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

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.

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.

When it comes to headaches, you should go to the emergency room (ER) for what doctors consider red flag symptoms. For example:

  • If you've never really had headaches and it comes on out the blue suddenly, feeling like the worst headache of your life, that is very worrisome and should send you to the ER.
  • If you have a headache accompanied by fever, neck pain, or stiffness, the worry is that you may have meningitis, which is definitely a reason to come to the ER.
  • If you've been having nagging headaches for weeks or months, accompanied by vision changes, dizziness or weakness, that would be worrisome, too.
  • A traumatic headache would obviously be something you should go to the ER for. For example, if you've fallen or been in a car accident and hit your head, you should go to the ER.

But if you have a mild headache and a history of headaches, you might respond to something like Tylenol or ibuprofen. You should at least give those medicines a shot before you come to the ER for something like that.

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

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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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.

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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.