Headaches: When to Worry and When to Watch

Red flags and urgency levels

• EmergencyCall 911 or go to an emergency department now

  Sudden, severe headache that peaks within seconds to minutes ('thunderclap').

• EmergencyCall 911 or go to an emergency department now

  Headache with weakness, numbness, trouble speaking, vision loss, seizure, or confusion.

• UrgentSeek care today

  Headache with fever and a stiff neck, or a new headache after a head injury.

• SoonMake an appointment within days to a couple of weeks

  A new headache pattern after age 50, headaches that wake you from sleep, or headaches steadily worsening over weeks.

• MonitorKeep track and mention it at your next visit

  Familiar tension or migraine headaches responding to your usual approach.

• Tension-type headache is the most common pattern; migraine is another common recurring primary pattern.
• Frequent use of pain medicines can lead to medicine-overuse (“rebound”) headaches.
• Sleep problems, dehydration, stress, caffeine (or caffeine withdrawal), skipped meals, and alcohol are common modifiable triggers.
• Most headaches are primary (not caused by another disease) and are not emergencies, but some patterns need prompt care.
• A sudden severe headache is among the warning signs of stroke and needs immediate emergency evaluation when it occurs with other stroke signs.
• Fever with headache and a stiff neck is a meningitis cluster that needs urgent evaluation.
• A headache diary can help you and your clinician spot patterns — timing, intensity, sleep, stress, foods or drinks, and medicines.

1. 1

   Keep a diary: date and time, duration, severity, sensitivity to light, sound, or smell, activity before onset, sleep, stress, foods and drinks in the prior 24 hours, medicines taken, and whether they helped.

2. 2

   Count how many days per month you take any pain reliever for headache, and talk with a clinician if you use pain medicine three or more days a week on a regular basis.

3. 3

   Stabilize the basics: regular sleep, regular meals, steady caffeine, and hydration.

4. 4

   Bring your diary and monthly pain-medicine day count to your visit.

5. 5

   Note any new neurological symptoms even if brief; seek emergency care for sudden numbness or weakness, trouble speaking, vision loss, confusion, or a sudden severe headache.

6. 6

   Escalate to emergency or urgent care for a sudden explosive or “worst” headache, fever with a stiff neck, or a new headache after a head injury.

7. 7

   Schedule a visit if headaches wake you from sleep, your pattern or intensity changes, headaches worsen over days to weeks, or treatments that once worked no longer help.

8. 8

   If you get two or more headaches a week, arrange a non-urgent clinician visit rather than escalating over-the-counter medicine alone.

• “What type of headache do my symptoms fit best?”
• “Do I need imaging, and if not, what would change that?”
• “Is my current pain reliever use putting me at risk of rebound headaches?”
• “Would preventive treatment be reasonable for how often I get these?”
• “Which symptoms should send me to the emergency department?”

• NINDS Headache: Hope Through ResearchNational Institute of Neurological Disorders and Stroke (NIH)
• Stroke Signs and SymptomsCenters for Disease Control and Prevention
• MedlinePlus Migraine (topic)MedlinePlus (NIH)
• MedlinePlus Headache (topic)MedlinePlus (NIH)
• MedlinePlus Headache (encyclopedia)MedlinePlus (NIH)
• MedlinePlus Migraine (encyclopedia)MedlinePlus (NIH)
• MedlinePlus Headache — when to call the doctorMedlinePlus (NIH)
• NINDS MigraineNational Institute of Neurological Disorders and Stroke (NIH)
• About MeningitisCenters for Disease Control and Prevention

• High blood pressure
• Sleep problems
• Persistent fatigue