When should you go to the hospital for a headache? Doctor explains how to tell if it is an emergency



“I waited for hours in the ER last night with this terrible headache, but I finally gave up and left. Should I have waited at the hospital?

This is a surprisingly common scenario that I encounter as a general practitioner. If you are wondering how bad your headache must be to go to the hospital, here is the advice I give to my patients.

Let’s start with when you absolutely have to go to the hospital for a severe headache.

Serious and urgent causes of headaches include infections, bleeding, clots, and tumors. Do not hesitate to go directly to the hospital (by ambulance or with a trusted driver) if you notice one or more of the following:

  • sudden onset of the worst headache you have ever had
  • headaches that get worse with exercise or sex
  • stiff neck (new since the onset of the headache)
  • high fever that does not decrease with over-the-counter pain relievers
  • headache after trauma to the head or neck
  • personality changes and / or strange behavior
  • weakness / numbness on one side of your body.

Three specific situations are also urgent:

  • pregnant or recently pregnant women who develop a sudden and severe headache
  • people who are immunocompromised (such as someone living with HIV or taking strong immunosuppressive drugs)
  • people who have received a COVID-19 vaccine in the past four to 42 days and who have a persistent headache despite taking simple pain relievers.

If you are reading this and identify with any of the above, stop reading now and go straight to the hospital.

Fortunately, most headaches are less severe and can be managed without going to the hospital. But they can still wreak havoc.

As you read this, 15% of Australians take pain relievers for a headache.

But just because you don’t have to run to the hospital doesn’t mean you shouldn’t get help, especially if you have a headache on a regular basis.

Start by making a long appointment with a GP to discuss your headache and nothing else. Give it the time and attention it deserves.

It helps to write down your headaches for your doctor’s appointment: a “headache diary”.

The most important tool doctors have for diagnosing headaches is your story. You might feel like they’re asking a lot of questions, but that’s because there are so many possible causes. Be patient with your GP as he tries to give you the most accurate diagnosis.

These are the kinds of questions a doctor may ask or ask themselves while they are assessing you:

  • Is the pain caused by something simple?

Common possible causes include dehydration, eye / neck strain, teeth grinding, lack of sleep, or caffeine withdrawal. Even the regular intake of pain relievers can cause headaches associated with “drug abuse”; the remedy may become the cause.

  • Where in your head is the pain?

Sometimes the location of the pain gives a clue. For example, about 35% of headaches are “tension headaches,” which look like a tight band around both sides of the head. Another 4% are “cluster headaches,” which start behind one eye (which may turn red and watery) and are often associated with a stuffy nose.

  • Do you have any other symptoms accompanying the headache?

A migraine episode may be preceded by an “aura” (such as flashes of light) and often includes symptoms such as nausea or vomiting, extreme sensitivity to sound and light, and blurred vision.

Fever, altered smell, fatigue, and pressure in the ears are features associated with acute sinusitis.

  • Is there a reason for your headaches?

Some headaches, such as migraine episodes or tension headaches, may have triggers that trigger them, including certain foods, sleep deprivation, peculiar smells, or emotional stress.

Hormonal headaches follow menstrual cycles. Once an association is noticed, you may be able to anticipate and treat headaches early on.

  • Do you have other medical conditions?

Rarely, very high blood pressure (hypertensive crisis) can cause headaches. However, high blood pressure during a headache is usually just your natural response to pain.

It is essential that chronic and recurring headaches are properly diagnosed by a doctor. Your GP may refer you to another specialist (such as a neurologist or an ear, nose and throat surgeon) depending on the complexity of your situation.

Headaches rarely require diagnostic tests, but if your doctor is concerned, they may arrange for a CT scan, MRI, or lumbar puncture.

Even if you are sent for further testing, a specific cause may not be found. If so, your doctor’s goal will be to help you manage your headaches and reduce their impact on your life.

Migraines deserve special mention here because they can be so debilitating and poorly understood.

Many people misdiagnose themselves with “migraines”. But a bad headache isn’t the same as a migraine attack, and some migraine attacks don’t even include a headache.

If you think you are having migraine attacks, get them diagnosed and treated properly.

If you can avoid going to the hospital unnecessarily when you have a headache, it will benefit you and the Australian healthcare system.

Every time you show up to an emergency department it costs you hours of your life and the community on average AUD 561.

Seeing your GP is obviously faster and costs the community between 38 and 75 Australian dollars.

If headaches are interfering with your life, please put your health first. See a doctor, get a management plan for them, and avoid a painfully long wait in an emergency.

Natasha Yates is Assistant Professor of General Medicine at Bond University in Australia.

This article is republished from The conversation under a Creative Commons license. Read it original article.


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