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The best statement to begin with is:

"You should visit your doctor ASAP when you experience a very severe headache for the first time".

Headache is very common complaint and usually has no serious cause. Even though most of the headaches are primary (means there is no medical condition causing them) it is very important to rule out secondary cause of the headache. Doctors are trained to recognize certain red flags that point to serious condition rather than a regular headache. Severity is a very important red flag, even though very severe headaches that are stabbing in nature or electric shock like often are primary benign headaches called ice pick headaches, they also could be due to a subarachnoid hemorrhage which is a life threatening condition. That's why it is very important to visit your doctor as soon as you get a very severe headache.

Ice pick headache

Momentary (lasting only a few seconds), sharp, stabbing or electrical headache that occurs once or more than once a day at irregular unpredictable intervals. Other commonly used nicknames for this headache are "stabs and jabs" or "jabs and jolts" headache. The pain is often located around the eye or above the ear in the temple area. It is common for the pain to recur in the same place but it also may move to other places of the head even on the opposite side. Although these headaches may occur without any previous headaches they are more likely to happen in patients with other primary headaches such as migraine or cluster headaches. These headaches are more common in adults and very uncommon in the pediatric and adolescent ages. This type of headache treated successfully with Indomethacin or in many cases it may disappear spontaneously.

Subarachnoid hemorrhage

Usually present with severe headache that is described as "the worst headache of life" this headache usually starts suddenly and progresses very quickly. The brain tissue is protected by a membrane called meningis that separate the brain from the skull. Subarachnoid hemorrhage is bleeding in the space located between the brain and this membrane. Bleeding usually comes from ruptured aneurysm (an abnormal bulge in a brain vessel). Or less commonly from arteriovenous malformation (an abnormal communication of blood vessels in the brain). A subarachnoid hemorrhage is very serious neurological condition that may lead to permanent brain damage or even coma and death if not treated.

It is important to mention here that if you had a headache that is associated with any other symptom, such as weakness of one of your limbs or difficulty finding words or articulating it is very important that you call the emergency services as soon as possible because the headache and the associated symptoms might point to a stroke in this situation.

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