When to Be Concerned About Night Sweats

Night sweats can happen for a number of reasons, and many of them aren’t too serious, such as being too hot or hormonal fluctuations. In some cases, regular episodes of night sweating could indicate a serious medical condition.

It’s not uncommon to sweat at night. You may sweat a little or a lot, depending on how many blankets you sleep with, how warm your room is, and even what you ate before bed.

But if you sweat enough that you regularly wake up with wet pajamas and bedding, there could be an underlying medical issue.

Read on to learn more about possible causes of night sweats, tips to relieve night sweats on your own, and when it may be a good idea to see your healthcare professional.

It’s not always possible to determine the cause of night sweats. But other symptoms you experience along with nighttime sweating could help you narrow down an underlying medical cause.

Your environment

Your room, mattress, and pajamas could all influence whether you sweat during the night. Your bed may be adorned with several cozy blankets that cause overheating. Similarly, your pajamas could be too heavy, or your mattress may not be breathable. Adjusting the environment may help alleviate your night sweats.

Your nighttime routine

External factors beyond your sleeping environment may impact night sweats. These include:

• alcohol use at night
• eating spicy foods at dinner or as a late-night snack
• exercising before sleep

Avoid these behaviors before bedtime to see if your night sweats decrease.

Stress and anxiety

Anxiety and stress are mental health issues, but they often involve physical symptoms, too. Increased sweating is one common physical sign associated with these conditions.

If your night sweats are happening because of anxiety or stress, you might also:

• have feelings of worry, dread, and fear that keep coming back
• find it hard to think about anything besides these feelings
• have sleep issues or unpleasant dreams
• have stomach and digestive trouble
• have unexplained aches, pains, or muscle tension
• feel irritable or have other mood changes
• feel weak, tired, or generally unwell

Addressing the underlying cause of stress and anxiety, generally by working with a therapist, may help improve all of your symptoms.

Hormonal issues

A range of hormonal issues and hormone disorders can cause excessive nighttime sweating.

These include:

• menopause
• low testosterone
• carcinoid syndrome
• hyperthyroidism

Hormonal conditions can cause a range of symptoms, but some general ones include:

• unexplained weight changes
• changes in energy level
• headaches
• sexual dysfunction
• menstrual changes

Many hormonal issues can be managed.

Medication side effects

Certain drugs can cause night sweats as a side effect. If you’ve recently started a new medication and are experiencing night sweats, talk with the doctor who prescribed your medication.

Some common drugs known to sometimes cause night sweats include:

• steroids, including prednisone and cortisone
• both tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants
• pain relief medications, such as aspirin and acetaminophen
• medications for diabetes that help lower blood sugar
• hormone therapy medications
• phenothiazine antipsychotics

If the night sweats have a negative impact on your sleep, a doctor may recommend a different medication or have suggestions to help you manage the side effects.

Hyperhidrosis

Hyperhidrosis causes you to sweat excessively to the point of it being noticeable to you and possibly others. It may interfere with your daily life.

But it can be inconvenient and require management. You may have the condition with no underlying causes. Or it may be a symptom of another medical condition or a side effect of medication.

Hypoglycemia

Hypoglycemia occurs when you have low blood sugar. It could cause you to sweat at night or during the day. You may have hypoglycemia if you have type 1 or type 2 diabetes. Other reasons for low blood sugar may include alternations in hormone levels or metabolism.

In addition to excessive sweating during sleep, you may have nightmares or feel disoriented after awakening.

Other symptoms of hypoglycemia are:

• unsteadiness
• shaking
• hunger
• exhaustion or fatigue
• racing or irregular heartbeat
• headaches
• disorientation

Severe symptoms include losing consciousness or having a seizure.

Gastroesophageal reflux disease (GERD)

You can experience GERD during the day or at night, and it can sometimes cause night sweats.

Along with night sweats, GERD can cause:

• heartburn, often after meals
• chest pain or esophageal spasms
• problems with swallowing
• regurgitation (when liquid or food comes back up after swallowing)
• sleep issues
• respiratory problems, including coughing or increased symptoms of asthma

GERD is generally diagnosed if you experience this at least twice per week, or if more severe reflux happens once per week or more.

