Self-Diagnosis 101
Does your headache warrant a trip to the ER or just an aspirin and a nap? Knowing when it's actually appropriate to call a doctor, or maybe rush to the hospital, can be doubly useful: It lets worriers rest easy and prods those with serious symptoms to take action. The Harvard Medical School Family Health Guide and its editor in chief, Anthony L. Komaroff, MD, help you decode your pain.
It's probably not cause for worry if...
- The headache comes on after you've consumed a large amount of alcohol. You likely have a hangover.
- Your head hurts on days you drink less than your usual amounts of coffee, tea, or soda. You're probably feeling the effects of caffeine withdrawal.
- You feel a bandlike pain across the front or back of your head or neck. When accompanied by stress or sleep problems, this is most likely a tension headache. If you get one frequently, make an appointment to see your doctor.
- You also have a runny or stuffy nose, sore throat, cough, aching muscles, or fever—indications of a viral infection, such as a cold. If the symptoms last more than two weeks, contact your physician; you could have something more than a simple infection.
- You have nausea or vomiting and you recently began taking prescription or nonprescription medication. You may be suffering from a drug reaction. It's important to notify your physician so that she can adjust your treatment and know what not to give you in the future.
- There's also throbbing eye pain and/or blurred vision. These symptoms can indicate increased eye pressure (caused by anything from glaucoma to a tumor) or high blood pressure.
- Your headaches are severe and tend to occur repeatedly over several days, go away for weeks or months, and then start again. This pattern is typical of cluster headaches, and your doctor may be able to prescribe drugs or suggest lifestyle changes to help prevent future attacks.
- You have nausea or vomiting, impaired vision, or fatigue just before your headache. These are all migraine symptoms. If you get this kind of headache on a regular basis, talk to your doctor about medications that can alleviate the pain or prevent the migraine altogether.
- You're over 50 and have suddenly started to get frequent headaches. This could indicate something serious, like an aneurysm, a brain tumor or an infection (such as encephalitis), so call your doctor immediately. The most common types of headaches—migraine and tension—usually begin earlier in life.
- You've suffered a blow to your head and, although you have no other symptoms, the headache lasts more than two days. You may have a mild concussion.
Go to an emergency room when...
- A headache caused by a blow to the head is accompanied by vomiting, nausea, blurred vision, confusion, or memory problems. You could have a concussion or bleeding in the brain.
- You have severe pain, nausea, vomiting, or confusion and a fever of more than 100 degrees, increased pain when you bend your head forward, a stiff neck, or blurred or double vision. These are all signs of a dangerous infection like meningitis or a brain hemorrhage.
- It feels as if you're having the worst headache of your life. Although you may be just fine (except for the pain), your doctor should make sure nothing else is going on.
- You feel dizzy, confused and nauseated. First, get fresh air immediately, since the headache could be caused by toxic fumes.
It's probably not cause for worry if...
- You feel a burning pain after meals or when lying down, and it's accompanied by belching, bloating, or an acid taste. These are all symptoms of heartburn. If you get it only occasionally, over-the-counter antacids should make you feel better.
- Heartburn recurs frequently. This is a sign that you could have gastroesophageal reflux disease (GERD).
- The pain occurs after you exert yourself or when you're angry, and goes away within 20 minutes when you stop to rest. You may have angina—chest pains caused by coronary artery disease.
- You're short of breath, you're coughing a lot, you've developed a fever, your phlegm is yellow or green, or the pain lasts more than three days. Although some of these symptoms could indicate only a pulled chest muscle, you might have pneumonia.
- The pain is limited to one side, and you recently had a severe cough or trauma to the chest area, such as surgery or an injury. Again, you may have pulled a muscle or even fractured a rib, so contact your physician if symptoms last longer than two days.
- The pain is severe, crushing, squeezing, or pressing, and is accompanied by dizziness, sweating, shortness of breath, or pain or tingling in the jaw, neck, or arms. These are all signs of a heart attack. Call 911. Then chew and swallow an aspirin, and drink a glass of water—this thins the blood, helping to get more of it to the heart.
- You feel short of breath or the pain gets worse when you inhale. You could have a collapsed lung, or a blood clot that's traveled to the lung—this most often occurs after you've been confined to a bed or seat (car, bus, train, or plane) for many hours.
It's probably not cause for worry if...
- You have diarrhea. When that's the only other symptom, the culprit is most likely a mild gastrointestinal irritation or an infection (such as the stomach flu). Drink plenty of clear fluids to prevent dehydration, and call your doctor if the symptoms become severe or last more than five days.
- The pain is in the upper part of your abdomen and occurs either just after meals or many hours later when your stomach is empty. You may have heartburn or an ulcer. Take antacids or over-the-counter H2-blockers (such as Prilosec), which reduce the amount of acid your stomach produces.
