What should you know about excruciating headache?

Severe head pain may occur with migraine, an infection, dehydration, heat exhaustion, or marked muscle tension. A cold, allergic rhinitis, or chronic sinusitis can produce pressure around the face, although very intense pain should not be assumed to be sinus-related. Dengue fever and COVID-19 may also include headache alongside fever or other illness symptoms. The pattern matters: note whether the pain began suddenly, where it is located, and whether light, movement, fever, vomiting, neck stiffness, weakness, confusion, or vision changes accompany it.

Stop strenuous activity and rest in a quiet, dim room. Sip fluids if you can keep them down, especially after heat exposure, sweating, vomiting, or poor intake. Avoid driving if the pain affects your vision, balance, or alertness. Do not take more medicine than the label allows, and check with a pharmacist or clinician if you have pregnancy, kidney disease, stomach ulcers, or other regular medicines. Record the onset and associated symptoms so an assessor can judge the pattern.

Seek emergency help for a sudden thunderclap headache, new severe pain after a head injury, fainting, seizure, confusion, weakness or numbness on one side, trouble speaking, severe vision change, fever with a stiff neck, or repeated vomiting. Obtain same-day medical advice when the headache is unusually severe, keeps worsening, follows a new pattern, or occurs with pregnancy, cancer, immune suppression, or very high blood pressure. Do not wait for it to settle if you feel seriously unwell.

Ask what causes fit the timing and accompanying symptoms, whether an examination or tests are needed, which pain medicines are suitable for you, and how to recognise a recurrence that needs urgent review.