PITTSBURGH (KDKA) — When is it just a headache and when is it something serious?

Certain types of headaches, you don’t want to ignore.

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A headache with fever and stiff neck could be meningitis, an infection around the brain.

“When I would get up, it would almost feel like my neck couldn’t support my head,” Elisa Cavalier, of Sewickley, said.

“Then it got to the point where I didn’t even feel I could walk down the stairs. I had a temperature that was 102-103.

“By that point and time, my entire body hurt.”

Cavalier went to the hospital where a spinal tap showed the life-threatening infection.

“I was in the hospital for many days, apparently coded,” she said. “Basically, they didn’t think I was going to make it.”

She was treated with powerful antibiotics. That was 20 years ago. She’s essentially doing just fine today.

“Your neurologic symptoms mirror the degree of the infection,” Dr. James Valeriano at Allegheny General Hospital explained. “It gets harder to treat and your chances of having long term neurologic injury get worse and worse.”

A headache with nausea could be harmless.

“The most common reason people have headache with nausea is migraine,” Dr. Valeriano said.

But if it’s new for you to have nausea with a headache, or if you also have confusion, slurred speech or weakness, you need to get emergency help.

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It could be bleeding or a stroke. Or if the headache lasts longer than usual, that’s concerning.

“If you have a headache for a couple weeks and that would be an unusual thing, then you start thinking about things like can this be a brain tumor,” Dr. Valeriano said.

The worst headache of your life could be a ruptured aneurysm.

“That will be a very abrupt onset of a headache and people classically will describe it as the worst headache of their life,” Dr. Valeriano added.

The bleeding that results, called a subarachnoid hemorrhage, is very worrisome.

“The death rate from a subarachnoid hemorrhage, just from the bleeding, is probably about 45 percent,” he said.

This happened to Judy Painter, of Wexford, but she was distracted by planning a dinner party.

“I thought it was a stress headache, because I had this piercing headache as I was driving up 279,” she recalled.

At first she refused to go to the hospital. It was just a headache, she thought. But friends and family convinced her it was an emergency.

The results of a spinal tap and other testing showed it truly was.

“I got scared when they said, ‘I think you should call your daughter,’” Painter said. “It did show that there was an aneurysm, there was a bleed and I was operated on that night.”

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Dr. Maria Simbra