Almost everything here is an appointment. This page is not.

THE PAGE TO READ FIRST

Go to an emergency department or call 911 for a thunderclap headache that peaks within about a minute, the worst headache of your life, headache with fever and a stiff neck, new weakness, numbness, confusion or vision loss, a seizure, or a headache after a head injury.

Almost everything else on this site is about an appointment. This page is about the small number of headaches that are not an appointment. Over-read it rather than under-read it.

Those go to an emergency department or 911. Not to us, and not to a scheduling line. Nothing on this site is a substitute for that.

Can years of headaches make you miss a dangerous one?

Yes. The population most likely to ignore a dangerous headache is the population that has had headaches for years. When your baseline is three bad days a month, a genuinely different headache has to compete for attention against a long history of headaches that turned out to be nothing. The pattern-change entry above is there for exactly that reason.

The inverse is also true and worth saying plainly: the great majority of headache, including severe and disabling headache, is not dangerous. Being told that repeatedly without ever being given a plan is its own harm, and it is what this clinic is for.

What the emergency department can and cannot do

It can exclude the dangerous causes, and it is very good at that. It can stop an attack today. What it cannot do is see you again, which means it cannot write a preventive plan or find out whether one worked. That is not a criticism of emergency medicine; it is a description of what the setting is built for.

If you have been more than twice this year for headache, the pattern itself is the finding. The emergency room cycle.

Questions about the red flags

What is a thunderclap headache?

One that goes from nothing to maximum intensity within about a minute. It is the single most important headache description in medicine because of what it can indicate, and it is an emergency regardless of whether it eases afterward.

How do I know if it is a migraine or something serious?

The reassuring features are a long history of similar attacks, a recognizable build, and full recovery between them. The concerning features are the lists above — sudden onset, new neurological findings, fever, a clear change in pattern, or first onset after 50. When those are absent, imaging rarely adds anything: do I need a scan.

Should I go to the ER for a bad migraine?

If it is your usual pattern and you have no red flags, an emergency department will most likely give you something and send you home with advice to follow up. That is a reasonable option at three in the morning with nothing else available, and it is also the loop worth getting out of — by counting the days and writing a preventive plan.

I have had these for years. Do the red flags still apply?

Yes, and one applies specifically to you: a clear change in your usual pattern. A long headache history does not protect against a new cause, and it does make a new cause easier to dismiss.

When a changed pattern calls for a scan is covered in do I need a scan.

What can the ER do for a bad headache?

The emergency department is very good at ruling out the dangerous causes of a headache, and it can stop an attack today. What it cannot do is see you again. That means it cannot write a preventive plan or check whether one worked. For a red-flag headache, the ER is the right place. For years of ordinary attacks, the plan gets written at an appointment.

When should you go to the hospital for a headache when pregnant?

Go to an emergency department or call 911 for a headache in pregnancy or just after delivery that comes with high blood pressure or swelling. The same red flags apply as for anyone else: a thunderclap onset, the worst headache of your life, fever with a stiff neck, new weakness, numbness, confusion or vision loss, or a seizure. Do not wait for an appointment.

What if I keep going to the ER for headaches?

If you have been more than twice this year for headache, the pattern itself is the finding. Each visit can rule out danger and stop one attack, but nobody there will see you again to count your headache days or write a preventive plan. That plan is what an appointment here is for. Any new red flag still goes straight to the ER.

How long should a headache last before I see a doctor?

Count days, not hours. A single attack still going after 72 hours despite treatment (status migrainosus) needs to be seen that day, and anything on the lists above goes now however long it has lasted. Short of that, book an appointment once headaches reach about four days a month, once you are taking something for them on ten or more days a month, or once the pattern changes. Learn more: when the painkillers are causing the headache.

What is the difference between a primary and a secondary headache?

A primary headache is the disorder itself: migraine, tension-type and cluster headache. A secondary headache is a symptom of something else, such as bleeding, infection, raised pressure inside the skull, giant cell arteritis, a structure in the neck, or the medication taken to treat it. The red flags on this page are there to catch the dangerous secondary causes; in an ordinary clinic week, the secondary causes that hide in plain sight are medication overuse and the neck, which is why cervicogenic headache gets examined for rather than assumed away. Learn more: why a first headache after fifty is worked up differently.

For everything that is not an emergency

• The emergency room cycle
• Do I need a scan?
• How many days did you lose last month?
• Headache specialist or neurologist?
• What happens at a headache clinic
• Headache clinic in St. Louis