- If your symptoms last longer than a month or get worse, call your doctor. If the pain occurs only when you eat specific foods, then you most likely have a food allergy or intolerance.
- You have a frequent urge to urinate, and/or there's a burning sensation when you do. If you also have a pain in your groin, you may have a kidney stone; if not, the cause could be a urinary tract infection.
- You're also feeling pain between your shoulder blades, accompanied by nausea, bloating, belching, or fever. These are signs of gallbladder disease.
- You've missed a menstrual period and have constant, increasing pain in your lower abdomen or lower back. You may have an ectopic pregnancy (when a fetus develops outside the uterus). Call your ob-gyn right away.
- Your last period was unusually heavy or painful. You should have your ovaries checked for cysts or something more serious, like cancer.
- The pain is more severe now than it's ever been. This could be a warning sign of an intestinal or gallbladder infection, an ulcer, an ovarian cyst, or even cancer.
- The pain, even if not strong, develops after several months of poor appetite and an unexplained weight loss (certainly if it's more than ten pounds in six months). These could indicate a grave condition, such as cancer (pancreatic, stomach, intestinal, or liver) or chronic pancreatitis.
- You also have rectal pain, a constant urge to have a bowel movement with little or no success, or mucus from the rectum. This pattern is typical of an inflammation of the anus or rectum.
- The pain is in the upper abdomen and it comes on or gets worse when you're lying down—symptoms associated with several common conditions, including GERD and a hiatal hernia. If your symptoms last more than a week, despite taking antacids, call your doctor.
- Upper-abdominal pain is recurrent, you're tired, and your stool is black or tarlike. You could have a bleeding ulcer.
- The pain is in the lower abdomen and you've got diarrhea that contains either blood or mucus and/or you're running a fever. You may have an inflamed large intestine (colitis or diverticulitis).
- Lower-abdominal pain is accompanied by bloating and alternating bouts of diarrhea and constipation. An intestinal disorder like irritable bowel syndrome may be causing your problems.
- The pain is sudden and you have a fever of more than 100 degrees or your abdomen is unusually swollen. These symptoms could indicate an intestinal obstruction, appendicitis, acute pancreatitis, or peritonitis, and you should call the doctor right away.
Go to an emergency room when...
- The pain is not only sudden but severe, and unlike any stomachache you've ever had. You may have an intestinal obstruction, appendicitis, or acute pancreatitis and require immediate medical attention.
- The pain is high in the middle of your abdomen and goes into the center of your chest, neck, or shoulders. You could be having a heart attack. Call 911. Chew and swallow an aspirin, and drink a glass of water—this thins the blood, helping to get more of it to the heart.
It's probably not cause for worry if...
- You're drinking a lot of alcohol or taking narcotics. Excessive dizziness can be caused by either.
- You're vomiting and have been in a car, boat, or plane within the last 12 hours. You could just be reeling from temporary motion sickness. If symptoms don't improve after a day or if they last more than three, call your doctor.
- You've recently started taking medication, even nonprescription. You could be having a drug reaction. It's important to notify your physician so she can adjust your treatment and know what not to give you in the future.
- You have difficulty breathing or are breathing rapidly, and feel a sense of fear or unreality. These symptoms could mean you're having an anxiety attack. If it happens often, you may have a panic disorder and should talk to your doctor or a mental health professional. The dizziness occurs when you move your head or turn it rapidly, or it has lasted a few hours to a few days. You could be suffering from a mild inner-ear disorder.
- The dizziness is recurrent and accompanied by vomiting and a ringing in your ears—possible indications of a serious inner-ear disorder called Ménière's disease.
- The dizziness has lasted several weeks, and you also have hearing loss in one ear and/or pain, numbness, or tingling of the face. You may have nerve damage caused by a benign tumor called an acoustic neuroma.
- You start feeling dizzy immediately before a headache—dizziness frequently precedes (or accompanies) a migraine. You have a persistent headache that's worse when you wake up or lie down. This could indicate a brain disorder such as a tumor.
- The dizziness lasts more than two weeks—even if it seems fairly harmless, you should consider it a red flag that you may need medical attention. (Some potential causes include high blood pressure or low blood sugar.)
- You get dizzy after a blow to the head. You could have a brain injury.
- The dizziness is accompanied by crushing pain in your chest; pain or tingling in your jaw, neck, or arms; shortness of breath; or sweating. These are all signs of a heart attack. Call 911. Chew and swallow an aspirin, and drink a glass of water—this thins the blood, helping to get more of it to the heart.
- You also have paralysis on one side of your face, numbness or tingling in your arms or legs, slurred speech, blurred or double vision, or a sudden loss of vision in either eye. It's possible you've got multiple sclerosis, but these symptoms could also signify something more urgent like a stroke.
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