Sleep apnea

Sleep apnea is a condition that causes you to stop breathing while asleep, usually multiple times in a night.

Obstructive sleep apnea generally occurs when something like throat tissue blocks your airway. You can also develop central sleep apnea when certain health conditions affect the function in your central nervous system.

If you have sleep apnea, you might also:

• feel tired during the day
• wake often in the night or sleep restlessly
• wake up struggling to breathe
• have difficulty focusing during the day
• have headaches

Sleep apnea can have serious complications if it goes untreated, such as increased risk for respiratory and cardiovascular issues.

Women going through menopause who experience night sweats may also be at a greater risk for developing sleep apnea, according to a 2018 study.

It’s a good idea to see a doctor for night sweats that happen with other symptoms of sleep apnea.

Serious infections

Some serious infections can also cause night sweats, including:

• tuberculosis, a highly contagious infection that usually affects your lungs
• endocarditis, an infection in the valves of your heart
• osteomyelitis, an infection in your bones
• brucellosis, an infection you can get from animals with brucellosis or unpasteurized products from infected animals
• HIV
• fungal infections
• infectious mononucleosis (mono)
• other infections

But as with cancer, infections also tend to cause other noticeable symptoms. These include:

• chills and fever
• aching muscles and joints
• body pain
• general weakness or fatigue
• weight loss
• lack of appetite

Call a doctor if you have any of the symptoms above.

Neurological disorders

In rare cases, night sweats can occur as a symptom of certain neurological issues, including:

• stroke
• autonomic dysreflexia
• autonomic neuropathy
• syringomyelia

Neurological issues can involve many symptoms, but some might include:

• appetite loss or other GI or urinary symptoms
• losing consciousness
• feeling dizzy or lightheaded
• trembling
• muscular weakness
• numbness and tingling in your arms, hands, legs, and feet

Cancer

It’s possible for unexplained night sweats to be a symptom of cancer, but this doesn’t happen often. If you do have cancer, you’ll most likely have other noticeable symptoms, too.

These symptoms may seem to resemble other, less serious health issues, like the flu.

It’s a good idea to contact a doctor if you have night sweats and feel fatigued or generally unwell.

It’s particularly recommended to see a doctor if you have a fever that doesn’t go away and you’ve recently lost weight without trying, as these can be early signs of cancer.

Types of cancer often linked to night sweating include:

• Hodgkin’s lymphoma
• non-Hodgkin’s lymphoma
• leukemia

These cancers also involve the following symptoms:

• persistent fatigue and body weakness
• fever
• chills
• unintentional weight loss
• swollen lymph nodes
• chest and stomach pain
• bone pain

If you don’t have other symptoms that might indicate something more concerning, try these tips to relieve night sweats:

• Crack a window. Sleep in a cooler room. Leave windows cracked open at night, if possible, or try using a fan.
• Change your bedding. Replace plush or heavy blankets with breathable sheets, light quilts, or even moisture-wicking sheets. It can even help to remove extra bedding and sleep under lighter layers, so you may not need to buy new sheets or blankets.
• Adjust exercise timing. Physical activity just before sleeping could contribute to increased sweating in the night.
• Avoid sweat triggers. Avoid eating spicy foods, smoking cigarettes, or drinking alcohol right before going to bed.

If you only get night sweats occasionally and they don’t significantly affect your sleep quality, you probably don’t need to be too concerned. Still, you may want to mention them the next time you see your doctor.

But if you’re having trouble sleeping, regularly have night sweats, or have other symptoms that concern you, it’s best to check in with a healthcare professional.

Some potentially serious symptoms to watch for include:

• unexplained weight loss
• body aches and pains
• high fever and chills
• chronic or bloody cough
• diarrhea or stomach pain

A doctor can help you get to the bottom of your night sweats and, if needed, come up with a treatment plan.

