When a Headache Is an Emergency

Call 911 now if a headache arrived suddenly and reached its worst within
seconds or a minute or two — especially if it is the worst headache you have
ever had. That pattern has a name, and it needs a scan today, not tomorrow.

Also call 911 for a headache with any weakness, drooping, confusion, trouble
speaking, vision loss, or a seizure, and for a headache with a fever and a
stiff neck.

Most headaches are not emergencies. This article is about telling the difference,
and the honest version of that is that a small number of patterns matter and
severity alone is not one of them.

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The one pattern to memorise

Sudden onset, worst within a minute or two, unlike anything before.

Clinicians call it a thunderclap headache, and the phrase people use afterwards
is almost always some version of "it hit me like a switch." It can be a
bleed around the brain, and the window for doing something about it is short.

It does not have to be the worst pain imaginable — it has to have arrived
that fast. A headache that builds over an hour is a different thing, however
badly it ends up hurting.

Do not drive. Call 911.

Other patterns that mean be seen now

Any one of these on its own is enough.

• Headache with fever and a stiff neck, especially with a rash or with light
  hurting your eyes
• Headache with any neurological change — weakness or numbness on one side,
  a drooping face, slurred or confused speech, double or lost vision, unsteadiness
• Headache after a head injury, particularly if you are on a blood thinner,
  or if it is getting worse rather than better
• Headache with a seizure, or with fainting
• A headache that wakes you from sleep, or that is clearly worse when you
  lie down, cough, strain or bend forward
• A new headache when you are pregnant or recently gave birth — be seen
  today, because blood pressure can be the cause
• A new, persistent headache if you are over 50, particularly with scalp
  tenderness, jaw ache when chewing, or any visual change. Vision can be at
  stake and it responds to treatment.
• A new headache if you have cancer, HIV, or take immune-suppressing
  medication — the threshold is lower, and so is the amount of pain a serious
  cause may produce.

"First and worst" is the shorthand

The first headache of a new kind, and the worst headache of your life. If a
headache is genuinely unlike your usual pattern — different place, different
character, different company — that difference is the signal, not the severity.

People with migraine know this instinctively: a bad migraine is frightening and
familiar. A mild headache that feels wrong is more worrying than a severe one
that feels known.

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The headaches most people recognise

Most headaches are familiar ones: a tension headache, a migraine following its
usual course, one that arrives with a cold or sinus congestion, one after a bad
night's sleep, too little water in an Arizona summer, or the caffeine you
skipped.

The thing that matters is not how much it hurts. It is whether it is new.
Three questions are worth asking about any headache:

1. Does it match a pattern you recognise? Novelty is the signal.
2. Is anything from the lists above present?
3. Is it settling, or escalating? A headache getting worse over hours
   deserves attention even if it started ordinarily.

And if the answer to any of them unsettles you, come in. A headache you
cannot place is exactly the kind of thing an emergency room is for — the CT is
in the building, a physician sees you at any hour, and nobody here thinks less
of a visit that ends in reassurance. Call (480) 237-4922 or walk in.

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What happens when you arrive here

Headache is a presentation where the answer usually depends on imaging, and
where having it in the building changes the visit rather than shortening it.

• A physician sees you — board-certified, every visit, at every hour.
• CT on site. For a suspected bleed this is the question, and it is
  available here at three in the morning as readily as at three in the
  afternoon.
• Laboratory work in the building if infection or another cause is in the
  picture.
• A critical care room here for the presentations that need one.
• Monitoring for up to 24 hours, which matters for headache specifically —
  some causes declare themselves by changing, and a second examination hours
  later can be more informative than the first.

If you need admission, a specialist, or a procedure we do not perform here, we
stabilise you and arrange the transfer to a hospital. We are a freestanding
emergency room, not a hospital. For headache that distinction is worth knowing
in advance, because the serious causes are exactly the ones that end in a
transfer.

What helps us most: when it started and how fast it came on — that single
detail changes what we look for more than anything else you can tell us —
whether you have had headaches like it before, any medication you take
(especially blood thinners), and anything that makes it better or worse.

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What not to do

• Do not wait out a sudden, severe headache to see whether it settles. If it
  arrived in seconds, the waiting is the risk.
• Do not drive yourself if there is any confusion, visual change or
  weakness.
• Do not assume a headache after a fall is nothing, especially on a blood
  thinner and especially in the following days.
• Do not keep taking painkillers for a headache that is not behaving like
  your usual one. Relief is not reassurance, and taking something can mask
  the pattern we need to see. Call and ask first — (480) 237-4922.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what is happening to you
now. If you are unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• MedlinePlus (National Library of Medicine) — Stroke — https://medlineplus.gov/stroke.html

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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