Emergency Room for Headaches: When Should You Go?
A headache can be more than a temporary painful episode. Sometimes, it can be a symptom of a serious medical issue. While most headaches resolve on their own, certain symptoms are red flags that demand immediate attention. Understanding when to go to the ER for a headache can be the difference between a fast recovery and a lasting complication.
When to Get Emergency Care for a Headache
Navigating the pain and associated symptoms can be confusing, especially if you suffer from chronic conditions like migraines. The key is to pay attention to what is different or unusual about your headache. If the pain or accompanying symptoms are unlike anything you’ve experienced, it’s best to seek a professional medical opinion without delay.
Symptoms Are Worse Than Usual
If you find yourself thinking, “This is the worst headache of my life,” you should take action. A significant change in the intensity or character of your headache pain is a critical warning sign. This isn’t just a bad headache; it’s a level of pain that feels fundamentally different and more severe than anything you’ve had before.
An unusually severe headache may indicate:
- A brain aneurysm
- A stroke
- Meningitis or encephalitis
- A brain tumor
Pain Has Lasted More Than 3 Days
For those who experience migraines, an attack that lasts longer than 72 hours despite treatment is known as status migrainosus. This is considered a dangerous stage of a migraine and is a sign you need medical help. When a migraine or any headache persists for several days, it can lead to other health complications beyond the pain itself.
Prolonged headache pain may indicate:
- Dehydration and electrolyte imbalance from nausea or vomiting.
- An increased risk of stroke.
- An underlying issue that is causing the intractable headache.
Experiencing Dizziness, Vision Problems or Slurred Speech
One of the clearest signs that a headache is an emergency is the presence of neurological symptoms. Don’t try to wait out a headache that is accompanied by symptoms such as dizziness, vertigo, blurred or double vision, or difficulty speaking clearly. You should have someone take you to the emergency room immediately or call 911.
These symptoms can indicate a potential brain-related crisis. For example, weakness or numbness on one side of the body, combined with a headache, is a classic sign of a stroke. Confusion, personality changes or difficulty walking are also serious indicators that your headache may be part of a larger medical issue that requires immediate evaluation by a healthcare professional.
Recently Had a Head Injury
A headache that develops after a car accident, fall, sports injury or any type of head trauma should never be ignored. Even a seemingly minor bump can cause bleeding or swelling in or around the brain. A post-traumatic headache could appear immediately after the incident or develop hours or even days later.
The onset of a headache after an injury warrants a trip to the emergency room to rule out a concussion or a more severe traumatic brain injury (TBI). The medical team will assess your condition and determine the appropriate course of action to help prevent further complications. This is an instance where knowing when a headache is an emergency can protect your long-term health.
Symptoms Come Faster Than Normal
The speed at which a headache develops can point to its potential cause. A “thunderclap headache” is a severe headache that strikes suddenly, reaching its maximum intensity in under a minute. This type of headache can be life-threatening and is a medical emergency that requires immediate evaluation.
A thunderclap headache could be related to:
- Bleeding in the brain
- A stroke
- A tear in an artery’s lining
When to Wait for a Doctor’s Visit Instead
Not every severe headache requires a trip to the ER. If you have a history of migraines and are experiencing a painful but typical episode without the red-flag symptoms described above, it may be more appropriate to contact your primary care provider or neurologist.
They can help you manage your ongoing migraines with treatment as part of your overall healthcare plan. Your provider can adjust your medication, suggest lifestyle changes or explore other therapies to reduce the frequency and severity of your attacks.
An urgent care center may be a good middle ground if your migraine is unresponsive to your usual medication but you aren’t experiencing emergency symptoms like slurred speech or one-sided weakness. Knowing when to go to urgent care can save time and cost; however, if you’re ever in doubt, heading to the emergency room is the safest choice.
Tests for Diagnosing Your Headache
When you arrive at the emergency room, the first step is to determine the cause of your headache, especially to rule out life-threatening conditions. The healthcare provider will perform a physical and neurological exam, checking your vision, balance, reflexes and mental alertness. They’ll also ask detailed questions about your symptoms and medical history.
To get a clear picture of what’s happening inside your brain, they may order one or more of the following tests:
- CT (computed tomography) scan
- MRI (magnetic resonance imaging)
- Lumbar puncture (spinal tap)
Treatments for a Migraine in the Emergency Room
What can the ER do for a migraine? Once life-threatening conditions have been ruled out, the focus of emergency room treatment shifts to relieving your pain and managing other debilitating symptoms like nausea. The goal is to break the cycle of the migraine attack and provide comfort as quickly as possible.
The treatment you receive may include a combination of medications and fluids—often administered through an IV for faster relief. This combination—often called a “migraine cocktail” in the ER—is often effective at stopping severe migraine attacks.
- Intravenous fluids
- Pain relievers
- Triptans (constrict blood vessels and block pain pathways)
- Anti-nausea medications
- Dexamethasone (helps prevent short-term recurrence)
You can use our online provider directory to find a Baptist Health provider if you don’t have one.
Next Steps and Helpful Resources
Learn More About ER and Urgent Care at Baptist Health
Find an ER & Urgent Care Location
Tips to Head Off Migraine Pain
Why Are Migraines More Common in Females?