Your doctor will use several different methods to determine the cause of frequent or disruptive night sweats. These may include:

• discussing your symptoms, health history, and medications
• going through your family history
• conducting a physical exam
• ordering laboratory or imaging tests to determine an underlying health condition

Your doctor may refer you to a specialist if they suspect an underlying health condition that requires specialized treatment.

There are many reasons you may sweat at night.

The first culprit to consider is your environment, including your clothing, bedding, and the temperature of your room. Next, examine your habits before bedtime.

If you adjust these factors and still wake up in sweat, there may be another cause. Speak with a doctor to diagnose and treat the cause so you can get back to more comfortable sleep.

When to Be Concerned About Night Sweats

Night sweats can happen for a number of reasons, and many of them aren’t too serious, such as being too hot or hormonal fluctuations. In some cases, regular episodes of night sweating could indicate a serious medical condition.

It’s not uncommon to sweat at night. You may sweat a little or a lot, depending on how many blankets you sleep with, how warm your room is, and even what you ate before bed.

But if you sweat enough that you regularly wake up with wet pajamas and bedding, there could be an underlying medical issue.

Read on to learn more about possible causes of night sweats, tips to relieve night sweats on your own, and when it may be a good idea to see your healthcare professional.

It’s not always possible to determine the cause of night sweats. But other symptoms you experience along with nighttime sweating could help you narrow down an underlying medical cause.

Your environment

Your room, mattress, and pajamas could all influence whether you sweat during the night. Your bed may be adorned with several cozy blankets that cause overheating. Similarly, your pajamas could be too heavy, or your mattress may not be breathable. Adjusting the environment may help alleviate your night sweats.

Your nighttime routine

External factors beyond your sleeping environment may impact night sweats. These include:

• alcohol use at night
• eating spicy foods at dinner or as a late-night snack
• exercising before sleep

Avoid these behaviors before bedtime to see if your night sweats decrease.

Stress and anxiety

Anxiety and stress are mental health issues, but they often involve physical symptoms, too. Increased sweating is one common physical sign associated with these conditions.

If your night sweats are happening because of anxiety or stress, you might also:

• have feelings of worry, dread, and fear that keep coming back
• find it hard to think about anything besides these feelings
• have sleep issues or unpleasant dreams
• have stomach and digestive trouble
• have unexplained aches, pains, or muscle tension
• feel irritable or have other mood changes
• feel weak, tired, or generally unwell

Addressing the underlying cause of stress and anxiety, generally by working with a therapist, may help improve all of your symptoms.

Hormonal issues

A range of hormonal issues and hormone disorders can cause excessive nighttime sweating.

These include:

• menopause
• low testosterone
• carcinoid syndrome
• hyperthyroidism

Hormonal conditions can cause a range of symptoms, but some general ones include:

• unexplained weight changes
• changes in energy level
• headaches
• sexual dysfunction
• menstrual changes

Many hormonal issues can be managed.

Medication side effects

Certain drugs can cause night sweats as a side effect. If you’ve recently started a new medication and are experiencing night sweats, talk with the doctor who prescribed your medication.

Some common drugs known to sometimes cause night sweats include:

• steroids, including prednisone and cortisone
• both tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants
• pain relief medications, such as aspirin and acetaminophen
• medications for diabetes that help lower blood sugar
• hormone therapy medications
• phenothiazine antipsychotics

If the night sweats have a negative impact on your sleep, a doctor may recommend a different medication or have suggestions to help you manage the side effects.

Hyperhidrosis

Hyperhidrosis causes you to sweat excessively to the point of it being noticeable to you and possibly others. It may interfere with your daily life.

But it can be inconvenient and require management. You may have the condition with no underlying causes. Or it may be a symptom of another medical condition or a side effect of medication.

Hypoglycemia

Hypoglycemia occurs when you have low blood sugar. It could cause you to sweat at night or during the day. You may have hypoglycemia if you have type 1 or type 2 diabetes. Other reasons for low blood sugar may include alternations in hormone levels or metabolism.

In addition to excessive sweating during sleep, you may have nightmares or feel disoriented after awakening.

