Brain Haemorrhage: Warning Signs, Causes and What to Do Immediately

A brain haemorrhage is an emergency in which time is decisive. And contrary to what many people assume, it does not always begin with a loss of consciousness — sometimes it begins with nothing but a sudden, severe headache. That is exactly why people wait at home when they should be in an emergency department.

This article explains the warning signs of a brain haemorrhage, how it differs from a clot, and precisely what to do if you suspect one.

What is a brain haemorrhage?

A brain haemorrhage happens when a blood vessel inside the skull ruptures and blood leaks out. The leaked blood presses on brain tissue and reduces the oxygen reaching brain cells, causing damage that grows with every hour that passes without treatment.

A haemorrhage is one form of stroke — less common than the type caused by a clot, but requiring completely different management. There is no way to tell which type it is from symptoms alone; brain imaging is what distinguishes them.

Types of haemorrhage — briefly

• Intracerebral haemorrhage: bleeding within the brain tissue itself. The commonest cause is long-standing high blood pressure.
• Subarachnoid haemorrhage: between the brain and its surrounding membranes, often from an aneurysm in an artery. Its classic sign is a sudden, extremely severe headache.
• Subdural haemorrhage: collects between the membranes and is frequently linked to a head injury — sometimes appearing days or weeks after the injury, particularly in older people.
• Extradural haemorrhage: usually follows a direct head injury and can develop rapidly.

Warning signs

Symptoms vary with the location and size of the bleed, but the most important are:

• A sudden, extremely severe headache — patients sometimes describe it as "the worst headache of my life", reaching its peak within seconds.
• Repeated vomiting alongside the headache.
• Sudden weakness or numbness on one side of the body.
• Slurred speech or difficulty understanding others.
• Seizures, or partial or complete loss of consciousness.
• A stiff neck with sensitivity to light.
• Double vision, or one pupil becoming enlarged.
• Unusual heavy drowsiness or difficulty waking.

Causes and risk factors

• Poorly controlled high blood pressure — the most common cause of bleeding within brain tissue.
• Aneurysms or arteriovenous malformations.
• Head injuries — including those that appear minor, especially in older people.
• Blood-thinning and anticoagulant medication — these raise the risk of bleeding and must be taken under medical supervision with regular monitoring.
• Clotting disorders and advanced liver disease.
• Smoking and excessive alcohol.
• Brain tumours, in less common cases.

What to do immediately

Do:

• Call an ambulance or go to the nearest emergency department at once.
• Note the exact time symptoms began.
• Tell the medical team if the person takes blood thinners or anticoagulants — this is critical information.
• If there was a head injury, describe it, even if it was several days ago.
• Keep the person calm and stable; if unconscious but breathing, lay them on their side.

Do not:

• Give any medication on your own initiative — particularly painkillers, as some can increase bleeding.
• Give food or drink.
• Wait "until the headache settles".
• Move the person forcefully if a neck or spinal injury is suspected.

Diagnosis

Assessment begins with a rapid neurological examination and evaluation of consciousness, followed by:

• A CT scan of the brain — the first and most important step, identifying quickly whether there is a bleed and its location and size.
• Vascular imaging if an aneurysm or arterial malformation is suspected.
• Clotting, liver and kidney function tests, particularly if the patient takes blood thinners.

At Town Hospital, the emergency department, imaging and laboratory operate 24 hours a day, shortening the interval between arrival and diagnosis — the factor that matters most in this condition.

Treatment

The treatment plan depends on the type, location and size of the bleed and the patient's neurological state. Broadly it includes:

• Stabilising the patient — controlling blood pressure and breathing, with close monitoring of consciousness.
• Reducing pressure inside the skull where needed.
• Reversing the effect of blood-thinning medication if the patient was taking it, as assessed by the medical team.
• Surgery in some cases — to drain a collection of blood or to treat an aneurysm — decided according to the individual case.

Not every haemorrhage requires surgery, and some cases are monitored carefully in hospital instead. The medical team decides after imaging and full assessment.

Recovery and rehabilitation

Once the patient is stable, rehabilitation begins and may include physiotherapy, speech and swallowing therapy, and occupational therapy, depending on the area affected. Outcomes vary considerably by case according to the location and size of the bleed and how quickly treatment began; the medical team explains what can realistically be expected in each individual case.

Prevention

• Monitor blood pressure regularly and stick to treatment — by far the most important preventive step.
• Attend regular follow-up if you take blood thinners, and have the tests your doctor requests on schedule.
• Never adjust or stop any medication on your own.
• Protect your head — seat belts, helmets, and reducing fall risks for older people.
• Stop smoking and reduce alcohol.
• Have any recurrent headache, or headache that changes in pattern, medically assessed.

Frequently Asked Questions

What is the difference between a brain haemorrhage and a clot?

A clot means an artery is blocked and blood cannot get through; a haemorrhage means blood is leaking from a ruptured vessel. Both are strokes and their symptoms overlap, but treatment differs completely — which is why brain imaging is essential before any treatment decision.

Does a severe headache always mean a haemorrhage?

No, and most headaches are not haemorrhages. But a headache that arrives suddenly, peaks within seconds and is unusually severe warrants emergency assessment rather than waiting.

Can a haemorrhage happen after a minor knock to the head?

It can, particularly in older people or those taking blood thinners. Symptoms sometimes appear days or weeks after the injury, so any change in consciousness or behaviour, or a worsening headache after a head injury, calls for immediate assessment.

Does every brain haemorrhage need surgery?

No. The decision depends on the location and size of the bleed and the patient's condition. Some cases are monitored closely in hospital; others need surgical intervention — the medical team determines this after imaging.

I take blood thinners — what should I do?

Keep to the follow-up and tests your doctor has arranged, and do not change the dose yourself. If you sustain any head injury or develop an unusual headache, tell the medical team immediately that you take blood thinners — that information changes how you are managed.

Can a haemorrhage happen again?

It can, particularly if the underlying cause — such as high blood pressure or an aneurysm — has not been addressed. Regular follow-up after recovery is an essential part of reducing that likelihood.

Neurosurgery consultation

If you need a specialist opinion after a brain haemorrhage, or an assessment of an aneurysm or a concerning recurrent headache, you can book with Dr Ahmed El Ghannam, Neurosurgery Consultant at Town Hospital, or with the neurosurgery team. For emergencies, Town Hospital's emergency department is open 24 hours — Fifth Settlement, New Cairo. Hotline 15276.

This article is for general awareness and does not replace medical advice. If you suspect a brain haemorrhage, go to the emergency department immediately.