Headache: When to Worry — ER vs Doctor vs Home Care
Learn when headaches require emergency care, doctor visits, or home treatment. Red flag symptoms, cost estimates, and effective management strategies.
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Updated September 2025
🚨 Call 911 Immediately If You Have:
- Sudden, severe headache (worst of your life)
- Headache with fever and neck stiffness
- Headache after head injury or trauma
- Headache with vision changes, confusion, or difficulty speaking
These may indicate serious conditions like stroke, meningitis, or brain aneurysm.
On this page
Emergency Red Flags — Go to ER Now
Thunderclap Headaches
- • Sudden onset, reaches peak in 60 seconds
- • "Worst headache of my life"
- • Feels like being struck by lightning
- • May indicate brain aneurysm
Neurological Symptoms
- • Vision changes or loss
- • Difficulty speaking or slurred speech
- • Weakness or numbness in face/arms
- • Confusion or altered mental state
Infection Signs
- • Headache with high fever (over 101°F)
- • Neck stiffness or pain
- • Sensitivity to light (photophobia)
- • Skin rash with headache
Post-Trauma
- • Headache after head injury
- • Worsening headache hours after trauma
- • Vomiting after head injury
- • Loss of consciousness
Time is critical: These symptoms may indicate stroke, brain aneurysm, meningitis, or brain bleed requiring immediate treatment.
When to See a Doctor (Same Day or Soon)
Pattern Changes
- • New headache pattern after age 50
- • Headaches becoming more frequent
- • Headaches getting progressively worse
- • Different location or quality than usual
Functional Impact
- • Headaches interfering with work/school
- • Frequent headaches (more than 2 per week)
- • Headaches not responding to OTC meds
- • Needing increasing amounts of medication
Associated Symptoms
- • Persistent nausea or vomiting
- • Dizziness or balance problems
- • Memory or concentration issues
- • Headache with jaw pain when chewing
Concerning Features
- • Headache with low-grade fever
- • Headache worsens when lying down
- • Headache worsens with coughing/straining
- • Headache in pregnancy
What to Expect at Doctor Visit
Assessment
- • Detailed headache history
- • Neurological examination
- • Blood pressure check
- • Eye examination if needed
Possible Tests
- • Blood tests (if fever/infection suspected)
- • CT or MRI (if red flags present)
- • Eye pressure test
- • Referral to neurologist if needed
Best Place to Go — Quick Comparison
| Care Setting | When to Choose | Tests You'll Get | Typical Cost |
|---|---|---|---|
Emergency Room | Thunderclap headache, fever + neck stiffness, neurological symptoms, or after head injury. | Neurological exam, CT/MRI scan, blood tests, lumbar puncture if needed. | $1,000–$3,000+ Advanced imaging available |
Doctor (Same Day/Soon) | New pattern, frequent headaches, worsening symptoms, or affecting daily life. | Detailed history, neurological exam, may order outpatient imaging or refer to specialist. | $100–$250 Ongoing management |
Home Care | Tension headaches, familiar migraines responding to usual treatment, no red flags. | Self-monitoring, symptom diary, OTC medications, lifestyle modifications. | $5–$20 OTC medications |
Cost Disclaimer: Estimates are before insurance and vary by location, tests needed, and specific treatments.
Sources: Cost estimates based on CMS Provider Data, KFF Healthcare Cost Analysis, and national healthcare pricing databases.
Got a bill already? See our Medical Bill Reduction guide for practical steps to lower what you owe.
When Home Care Is Appropriate
Tension Headaches
Characteristics:
- • Mild to moderate intensity
- • Feels like tight band around head
- • Both sides of head
- • No nausea or light sensitivity
Mild Migraines
Can manage at home if:
- • Familiar migraine pattern
- • Responds to usual treatments
- • No new concerning symptoms
- • Not interfering with daily activities
Effective Home Treatments
Immediate Relief
- • Rest in dark, quiet room
- • Apply cold or warm compress
- • Stay hydrated
- • Gentle neck/scalp massage
Medications
- • Ibuprofen (400-600mg)
- • Acetaminophen (500-1000mg)
- • Naproxen (220-440mg)
- • Follow package instructions
Prevention
- • Regular sleep schedule
- • Stay hydrated
- • Manage stress
- • Avoid known triggers
When to Follow Up or Seek Care
Return to Doctor If:
- • Headaches not improving with treatment
- • Headaches becoming more frequent or severe
- • New symptoms developing
- • Medication not working as well as before
- • Headaches affecting work or relationships
- • Using pain medication more than 2-3 days per week
- • Waking up with headaches regularly
- • Headaches with personality changes
Frequently Asked Questions
When should I go to the ER for a headache?
Go to the ER immediately for sudden, severe headache (worst of your life), headache with fever and neck stiffness, headache after head injury, or headache with vision changes, confusion, or difficulty speaking.
What is a thunderclap headache?
A thunderclap headache is a sudden, extremely severe headache that reaches maximum intensity within 60 seconds. It feels like being "struck by lightning" and requires immediate emergency care as it may indicate a brain aneurysm or other serious condition.
How much does headache treatment cost at different facilities?
ER visits for headache typically cost $1,000-$3,000+, urgent care visits cost $150-$400, and primary care doctor visits cost $100-$250. Costs vary by location, tests needed, and insurance coverage.
Can I treat most headaches at home?
Yes, most tension headaches and mild migraines can be managed at home with rest, hydration, over-the-counter pain relievers, and avoiding triggers. However, see a doctor for frequent headaches or if patterns change.
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