Other symptoms of hypoglycemia are:

• unsteadiness
• shaking
• hunger
• exhaustion or fatigue
• racing or irregular heartbeat
• headaches
• disorientation

Severe symptoms include losing consciousness or having a seizure.

Gastroesophageal reflux disease (GERD)

You can experience GERD during the day or at night, and it can sometimes cause night sweats.

Along with night sweats, GERD can cause:

• heartburn, often after meals
• chest pain or esophageal spasms
• problems with swallowing
• regurgitation (when liquid or food comes back up after swallowing)
• sleep issues
• respiratory problems, including coughing or increased symptoms of asthma

GERD is generally diagnosed if you experience this at least twice per week, or if more severe reflux happens once per week or more.

Sleep apnea

Sleep apnea is a condition that causes you to stop breathing while asleep, usually multiple times in a night.

Obstructive sleep apnea generally occurs when something like throat tissue blocks your airway. You can also develop central sleep apnea when certain health conditions affect the function in your central nervous system.

If you have sleep apnea, you might also:

• feel tired during the day
• wake often in the night or sleep restlessly
• wake up struggling to breathe
• have difficulty focusing during the day
• have headaches

Sleep apnea can have serious complications if it goes untreated, such as increased risk for respiratory and cardiovascular issues.

Women going through menopause who experience night sweats may also be at a greater risk for developing sleep apnea, according to a 2018 study.

It’s a good idea to see a doctor for night sweats that happen with other symptoms of sleep apnea.

Serious infections

Some serious infections can also cause night sweats, including:

• tuberculosis, a highly contagious infection that usually affects your lungs
• endocarditis, an infection in the valves of your heart
• osteomyelitis, an infection in your bones
• brucellosis, an infection you can get from animals with brucellosis or unpasteurized products from infected animals
• HIV
• fungal infections
• infectious mononucleosis (mono)
• other infections

But as with cancer, infections also tend to cause other noticeable symptoms. These include:

• chills and fever
• aching muscles and joints
• body pain
• general weakness or fatigue
• weight loss
• lack of appetite

Call a doctor if you have any of the symptoms above.

Neurological disorders

In rare cases, night sweats can occur as a symptom of certain neurological issues, including:

• stroke
• autonomic dysreflexia
• autonomic neuropathy
• syringomyelia

Neurological issues can involve many symptoms, but some might include:

• appetite loss or other GI or urinary symptoms
• losing consciousness
• feeling dizzy or lightheaded
• trembling
• muscular weakness
• numbness and tingling in your arms, hands, legs, and feet

Cancer

It’s possible for unexplained night sweats to be a symptom of cancer, but this doesn’t happen often. If you do have cancer, you’ll most likely have other noticeable symptoms, too.

These symptoms may seem to resemble other, less serious health issues, like the flu.

It’s a good idea to contact a doctor if you have night sweats and feel fatigued or generally unwell.

It’s particularly recommended to see a doctor if you have a fever that doesn’t go away and you’ve recently lost weight without trying, as these can be early signs of cancer.

Types of cancer often linked to night sweating include:

• Hodgkin’s lymphoma
• non-Hodgkin’s lymphoma
• leukemia

These cancers also involve the following symptoms:

• persistent fatigue and body weakness
• fever
• chills
• unintentional weight loss
• swollen lymph nodes
• chest and stomach pain
• bone pain

If you don’t have other symptoms that might indicate something more concerning, try these tips to relieve night sweats:

• Crack a window. Sleep in a cooler room. Leave windows cracked open at night, if possible, or try using a fan.
• Change your bedding. Replace plush or heavy blankets with breathable sheets, light quilts, or even moisture-wicking sheets. It can even help to remove extra bedding and sleep under lighter layers, so you may not need to buy new sheets or blankets.
• Adjust exercise timing. Physical activity just before sleeping could contribute to increased sweating in the night.
• Avoid sweat triggers. Avoid eating spicy foods, smoking cigarettes, or drinking alcohol right before going to bed.

