Essentially everyone gets headaches from time to time.  These can range from mild annoyances to incapacitating pain, nausea, and vomiting.  The vast majority of headaches are benign and do not require immediate evaluation.  However, sometimes headaches are a symptom of something more serious that requires immediate evaluation and treatment.  Below we will discuss some general guidelines about deciding if a headache is an emergency.

When Is a Headache an Emergency?

It’s natural to worry that our headaches represent a tumor, or maybe a stroke.  Fortunately, the vast majority of headaches are benign.  But, certain characteristics of a headache suggest something of more concern:

  1. Sudden and Severe Onset: A sudden and extremely severe headache, that is maximal in intensity at onset, is always concerning. These are often referred to as “thunderclap headaches,” to describe how suddenly and forcefully they develop.  One minute you are fine, the next you are incapacitated due to the pain.  Benign headaches almost never start suddenly and tend to gradually increase in intensity rather than being most painful at onset.  Thunderclap headaches should always be evaluated by a medical professional as they may be indicative of a condition such as a hemorrhagic stroke.
  2. Neurological Symptoms: When any headache is accompanied by unusual neurological symptoms such as confusion, slurred speech, weakness, change in vision, or loss of consciousness, it should be evaluated immediately. These symptoms could suggest a more serious issue like a stroke.
  3. Worst Headache of Your Life: If you consider your headache as the “worst headache of your life,” it could be a red flag. This terminology is often used by medical professionals to identify headaches that require immediate evaluation.
  4. Headache after Head Injury: If you experience any significant headache following a head injury or trauma, seek medical attention promptly. It could be a sign of a concussion, bleeding around your brain, or other traumatic brain injury.  This is particularly true if you are taking any blood thinner medications or if you are older than 65.
  5. Headaches With Fever: Severe headaches associated with a fever (temperature greater than 100.4) may indicate an underlying infection or other medical condition that requires immediate attention and should prompt an evaluation.  This is particularly true if you also experience stiffness or pain in your neck or increased pain with head movement.
  6. New Onset or Changes in headaches: If you haven’t previously experienced headaches and new headaches develop, or if you have an established headache pattern and a new type of headache develops, or if your usual headaches change in any significant way, this is a cause for concern and should prompt evaluation.

What to Do if You Suspect an Emergency

If you or someone you know experiences a headache that fits any of the above criteria or any other symptoms of concern, it’s crucial to act quickly:

  1. Call 911: If you suspect your headache is an emergency, consider calling 911.  The dispatcher or the ambulance crew can help guide you to the right destination for the best care for your condition.
  2. Do Not Drive: A person experiencing a headache that requires emergent evaluation, should not attempt to drive to the hospital. Ask for someone to give you a ride or call for an ambulance.
  3. Do not take any medications not prescribed specifically for this type of headache.  Many pain medications like aspirin, Advil (ibuprofen), or Aleve can increase bleeding if that is the cause of your headache.  It’s better to have your symptoms evaluated by a doctor before taking any medication for a concerning headache.


Headaches can be unpleasant and disruptive, but most of the time, they are not emergencies. However, it’s essential to recognize the signs that indicate a headache could be a symptom of a more serious underlying condition. 

If you or someone you know experiences a headache that is out of the ordinary and accompanied by severe symptoms, do not hesitate to seek medical attention.

CapRock Health offers 24/7 emergency care in Bryan, Texas as well as College Station, Texas. Give us a call if you or a loved one is suffering from a migraine that may need immediate medical intervention.