Migraine World Summit’s 2016 event, Dr. Alan Rapoport stated, “They can hurt their liver. They can hurt their kidneys. What I’m interested in is it’ll hurt their [headache] because they’ll end up having more [headache], and the stuff will stop working on them, and they come in and say to me, ‘I keep taking this medicine, and my headache is still bothering me even more,’ and, again, they don’t understand that they’re actually unintentionally contributing to the headache.”1 Additionally, some medications targeting various other conditions (e.g., blood pressure or hormones) can trigger headache as a side effect.2
Dr. Gisela Terwindt explains what medications can cause medication overuse headache, as well as approaches to treatment.
Symptoms of Severe Headache
To understand severe headache it is important to identify unique symptoms. This includes intensity of pain, associated symptoms, as well as duration and frequency.3

Pain Intensity and Location
Pain intensity and location can vary greatly depending on the headache type. For example, migraine attacks can cause intense, throbbing pain on one side of the head. At the same time, a tension-type headache is typically constant, dull aching around the forehead or back of the head and neck. On the other hand, cluster headache involves excruciating pain, usually around one eye or side of the head, in cyclical time patterns.
Associated Symptoms
Accompanying symptoms of severe headache often include nausea, vomiting, sensitivity to light (photophobia), sensitivity to sound (phonophobia), and visual disturbances (aura). These travel alongside the headache pain, providing clues to the headache type. For example, migraine attacks frequently involve these additional symptoms. At the same time, cluster headache attacks can cause eye redness and tearing on the affected side. For other severe headache, such as thunderclap headache, other less-known associated symptoms can exist, such as speech difficulties, dizziness, seizures, confusion, vision changes, numbness, etc.4
Duration and Frequency
How long and how often head pain occurs assists in diagnosis. Migraine typically lasts several hours or days and may occur once in a while (episodic) to at least half of the month (chronic). Cluster headaches are often short, intense episodes lasting but minutes, occurring multiple times a day over weeks or months.
Another severe headache type is the thunderclap headache, which is sudden and severe, reaching maximum intensity within 60 seconds, and lasting at least five minutes. Additionally, hemicrania continua headache, which features persistent and unilateral pain that fluctuates in intensity but never fully disappears, is often accompanied by autonomic symptoms, disruptions to automatic functions. One can start to see how complex understanding and treating headache is since there are several combinations related to headache duration and frequency.
When a Serious Headache Requires Immediate Attention