If you only get night sweats occasionally and they don’t significantly affect your sleep quality, you probably don’t need to be too concerned. Still, you may want to mention them the next time you see your doctor.

But if you’re having trouble sleeping, regularly have night sweats, or have other symptoms that concern you, it’s best to check in with a healthcare professional.

Some potentially serious symptoms to watch for include:

• unexplained weight loss
• body aches and pains
• high fever and chills
• chronic or bloody cough
• diarrhea or stomach pain

A doctor can help you get to the bottom of your night sweats and, if needed, come up with a treatment plan.

Your doctor will use several different methods to determine the cause of frequent or disruptive night sweats. These may include:

• discussing your symptoms, health history, and medications
• going through your family history
• conducting a physical exam
• ordering laboratory or imaging tests to determine an underlying health condition

Your doctor may refer you to a specialist if they suspect an underlying health condition that requires specialized treatment.

There are many reasons you may sweat at night.

The first culprit to consider is your environment, including your clothing, bedding, and the temperature of your room. Next, examine your habits before bedtime.

If you adjust these factors and still wake up in sweat, there may be another cause. Speak with a doctor to diagnose and treat the cause so you can get back to more comfortable sleep.

Night sweats

Night sweats – the causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

According to statistics, more than a third of patients complain of periodic sweating that occurs during the day. Far from always, this condition is a sign of a disease, but if such a symptom occurs regularly for no apparent reason and at night, this should be paid attention to.

Types of episodes of sweating

When talking to a doctor about the occurrence of episodes of sweating at night, many people mean different manifestations by this. In some cases, it refers to perspiration on the forehead, and in others, so much sweat that you have to change clothes, and sometimes bed linen. In addition, the number of episodes of increased sweating, or hyperhidrosis, per night and the accompanying symptoms (snoring, holding your breath, fever, fear, insomnia, frequent urination) are important.

Possible causes

Increased heat production and sweating can be caused by various reasons, including those not related to the disease.

First of all, you should pay attention to the microclimate of the room and bedding.

Too warm blankets, synthetic clothes, elevated temperature in the bedroom will inevitably cause bouts of night sweats. If the above is excluded from the list of causes of excessive sweating, then other possible factors should be considered.

Excessive sweating can occur as a result of infectious diseases with alternating periods of increase and sharp decrease in temperature. A sharp decrease in temperature in viral infections (flu, SARS, mononucleosis), bacterial diseases (pneumonia, tuberculosis, endocarditis, lung abscess), septic fevers is always accompanied by profuse sweating. A number of tumors also give such a symptom as increased sweating. Pheochromocytoma (a tumor of the adrenal glands that secretes the catecholamines adrenaline and norepinephrine) causes hyperproduction of sweat due to increased production of hormones.

With lymphoma, along with the general signs of intoxication, night sweats can be profuse (profuse). Excessive sweating is accompanied by some endocrine diseases.

In women, increased heat production, leading to hyperhidrosis, occurs during hormonal changes: during pregnancy and perimenopause. Against the background of a decrease in the level of estrogens and an increase in the content of follicle-stimulating hormone, a change in the distribution of blood in the vessels of the skin occurs. This explains the sudden reddening of the skin and sweating during hot flashes. Men can also experience night sweats during andropause, an age-related decrease in the production of the sex hormone testosterone.

Increased sweating can be a symptom of thyrotoxicosis – a disorder of endocrine regulation due to dysfunction of the thyroid gland.

In this disease, there is an increased metabolism and an increase in body temperature, which causes hyperproduction of sweat. Nervousness and psychological instability, characteristic of patients with thyrotoxicosis, also contribute to the increase in sweating.

Hypoglycemia in diabetics leads to episodes of night sweats.

Acromegaly, in which the production of somatotropin growth hormone is increased, is almost always accompanied by increased sweat production in the evening and at night.

Be sure to mention obesity, which also increases sweating. This process can be associated not only with the activity of the endocrine glands, but also with the use of products that stimulate the sweat glands.

