When Is a Headache Bad Enough That I Should Go to the ER?

woman with headacheDebra had a splitting headache that grew worse as the day grew long. Her eyes couldn’t bear the light and she felt nauseous. She had exceeded her dosage of pain medication, but nothing gave her relief. On a scale of 1 to 10, this headache was an 11.

She looked at the clock: 7:30. Too late to get an appointment with her doctor. Should she go to the Emergency Room?

Jessie Mueller, MD, Scott & White Headache Center, details when you should seek emergent medical attention for your headache.

“Most headaches result from a chronic condition and should not be treated in the Emergency Room,” says Dr. Mueller.

“In fact,” Dr. Mueller says, “ERs are the worst place for a headache sufferer. ERs are loud, bright and chaotic. They’re likely to make your headache worse. We recommend that you see your primary care physician or headache specialist in the morning.”

However, in some cases, the morning may be too late.

Dr. Mueller offers two sets of guidelines to help you decide whether you should seek emergency care for your headache — if your clinic is already closed for the day.

1. First – Worst – Changed

The only time a patient should go to the ER for a headache, Dr. Mueller says, is if the headache is:

  • First – The first headache you’ve ever had
  • Worst – The worst headache you’ve ever had
  • Changed – Your headache has changed in some way; it’s not progressing normally

First, worst or changed are all signs that there may be something more serious than your usual migraine, and you may need immediate medical treatment,” says Dr. Mueller.

If your severe headache doesn’t meet the above criteria, Dr. Mueller recommends:

  • Continuing headache-specific medications
  • Employing stress management techniques to help alleviate the pain and discomfort
  • Seeking medical attention from your primary care physician or headache specialist the next day

2. S–N–O–O–P

A mnemonic for keeping dangerous headache symptoms in mind, Dr. Mueller says, is S-N-O-O-P:

  • S – systemic symptoms – fever, tachycardia (racing heart beat), high blood pressure
  • N – neurologic symptoms – lost function in your arm, tingling in leg
  • O – onset abrupt – thunderclap headache explosive headache that reaches maximal intensity within 60 seconds of onset
  • O – older patients – patients over 65 without a history of headaches
  • P – previous headache history – NONE!

If you have an incapacitating headache and any of the above conditions, Dr. Mueller advises you seek immediate medical attention.

“Most headaches result from a chronic condition and should not be treated in the Emergency Room.”

However, if your headache is a chronic condition — like diabetes, high blood pressure or obesity — Dr. Mueller advises that you continue with the prescribed treatment protocol recommended by your physician.

“You wouldn’t go to the ER for diabetes, high blood pressure or obesity, so why would you go for a headache?” remarks Dr. Mueller.

Dr. Mueller’s advice for an after-hours severe headache? “Avoid the ER. Take your headache-specific medications, use your stress management techniques and make that call to your doctor first thing in the morning.”

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