While headaches are by far most commonly due to the more benign causes such as tension headaches or migraine headaches, occasionally they can be due to a more concerning cause. The following is a list of some suggestions regarding when to be most concerned about headache and how to consider the importance of seeking medical attention. Potentially the most concerning pattern that would lead one to often need emergency evaluation includes:

• A new very severe sudden onset (comes on instantly) and is unlike any headache experienced before.
• Headache accompanied by stiff neck, fever, nausea, vomiting, lethargy, drowsiness, and confusion.
• Headache accompanied by extremity weakness, numbness, double vision or visual loss, slurred speech or confusion.
• Headache the develops after a significant fall or blow to the head.

The next is a description of headache symptoms of which you should call your doctor to at least discuss if not to have an evaluation. These include:

• Awakening with headaches.
• A changing pattern to an existing headache problem.
• Headache occurring after physical exertion, sexual activity and coughing or sneezing (headaches occurring under these circumstances are usually benign but occasionally may indicate a more concerning cause).
• Headaches that are not improving with treatment either over the counter prescription treatment.
• Headaches that are changing the quality of one’s life, ability to do one’s daily activities such as in school or work.
• Headache also occurring along with anxiety or depression.
• Headaches that are occurring more than two or three days per month.
• Headache that is persisting after a fall or blow to the head.