At night, sweat can come out with a sudden cessation of breathing – apnea. As a rule, in this case, perspiration appears mainly on the face. Episodes of transient cerebrovascular accident, hypertensive crisis, encephalitis, and volumetric brain tumors can lead to sweating disorders. All these diseases can be accompanied not only by increased sweating, but also by other signs of autonomic dysfunction: chills, fear, irritability. Sweat on the face often occurs with Parkinson’s disease. Panic attacks are among the neurological conditions associated with excessive night sweats. They are characterized by an unexpected and inexplicable attack of feeling unwell, accompanied by fear or anxiety. Panic attacks can occur either in certain uncomfortable situations, such as when riding the subway, or develop for no apparent reason (at night) and be accompanied by a feeling of fear, palpitations and sweating.

Increased sweating is often provoked by taking medications (cytostatics, aspirin, insulin, prozerin), alcohol, drugs, sometimes this phenomenon is observed during withdrawal reactions (occurring when psychoactive substances are stopped).

Diagnostics and examinations

First of all, you need to make sure that sweating does not serve as a reaction to elevated room temperature, excessively warm bedding and clothing. It is necessary to exclude the infectious nature of sweating, in particular, tuberculosis. At the same time, it is important to establish the patient’s belonging to risk groups for tuberculosis (migrants; persons released from prison; persons in whose families there is a patient with tuberculosis; frequently ill patients; HIV-infected; patients with diabetes mellitus people receiving corticosteroids and immunosuppressive therapy, as well as chemotherapy and radiation therapy for cancer). Long-term respiratory symptoms dictate the need for chest x-ray, clinical blood test, sputum examination for acid-resistant mycobacteria by microscopy (three times) and immunodiagnosis of tuberculosis infection.

In the absence of data confirming the infectious or endocrine nature of sweating, an examination for the presence of oncological diseases is necessary.

Which doctors should I contact?

First of all, you need to visit
a therapist who, after a survey and an initial examination, can give directions for tests and additional examinations. With hormonal disorders, further treatment is
endocrinologist. In the case of infectious diseases, either the therapist or the infectious disease specialist will continue the treatment. When tuberculosis is confirmed, the patient is sent to the anti-tuberculosis dispensary. In the presence of tumor diseases, they turn to an oncologist.

What should I do if I’m sweating?

If sweating is associated with a natural restructuring of the hormonal background, you need to take it calmly – experiences and nervous breakdowns will only exacerbate the problem.

Treatment

Increased sweating, if it is not caused by uncomfortable temperature conditions and a genetic predisposition, is only a symptom of a pathological condition.

Therefore, the main task is the treatment of the causative disease.

Sources:

1. Clinical guidelines “Tuberculosis in adults”. Developed by: Russian Society of Phthisiologists, Association of Phthisiologists. – 2022.
2. Clinical guidelines “Tuberculosis in children”. Developed by: Russian society of phthisiatricians. – 2020.
3. Clinical guidelines “Menopause and menopause in women.” Developed by: Russian Society of Obstetricians and Gynecologists. – 2021.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

What diseases can cause a headache?

Vostretsova Yulia Vladimirovna, an anesthesiologist-resuscitator, specialist in pain treatment of the department for the treatment of patients with chronic pain syndromes of City Clinical Hospital No. 52.

Secondary headache is a symptom of some underlying disease.
With secondary headaches, the main task is to treat the underlying disease, since if it is successful, this also has a positive effect on the symptom of headache – it either stops completely or at least greatly decreases.

Headache associated with neoplasms of the brain
Contrary to popular belief, headache is not a common symptom of a brain tumor. Only 30% of patients diagnosed with a tumor complain of headache at the initial appointment, and only 1-2% of patients have headache as the only symptom of the tumor.
Such pain is often accompanied by other neurological symptoms, aggravated by exercise or a change in body position, and is the cause of nocturnal awakenings. However, such symptoms can also occur with primary headaches, such as cluster headaches and migraines, which we discussed in a previous article.
Vomiting a week before the onset of a headache can be a sign of a posterior fossa mass, as can pain from coughing, lifting weights, or bending over. The appearance of discharge from the nipples or amenorrhea in itself should alert the doctor and the patient, and in combination with a headache should suggest such diseases as polycystic ovary syndrome or prolactin-secreting pituitary adenoma. In patients with an already confirmed oncological diagnosis, new onset headache requires the exclusion of brain metastases or carcinomatous meningitis.