When is a headache sufficiently serious to warrant outside help? While many times a headache can be treated at home, specific symptoms signal the need for urgent medical support. Recognizing these red flags is critical to avoid serious health complications.
One tool that can help identify these warning signs is the SNNOOP10 tool, a clinical guide used by healthcare providers in assessing headache symptoms. The SNNOOP10 tool covers areas such as:
- Systemic symptoms (i.e., affecting the whole body, such as fever or weight loss)
- Neurological signs (e.g., vision changes, speech issues)
- New onset in people over 50 years old
- Occurrence with positional changes (i.e., when you stand up or move around)
- Onset during pregnancy
- Previous headache history
- Plus 10 other signs highlighting underlying conditions such as infection, vascular disorders, or structural brain issues.5
A tool like this can help you tell the difference between a typical headache and one that might indicate a life-threatening condition. The following are some key warning signs, which align with the SNNOOP10 criteria, indicating a headache may require immediate attention by a healthcare provider.6
Sudden Onset of Severe Headache
Imagine a headache that appears to come out of nowhere, and you would describe it as the worst headache of your life. For example, a pain so agonizing and disorienting that it causes you to pass out. These sudden and intense headaches can signal more critical conditions like the ones discussed earlier (e.g., subarachnoid hemorrhage from an aneurysm rupture). These types of headaches often quickly worsen and require immediate medical attention, as they can be life-threatening.
Headache with Neurological Symptoms
Imagine experiencing an intense headache but also slurring your words or noticing a side of your face drooping. As stated before, a headache accompanied by neurological symptoms (e.g., vision changes, speech difficulties, weakness, numbness, and seizures) could suggest a possible underlying, serious problem impacting the brain, such as a stroke or brain tumor. Time-sensitive evaluation by a healthcare professional is recommended when these symptoms occur.
Headache After a Head Injury
If a headache persists or worsens following a concussion/head injury, other problems may be involved (e.g., brain swelling or bleeding). That’s especially so if the head pain is accompanied by confusion, dizziness, vomiting, or changes in alertness. For example, imagine having a head injury and initially feeling fine. But then, you start experiencing a relentless, worsening headache. You might become more irritable, light-headed, and confused. Prompt medical assessment is needed to rule out serious injuries.
Persistent or Worsening Headache
Envision experiencing a headache for several weeks. Still, the pain has become sharper and more intense without relief from regular painkillers. You might also start feeling nauseous to the point of vomiting. Over time, a constant or worsening headache can be a sign of severe conditions (e.g., a brain tumor or a build-up of fluid in the brain’s ventricles). A headache that transitions from mild to severe and does not stop needs a more thorough investigation.
Headache with Fever or Stiff Neck
Severe headache, fever, and stiff neck can sometimes signal an infection. Meningitis, for example, is an infection of the membranes around the brain and spinal cord. An individual with meningitis might become sensitive to light and develop a rash, fever, and pounding headache.7 This mix of symptoms requires immediate medical intervention to prevent severe, possibly life-threatening complications.
Mental Health Considerations
Severe headache can have a significant impact on mental health, contributing to anxiety, depression, and an overall reduced quality of life. If you experience a daily headache, you might feel trapped by your pain. Over time, you may withdraw from social activities and become increasingly anxious about the next attack. Persistent pain and discomfort can lead to emotional distress, irritability, and difficulty concentrating — further exacerbating mental health challenges. This ongoing struggle can leave you feeling hopeless and frustrated, making it essential to seek support.
At the 2018 Migraine World Summit, Dr. Dawn Buse discussed migraine and two of its common comorbidities, anxiety and depression. She shared, “They are their little evil team of three. I’m thinking of the arch-villains in a comic book with these three. In research, we have noticed that when we can treat any one of them, the others get better. If we just reduce headache days somewhat, migraine, depression, and anxiety get better.”8
Access to support networks and professional guidance can help you manage pain and provide coping strategies, fostering resilience and improving mental and physical well-being.
Diagnosis and Medical Evaluation
Where to Go for Care
Immediate consultation (at an emergency room) is crucial if your headache is sudden and intense, accompanied by neurological symptoms, or follows a head injury. For persistent or worsening headaches, regular visits to your general physician or neurologist can help identify and manage underlying causes. So, what happens when someone reaches out for help in dealing with severe head pain?
Diagnostic Tests and Procedures (CT Scan, MRI, etc.)
To determine the cause of severe headache, health professionals may recommend various tests and procedures. Tests like CT scans and MRIs can reveal issues in the brain that might be causing pain. Blood tests check for infections or other underlying conditions. In some cases, a lumbar puncture (i.e., spinal tap) can rule out conditions such as meningitis or a subarachnoid hemorrhage.9
Importance of an Accurate Diagnosis
An accurate diagnosis is necessary for effective treatment and management of severe headache, and identifying underlying causes. Whether the head pain is due to migraine, cluster headache, or potentially life-threatening conditions like a brain tumor or aneurysm, understanding the exact cause allows for strategic treatment, quality of life improvement, and prevention of further issues.
This is not always a straightforward or smooth process. Sometimes, you must self-advocate and be assertive when navigating the complex web of healthcare systems. Joe Coe from the Global Healthy Living Foundation emphasizes this: “If you feel like you’re going to be shamed or questioned about who you are as a person, you’re not going to live that indignity and seek care. We know that people are delaying treatment to routine wellness visits because their primary care physician isn’t affirming of their identity or sexual orientation.”10
How Tracking Health Data Helps
For an accurate diagnosis, doctors gather detailed health information. Be prepared to track important data and answer questions about themes discussed in this article, such as:
- Onset, duration, and frequency of headache
- Associated symptoms like nausea, light sensitivity, or aura
- Medical history, including any past head injuries, family history of headache, and current medications/treatments
- Potential triggers
These clues help doctors paint an accurate picture (e.g., type of headache, more serious conditions, etc.) and develop a holistic treatment plan tailored to your needs. For instance, noting if your head pain worsens after physical exertion or specific stressors can guide more targeted testing.
Also, by tracking your symptoms (in a diary or tracking app like Migraine Buddy), you can capture insights consistently, improving communication and navigation within the healthcare system and enhancing the chances of an accurate diagnosis. This also allows you to better understand your condition and recognize potential triggers or patterns, leading to improved lifestyle management.
Preventing Strategies: A Balanced Approach
While certain severe headache conditions like migraine and cluster headache may have specific triggers, prevention often comes down to maintaining a healthy, balanced lifestyle. For headache caused by other factors, such as tumors, the best we can do is stay as healthy as possible. Although some individuals may experience a severe headache despite being in good health, adopting a balanced lifestyle can enhance recovery and management of these conditions. For more insights on managing severe chronic headache conditions, check out a related article here.
Summary

A severe headache isn’t just an inconvenience. It can profoundly impact your life and well-being. This article provides an overview of the complexities of severe headache, exploring various causes, triggers, and associated conditions. Recognizing warning signs and understanding when to get help early can prevent serious complications. Gaining a better understanding of severe headache conditions allows for making more informed decisions about your health, improving your quality of life, and helping you navigate the challenges that come with severe head pain.
Resources and References
Links to outside organizations and articles are provided for informational purposes only and imply no endorsement on behalf of the Migraine World Summit.
Further Reading
- International Headache Society. (2018). The international classification of headache disorders, 3rd edition (ICHD-3). Cephalalgia, 38(1), 1-211. https://www.ichd-3.org/
- National Institute of Neurological Disorders and Stroke. (2023). Migraine information page. https://www.ninds.nih.gov/health-information/disorders/migraine
- World Health Organization. (2016). Atlas of headache disorders and resources in the world 2011. World Health Organization. https://www.who.int/publications/i/item/9789241564212
Support
- Migraine World Summit: gathers leading headache experts from around the world to share the latest research, treatments, and strategies for managing migraine. The summit offers extensive video interviews, articles, and resources for individuals dealing with migraine.
- European Headache Federation (EHF): provides educational resources, conducts research, and collaborates with other organizations to enhance understanding and treatment of headache.
- Migraine Trust (UK): offers a wealth of resources including information on treatments, support groups, and advocacy for people living with migraine. They also conduct and support research initiatives focused on migraine.
- American Migraine Foundation (AMF): provides comprehensive resources, including educational materials, research updates, and support networks for those living with migraine. Their global outreach includes webinars and community support initiatives.
- Migraine Canada: offers educational resources, treatment information, and a community forum for individuals suffering from migraine. They also collaborate with international organizations to enhance migraine awareness and research.
- International Association for the Study of Pain (IASP): promotes the study of pain, including headache. They provide resources for both professionals and patients, host international conferences, and support global pain research.
- The World Federation of Neurology (WFN) – Headache Group: focused on improving the care and management of headache globally. They offer educational resources and guidelines, and promote research in the field of headache disorders.
- Global Patient Advocacy Coalition (GPAC): advocates for patients with chronic pain conditions, including migraine, on an international scale. They work to influence global health policies and provide resources and support for patients and caregivers.