Heart tests may be ordered if the headache is exercise-induced, which may suggest heart disease. Besides heart disease, if the headache is exercise-induced, or temporal arteritis, suffered by Ross' patient, there are many other possibilities. Some headaches are induced by medication for high blood pressure, Parkinson's disease, chronic obstructive lung disease, and other conditions that are more common with age. Hormone replacement therapy can be associated with midlife headache, too, Saper says. But because HRT provides other benefits such as a reduction in heart disease risk, Saper does not generally recommend that women discontinue the treatment.
Headaches also can be a symptom of certain types of strokes.
Subdural hematomas, or bleeding in the brain, are another possibility. Another patient of Ross got up in the middle of the night to use the bathroom, fell and struck her head, but went back to sleep, since she was not in great pain. Three days later, she sought help for a severe headache. Hypnic headache is another, more remote possibility. These headaches are marked by painful attacks that occur at night, waking the person.