Like nearly all conditions that revolve around pain , headaches can be tricky to categorise . A headache one person would call “terrible” might feel mild to someone else .

But speaking generally , you need to see your primary care physician if your headache status changes , says Mark Morocco , MD, a clinical professor and ER doc at the University of California, Los Angeles Medical Center.

That means if you never had headaches , but now you seem to have them all the time , your doctor should know about that change , Morocco says . Or if the intensity of your regular migraines has suddenly ratcheted up, that ’s also something worthy of your doctor ’s attention .

Even in those situations, chances are good your headaches are not of the life - threatening variety .

“People are always worried about brain tumors ,” Morocco says . But headaches are actually not among the symptoms experts usually associate with a tumour
On the other hand, there are some warning signs that your headache is a true medical emergency .

You have a ‘ thunderclap ’ headache

If a severe headache comes on suddenly—”Like someone flipping a light switch, or hitting you with a hammer,” Morocco says —that ’s something to take seriously.

It could be a “ subarachnoid hemorrhage” (SAH ), or bleeding within your brain caused by a leaking aneurysm . “ That’ s a dangerous headache , and you need to call 9 - 1 - 1 or have someone take you to the hospital ,” Morocco says . To be clear , this isn ’t a sharp pain that recedes in a matter of seconds or minutes . “It won ’t go away quickly ,” he adds . “ But you don ’ t want to make the mistake of taking heavy pain pills and going to sleep . ”

Your headache changes its tune

If you experience migraines or tension headaches , an especially severe headache —while terrible —isn ’t necessarily something you should worry about . “

One way to think about it is, if the quality of your headaches were a song , is this the same song but with the volume but turned up higher?” Morocco says . If the answer is yes , he says that ’s reassuring . What he worries about is if the song changes , meaning your headache feels both severe and different from what you normally experience . If that ’s the case , you should get to the ER , he says . Again , this could be an aneurysm or some other urgent medical situation .

Your headache isn ’ t your only issue

A bad headache accompanied by a fever is concerning. “This could indicate an infection of the brain —something like meningitis ,” Morocco says . It could also be a warning sign of encephalitis , or inflammation of the brain .

Especially if your bad headache and fever are accompanied by an altered mental state—you can ’t remember your kids, or are otherwise acting unlike yourself—that ’ s a good reason to call 9 - 1 - 1 or head to the ER .

The ache is behind or around your eye

“If you have a headache with eye pain, and especially if you have a change in your vision , that ’s an emergency ,” Morocco says . The big concern here is acute glaucoma, or a buildup of pressure in your eye that cuts off its blood flow and can result in blindness.

“What we see a lot is a person goes to a movie, and when the lights go down and the pupil dilates, that change in pressure leads to the headache and the other symptoms ,” he says.

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