From headaches to back pains – here’s how you can determine the seriousness

(Photo: Getty/Gallo Images)
(Photo: Getty/Gallo Images)

If you have a worrying new symptom, should you freak out or chill out? That’s the question two US cardiologists aim to answer with their new book, Am I Dying?!

Whether you have a nagging headache or blood in your urine, you don’t want to ignore a niggle that could point to a serious health problem. But you don’t want to behave like a hypochondriac either.

Thankfully, as Dr Christopher Kelly and Dr Marc Eisenberg point out, most new symptoms turn out to be no big deal. But sometimes a headache isn’t just a headache, and could be a sign of a lifethreatening condition.

This extract from their book looks at some common symptoms and offers guidance on whether you can make yourself a cup of tea and relax, or whether you should immediately pick up the phone to make an appointment with your GP.


Most of us know the familiar pounding sensation that occurs at the end of a long week. But what if this headache is different? What if it’s . . . the big one? Before you panic, let’s pause to review the facts.

Many people have experienced headaches severe enough to warrant a trip to a hospital’s emergency room.

In fact, one in 50 visits to ERs is about headaches. Yet most of those people survive, and you probably will too.

Take a chill pill if . . .  

Your headache is mostly in your forehead or face and you’ve recently had symptoms of a cold, such as a fever and runny nose. One of your sinuses is probably jammed with mucus and too swollen to drain properly. You can try to thin out the mucus by inhaling warm vapour.

Take ibuprofen along with a decongestant such as pseudoephedrine or phenylephrine (available over the counter from your pharmacist).

If the pain gets steadily worse and lasts for more than a week, you might need antibiotics so make an appointment to see your doctor.

  • You also have a fever, body aches, pain in your muscles and a sore throat. You probably have the flu.
  •  You’ve recently kicked your coffee habit. You’re in caffeine withdrawal. You’ll need to ride this one out, preferably with the help of a pain reliever such as ibuprofen.

  •  Your headache feels like a band around your skull but gets better with rest and medications such as paracetamol. These symptoms are typical for a tension headache – the most common and least dangerous type of headache.
  • They don’t require medical attention unless they’re happening often enough to interfere with the quality of your life.
  • The pain is uncomfortable but not intolerable. It came on gradually and isn’t associated with any other symptoms. Some headaches don’t fit any specific pattern but also don’t have any alarming features.
  • Take a pain reliever with a tall glass of water and lie down in a quiet room. Give the medicine at least an hour or two to work. You should feel better soon. If the pain keeps getting worse or becomes more regular, take a look through the next sections.

See your GP if . . .

  • You’re having frequent or intense headaches now but never used to before. High levels of stress, poor sleep or a sudden decrease in caffeine intake can cause new-onset headaches in a person who doesn’t normally have them. If there’s no obvious explanation, however, you should see your doctor to rule out rare but dangerous causes of headache.
  • You occasionally have gradual-onset throbbing headaches along with nausea and increased sensitivity to light and sound. This pattern is classic for migraines. If you think you’re having migraines, see a doctor to confirm the diagnosis and get on the right medications.
  • You’re over 50, your scalp hurts when you brush your hair and your jaw gets tired after chewing for a few minutes. You may have temporal arthritis, a condition where the arteries on the side of your face become diseased and narrowed
  • Major symptoms include headache, scalp tenderness, jaw fatigue after chewing and vision changes or loss. If the disease isn’t quickly diagnosed and treated, permanent vision loss can occur. See your doctor asap.

Go to the emergency room if . . .

  • Your speech has also become slurred, or you feel weak or numb in an arm, leg, and/or the side of your face. You could be having a stroke. (Why are you still reading this article? Go to the hospital!)
  • You’re feeling groggy and generally not quite right. A headache associated with confusion, excess sleepiness or personality changes may indicate high pressure around the brain from infection, tumour or bleeding.
  • You have a fever and your neck hurts. An infection around the brain, known as meningitis, causes high fever, headache, and neck stiffness/pain. Some people also become sensitive to bright lights.
  • The headache came on fast and furious. Ones that go from zero to 10 in a few minutes are known as thunderclap headaches.They’re often a sign of a serious and rapidly progressing problem, such as bleeding on the brain. Get to the accident and emergency department for an urgent brain scan.

Chest pain

With chest pain, the main worry is that it could indicate a heart attack, which means part of the heart muscle is no longer receiving adequate blood flow.

If you’re having chest pain and haven’t already called an ambulance, you’ll be relieved to learn that most of the time it turns out to be wind or a pulled muscle.

But how do you know which way it’ll turn out? Do you need emergency heart surgery? Or just an antacid?

(Photo: Getty/Gallo Images)

Take a chill pill if . . .

  • You strained your chest and now have sharp chest pain when you twist your body or raise your arms. Perhaps yesterday you decided to go all out at the gym or took a tennis ball in the ribs. Either way, if your pain is worse when you contort your chest, it’s likely to be from a sore muscle or even a rib fracture.
  • As long as the pain isn’t disabling, soldier on with an ice pack and ibuprofen. See your doctor if you took a major blow to the chest and now have shortness of breath or tenderness over multiple ribs.
  • You have sharp pain in one spot when you take a deep breath. The most likely explanation is that you pulled one of the muscles between your ribs, which produces sharp pain when you take a deep breath and stretch the muscle out. The pain usually improves with ibuprofen or paracetamol. If you also have a fever, chills and a cough, you could have pneumonia, an infection in the lungs.
  • The infected area inflames the adjacent part of the chest, causing pain with deep breathing. If you think you may have pneumonia, see your doctor asap.
  • You have been cough ing a lot and now have sharp chest pain when you cough. Repeated coughing bouts can pull chest muscles.
  • They also irritate the airway. Both situations can result in sharp chest pain with coughing. Thankfully, neither is a big deal. The cough, on the other hand, may be a reason to see your doctor.

See your GP if . . .

  • You get chest pain when you really exert yourself, and you feel better with rest. The arteries supplying your heart muscle with blood may have severe blockages (also known as plaques). As a result, the heart isn’t getting enough flow when it’s working hard and needs extra blood. You may need an exercise stress test.
  • You have sharp chest pain that improves when you lean forward, but you otherwise feel fine. You may have an irritation of the lining around the heart, a condition known as pericarditis. This can be an isolated problem, can occur alongside or shortly after a bad cold or can be a sign of a serious disease, such as the autoimmune condition lupus.
  • See your doctor as soon as possible. If you also feel lightheaded or very short of breath, just head to an ER.
  • You get burning chest pain after eating or when you’re lying down. You may also have a sour taste in your mouth. You could have acid reflux, where digestive juices from the stomach bubble back towards the mouth.
  • If a glass of water improves the pain, consider the diagnosis confirmed (since water washes acid back down into the stomach).Try taking antacids to neutralise your stomach acid. If those fail, try taking ranitidine or omeprazole, which you can get over the counter from your pharmacist; these stop the stomach from generating acid in the first place.
  • If the problem (or need for medications) lasts for more than two weeks, see your doctor. 

Go to the ER if . . .

  • You’ve had severe, constant, pressure-like chest pain for several minutes, and it’s not getting better. You may be having a heart attack; call an ambulance.
  • You’re also short of breath. The combination of chest pain and shortness of breath can indicate a heart attack, fluid around the heart, a blood clot in the lungs, a bad asthma attack or pneumonia – all require prompt attention in the ER.
  • You have sharp chest pain along with a fever and cough. You could have pneumonia. See your GP today. But if you’re feeling lightheaded or really short of breath, go to the ER.
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