Which symptom may suggest an intracranial hemorrhage during a headache assessment?

The statement "It's the most painful headache I've ever had" is a significant indicator during a headache assessment that suggests the possibility of an intracranial hemorrhage, particularly concerning conditions like a subarachnoid hemorrhage. This type of headache is often described as a "thunderclap" headache and can signify a potentially life-threatening situation requiring immediate medical attention.

When a patient reports such severe intensity or a sudden change in their headache pattern, it raises red flags for possible serious underlying causes, such as bleeding within the cranial cavity. This type of headache is often unexpected and markedly different from the person's usual headache experience, prompting the need for urgent evaluation to rule out serious conditions like hemorrhagic strokes.

In contrast, while dizziness, feeling that a headache is "different," or it lasting longer than usual might be concerning, they do not specifically indicate an intracranial hemorrhage with the same urgency or specificity as the report of an exceptionally painful headache.