Headache: When to Worry and When to Go to the ER

Headache is one of the most common symptoms there is, which is exactly why it's so confusing: how do you know if this one is different? Maybe you took a painkiller two hours ago and it hasn't touched it, or you woke with pain pressing behind your eyes, or you read something online that frightened you. The reassuring truth is that the vast majority of headaches aren't dangerous. The important truth is that there's a specific pattern of warning signs that means acting now — and that's what you need to know.

Common headaches that usually aren't dangerous

The NHS and NICE divide headaches into primary — where the headache is the problem itself — and secondary, where it's a symptom of something else. Most of what we get is primary:

Medication-overuse headache deserves a pause because it's common and rarely recognised: taking simple painkillers on 15 or more days a month, or triptans, opioids or combination painkillers on 10 or more days, for more than three months can mean the medicine itself is what keeps the headache going. Don't stop abruptly on your own — ask your doctor for a plan.

When to call 911: the red flags

• Thunderclap headache: sudden and explosive, peaking within seconds to minutes, "the worst of your life". It can mean bleeding around the brain, even if it starts to ease afterwards.
• With fever and a stiff neck, or a rash that doesn't fade when you press a glass against it, or severe sensitivity to light — possible signs of meningitis.
• After a head injury, especially with repeated vomiting, drowsiness, confusion, or a headache that keeps getting worse.
• With neurological signs: weakness or numbness on one side, a drooping face, slurred or difficult speech, loss of vision or double vision, loss of balance, a seizure, or confusion.
• Several people at home with headaches, dizziness or nausea — especially with a heater or boiler running.

Sudden weakness, a drooping face or slurred speech with a headache can mean a stroke, and every minute counts. Learn the signs in our guide to stroke symptoms and the FAST test. If it's a child who hit their head, see when to go to the ER after a child's head injury.

Winter headaches and heaters: carbon monoxide

As Amman gets cold, gas and kerosene heaters come back into homes, and with them a risk you can't see or smell: carbon monoxide. Headache is its most common symptom, often with dizziness, nausea and tiredness. Clues that should make you suspect it: more than one person at home feels the same, symptoms ease when you go out and return when you come back, and the room has been closed up with the heater on for hours. Turn the heater off, open the windows, get everyone into fresh air and call 911. More in our guide to carbon monoxide poisoning symptoms from heaters.

When to get seen promptly (the same day)

These don't necessarily mean 911, but they do mean not waiting days:

• A new headache over 50: especially with scalp tenderness when brushing your hair, jaw pain when chewing, or vision problems — this can point to giant cell (temporal) arteritis, which threatens sight and needs prompt treatment.
• Pregnancy: a severe headache, especially in the second half of pregnancy or after birth, with vision problems or sudden swelling of the face or hands — this can be pre-eclampsia. Contact your maternity team or go to the ER straight away.
• A headache that wakes you from sleep with vomiting, or is clearly worse when you cough, sneeze, bend over or lie down.
• A headache getting worse day by day over days or weeks, or a clear change in your usual headache pattern.
• Sudden eye pain with a red eye and halos around lights or blurred vision — this can be a sudden rise in eye pressure.
• Weakened immunity or a history of cancer with a new headache.

Headaches in children

Headaches are common in children too, often linked to a fever or cold, hunger, poor sleep, or thirst after a long school day. The same red flags apply, plus: a child who seems very unwell or unusually drowsy, a headache with fever and a stiff neck or rash, a headache after a knock to the head, or one that wakes them at night with vomiting. Any change in walking, balance, vision or behaviour deserves a same-day check.

Can high blood pressure cause headaches?

In many Jordanian homes, the first thing anyone says about a headache is “check your blood pressure”. In reality, high blood pressure usually causes no symptoms at all — that's why it's called the silent killer — and an ordinary headache is rarely caused by it. The exception is a very high, sudden rise, which can come with a severe headache plus chest pain, shortness of breath, blurred vision or confusion; that's an emergency and a reason to call 911. If you measure your pressure during a headache and it's slightly raised, the pain and worry themselves can push it up. Recheck once you've rested, and see your doctor if it stays high.

What a doctor will ask about your headache

Most of a headache diagnosis comes from the story, not from tests. Think about these questions before you arrive, or jot them down for whoever is with you:

• How did it start — suddenly within seconds, or gradually over hours?
• Is it like your usual headaches, or completely different?
• Where is it, and does it come with fever, vomiting, vision changes or weakness?
• Which painkillers have you taken, and how often in the past month?
• Does anyone else at home have the same symptoms? Have you hit your head recently? Could you be pregnant?

After that, the doctor checks your blood pressure, temperature, neck, eyes and nervous system, and decides whether any further tests are needed.

What you can do at home

• Drink water, eat if you've missed a meal, and rest somewhere quiet and dim.
• Paracetamol or ibuprofen at the dose on the pack is enough for most tension headaches. Avoid ibuprofen without advice if you have a stomach ulcer, kidney problems or are pregnant.
• A cool or warm compress on the forehead or neck may help.
• Notice what comes before the headache: poor sleep, missed meals, caffeine (both too much and suddenly cutting back — see signs of too much caffeine), screens, stress. A simple headache diary helps your doctor a lot.
• If the headache doesn't improve despite this, or keeps coming back, see a doctor rather than taking more painkillers.

ER or urgent care?

For any of the red flags above — a thunderclap headache, stroke signs, fever with a stiff neck — call 911 first. For a severe headache that's different from usual but without those signs, or a headache in pregnancy or over 50, go to the emergency department, where an emergency physician will examine you and decide what tests you need. A familiar headache that's dragging on or not responding to painkillers, or a headache with a fever and a simple cold, can go to walk-in urgent care.

Sources

• NHS — Headaches
• NHS — Migraine
• NICE — Headaches in over 12s: diagnosis and management (CG150)
• Mayo Clinic — Headache: When to See a Doctor
• MedlinePlus — Headache