When should I go to the emergency room (ER) for a headache?

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Baptist Health South Florida
Administration Specialist

You should go to the emergency room (ER) or call 911 for a headache if the headache doesn’t seem routine at all and comes on suddenly and overwhelmingly. If you experience some or all of the following symptoms you should undergo immediate and careful evaluation by a physician.

  • new severe, worsening or persistent headache
  • sudden onset of very severe headache over a few minutes
  • confusion
  • headaches that are occurring more and more frequently
  • headache that worsens with changes in head position (sitting up or lying down)
  • headache that wakes you up from sleep
  • headache associated with nausea and vomiting upon awakening
  • headache worsened by bearing down, coughing, sneezing, or with sexual activity
  • headache with blurred or double vision
  • headache associated with other symptoms in the body, such as weakness, numbness, changes in how the person speaks, or other body pains

This is somewhat of a complicated question but there are some "red flags," which can point to a dangerous headache, one that should be seen in the ER. A useful mnemonic to remember about red flags is SNOOP—first mentioned in an article by Dr David Dodick of the Mayo Clinic.

  • Systemic - if you have other signs with your headache, like fevers, chills, weight loss, these should be checked out emergently. Headaches that also come with neck rigidity or vomiting can point to an infection in addition to other possible causes that should be seen quickly.
  • Neurologic - if you have other neurologic signs, like a facial droop, weakness or numbness in one arm or leg, trouble speaking or changes in vision, in addition to others
  • Older age - if this is your first headache and you are over 50, this should be checked out
  • Onset - if a headache comes on suddenly or very severely, it should be seen quickly 
  • Pattern - if there is a change in the pattern of headaches, like going from every few weeks to constant, that is a red flag

Other useful red flags are headaches that are not being controlled with your usual treatments, in people who have a previous hx of headaches, like migraines; or headaches that change with laying down or sitting up.

Intermountain Healthcare
Administration Specialist

Call 911 or go to the hospital emergency room if:

  • You have a headache that comes on suddenly and is very bad
  • You have a headache that is your "worst ever"
  • You have a headache with slurred speech, change in eyesight, problems moving your arms or legs, dizziness, confusion, or memory loss
  • You have a headache that gets worse and worse over 24 hours
  • You have a headache along with a fever, stiff neck, nausea, and throwing up
  • Your headache is from a head injury
  • You have a very bad headache around one eye, with redness in that eye
  • You are over age 50 and your headaches have begun recently—especially if you have trouble seeing or have pain while chewing
RealAge
Administration Specialist

You may have a headache emergency if you are experiencing the following:

  • severe headache with sudden onset
  • headache pain that feels like an explosion or thunderclap
  • severe headache that is clearly your worst-ever headache
  • headache pain that is becoming worse and won't go away
  • persistent headache after an injury to the head
  • headache accompanied by any of these symptoms: a stiff neck, severe pain when bending over, confusion, convulsions, loss of consciousness, or persistent, severe vomiting

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Medical City Dallas
Administration Specialist

You should go to the ER when you have a headache that you would describe as the worst headache of your life. In this video, Michelle Underwood, BSN, RN, CEN, MBA, at Medical City Dallas Hospital details which symptoms indicate an emergency concern.

You should go to the emergency room (ER) for a headache if you are having the worst headache of your life or if it is sudden like a “thunderclap". This could be a subarachnoid hemorrhage arising from a ruptured cerebral aneurysm. This can quickly lead to severe disability and death if not discovered. There are other headaches that can be very serious too, especially if there is fever or a neurological deficit.

Elissa Noyes
Emergency Medicine Specialist

Most headaches are not serious, however, a severe headache can signal something life threatening such as a stroke, aneurysm, or meningitis, which should be treated immediately in the emergency room (ER). If your headache includes any of the following symptoms, go to the ER:

  • stiff neck with fever (could be a sign of meningitis)
  • nausea combined with any difficulty walking, talking or speaking (early signs of a stroke)
  • experiencing what feels like the worst headache of your life (many patients feel this when an aneurysm is leaking)

These three illnesses are considered the most dangerous and require immediate medical attention.

There are many different types and causes of headaches. Some are caused by stress or a lack of nutrition. Others are migraines or life-threatening conditions. Some headaches get better with over-the-counter medications, dim lighting and a quiet space.

If those treatments do not work and your pain worsens or lasts longer than usual, you should go to the emergency room visit for pain relief and testing. Some headaches require an immediate visit to the ER.

Go to the ER right away if you have:

  • the worst headache of your life
  • headache with numbness or tingling
  • headache with high uncontrolled blood pressure

If you are experiencing any of these symptoms you may need immediate treatment. If you are concerned about any type of headache, the emergency room is always available.

You should go to the emergency room if you are experiencing what feels like the worst headache of your life or if your headache is different from your usual headaches. Other alarming signs are headaches associated with a stiff neck, weakness or changes in vision, speech or behavior. If any of these present, an emergency room evaluation is indicated. Headache after a trauma should also be evaluated in the emergency room.

Dr. David M. Dodd, MD
Emergency Medicine Specialist

Red flag headache symptoms include fever, stiffness and an out-of-the-blue very intense pain, says Michael Dodd, MD, from Frankfort Regional Medical Center. Learn what other kinds of headaches should send you to the ER in this video.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.