Headache associated with vascular disease
Subarachnoid bleeding – “the most terrible pain imaginable”, a thunderous headache. Accompanied by stiff neck muscles at normal body temperature. Approximately 25% of all thunderclap headache cases are associated with subarachnoid bleeding. However, in 50% of patients with hemorrhages, the headache may be milder. The main features of headache associated with subarachnoid hemorrhage are localization in the occipital region, a piercing character, an ultra-rapid increase in pain intensity, and meningeal signs.
An isolated headache may be a symptom of a ruptured aneurysm, arteriovenous malformation, or intracerebral hemorrhage. Aneurysm of the posterior communicating artery can be manifested by double vision, lack or decrease in the reaction of the icon to light, loss of focus, divergent strabismus, anterior communicating artery – weakness of both lower extremities, middle cerebral artery – weakness in the extremities on one side. A sharp increase in intracranial pressure in the posterior cranial fossa can lead to limited eyeball mobility, strabismus, double vision, nystagmus, dizziness, and loss of balance. If the above symptoms are present and subarachnoid hemorrhage is suspected, CT without contrast and lumbar puncture is performed, if necessary, MR or CT angiography.

Arterial dissection
Headache occurs in most cases of dissections (dissections) of the carotid artery – it is one-sided and intense, often accompanied by pain in the face and neck on the same side, the occurrence of Horner’s syndrome (drooping of the eyelid, pupillary constriction, exophthalmos).

Stroke
With ischemic stroke, headache occurs only in 27% of cases. The diagnosis is made on the basis of clinical symptoms, which vary depending on the location of the stroke. It must be borne in mind that migraine with aura increases the risk of stroke.

Venous sinus thrombosis
This is a fairly rare pathology in which headache is present in 90% of cases. Other symptoms are altered consciousness and papilledema. Risk factors include female gender, pregnancy and the postpartum period, as well as the use of estrogen-containing hormonal contraceptives.

Reversible cerebral vasoconstriction syndrome
It is characterized by recurrent attacks of very high intensity headache with a sudden onset and a rapid peak (thunder headache). Angiography visualizes vasoconstriction (narrowing) of the cerebral arteries, which resolves over the next 3 months. The cause of this pathology is not fully understood, however, it is known that certain substances, such as marijuana, tacrolimus, cyclophosphamide, as well as some drugs from the group of antidepressants, can be triggers. The incidence is also higher in the postpartum period. Headache is usually bilateral with attacks lasting 1 to 3 hours recurring for several weeks. Approximately 40% of patients experience nausea, vomiting, and neurological deficits. This condition is transient and requires symptomatic treatment.

Arterial hypertension
It often develops with an increase in systolic pressure up to 180 mm Hg. or diastolic up to 120 mm Hg. Such a headache usually increases with increasing pressure and decreases with its decrease. The pain is usually bilateral or diffuse, may be throbbing, and worsen with physical activity.

Headache in heart disease
It is known that myocardial ischemia can also be accompanied by headache. A characteristic feature of such pain is its reduction against the background of resolution of ischemia (with the introduction of nitroglycerin, etc.).

Headache in systemic diseases

Giant cell arteritis
Headache, which first appeared in a patient after 50 years of age and is accompanied by a weakening of the temporal artery pulsation, should suggest giant cell arteritis.
This is a systemic vascular disease with a predominant lesion of extracranial arteries of medium and large caliber. The disease begins acutely or subacutely with general weakness, subfebrile temperature, night sweats, insomnia, nausea, loss of appetite, weight loss, muscle and joint pain. Headache is the most characteristic symptom of temporal arteritis. It is localized more often in the temporal region, sometimes in the frontal and parietal regions of the head, less often in the occipital region (in case of involvement of the occipital artery).
The spread of the process to the arteries of the face is accompanied by the appearance of acute spontaneous facial pains or a kind of “intermittent claudication” syndrome, that is, pain in the masticatory muscles and tongue when eating and talking. This symptom is pathognomonic for temporal arteritis. Many patients experience visual impairment that can lead to complete blindness. The cause of blindness is either ischemic damage to the optic nerve with damage to the ophthalmic and posterior ciliary arteries, or blockage of the central retinal artery. Laboratory revealed an increase in CRP and ESR. This diagnosis can be accurately confirmed only after a biopsy of the temporal muscle.

Tholos-Hunt syndrome
The syndrome is characterized by intense unilateral headache, accompanied by a violation of the movement of the eyeball, attacks occur every few months or even years. Most often, people over 40 years of age are affected. The pathogenesis is associated with nonspecific inflammation in the cavernous sinus of the superior palpebral fissure or orbital cavity. Violation or complete absence of movement of the eyeball occurs as a result of granulomatous inflammation of the cranial nerves. The main clinical manifestations are acute unilateral pain in the eye area, the appearance of double vision.

Headache associated with infection
It does not make sense to dwell on this point in detail, since so many infectious diseases can be accompanied by a headache. With a headache of very high intensity, accompanied by stiff neck and other meningeal symptoms, it is important to perform the necessary examinations in time and start treatment.

Post-traumatic headache
Headache occurs in 70-90% of head injuries. It can be considered post-traumatic if it occurs within 7 days after the injury or 7 days after the recovery of consciousness and the withdrawal of painkillers. The pain phenotype can be variable, often migraine or tension-type headache, and may be accompanied by nausea, dizziness, cognitive impairment, anxiety, and insomnia.

Pain after craniotomy
Such pain also occurs within 7 days after surgery and usually regresses within the next 3 months. In some cases, the headache may become chronic. As risk factors for chronicity, the patient has a history of primary headaches, as well as surgical interventions in the suboccipital region.

Headache associated with diseases of the eyes, nose, ear, sinuses and other craniofacial structures

Acute angle-closure glaucoma
Angle-closure glaucoma is a form of pathology in which fluid accumulates inside the eye due to lack of access to the drainage system (the iris closes the angle of the anterior chamber). The result is an increase in intraocular pressure, which can lead to an acute pain attack. An attack of angle-closure glaucoma can be similar to migraine, as it is a unilateral pain in the eye area, accompanied by nausea/vomiting, photophobia, visual disturbances in the form of blurred visual images and iridescent halos around the light spot. On examination during an attack, redness of the conjunctiva and a moderately dilated pupil are noted. Between attacks, the appearance of the eyeball and intraocular pressure are usually normal. Seizure triggers are often: a sudden change in lighting, prolonged reading, as well as certain drugs, such as tricyclic antidepressants, topiramate, acetazolamide, etc. An ophthalmologist will help establish the diagnosis.

Trochleite
Trochleitis is an inflammation of the oblique muscle of the eye. The pain most often occurs in the inner corner or above the eyeball and can spread to the entire half of the head. The pain increases with eye movement, the paraorbital region is painful on palpation. Lachrymation and discharge from the nose are usually absent. Some patients may experience diplopia. The cause of trochleitis is often unknown (idiopathic trochleitis), but most commonly occurs in patients with rheumatic diseases such as systemic lupus erythematosus, rheumatoid arthritis, enteropathic arthropathy, and psoriasis.

Rhinosinusitis
The symptoms of rhinosinusitis are familiar to many. Rhinosinusitis can be both an independent cause of headache, and it can exacerbate the primary headache. The diagnosis is made on the basis of X-ray diagnostics by an ENT doctor. Usually this pain is preceded by an infectious disease with rhinorrhea and nasal congestion.

Headache associated with pathology of the temporomandibular joint
The causes of joint dysfunction can be trauma, joint asymmetry, disc displacement, joint hypermobility, osteoarthritis. The headache associated with this pathology usually corresponds to the side of the affected joint, but may be bilateral if the muscles are involved in the pathological process.