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Headache: when to worry and possible causes

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

  • A sudden, explosive headache, or the worst of your life
  • Slurred speech, weakness in an arm or leg, loss of balance or confusion
  • Vision changes
  • Fever with a stiff neck, nausea and vomiting
  • Severe pain and redness in one eye

Help lines:

Warning signs: when to go to the ER

When to worry about a headache: if it starts suddenly like an explosion, is the worst of your life, or comes with slurred speech, weakness, confusion, or fever with a stiff neck, call 911. Most headaches come from tension, migraine, a sinus infection or a cold, and they are not dangerous. If headaches keep coming back, a visit can help you find the cause.

  • Tension headache — band-like pressure, with tight neck and shoulders or stress
  • Migraine — throbbing pain, often one-sided, with nausea or vision changes
  • Sinus infection — forehead or facial pressure, worse bending forward
  • Flu or another infection — headache with fever and body aches
  • Dengue — headache with fever and pain behind the eyes
  • Rebound headache — from taking pain relievers more than 3 days a week

Headache: when to worry

Call 911 or go to the ER if a headache:

  • Starts suddenly and explosively, or is the worst you have ever had.
  • Comes with slurred speech, vision changes, weakness in an arm or leg, loss of balance or confusion.
  • Comes with fever, a stiff neck, nausea and vomiting.
  • Comes with severe pain and redness in one eye.

Common causes of headache

The causes table on this page sums them up:

  • Tension headache: the most common. It feels like pressure or a band around the head and often goes with tight neck, shoulder or jaw muscles, or stress.
  • Migraine: throbbing pain, often on one side, with nausea or vision changes. See migraine.
  • Sinus infection: pain and pressure in the forehead or face that gets worse when you bend forward. See sinus infection.
  • Cold, flu or fever: headaches come with many infections, such as flu.
  • Rebound headache: taking pain medicine more than 3 days a week on a regular basis can cause headaches that keep coming back.

Headaches in Puerto Rico: dengue and blood pressure

A headache with fever, pain behind the eyes and bone pain can be dengue. In that case use acetaminophen, avoid aspirin and ibuprofen, and read our dengue warning signs guide.

High blood pressure usually causes no symptoms, so a headache is not a reliable way to tell whether you have it. If you have high blood pressure, check it at home and keep a log. See high blood pressure.

Home care for a headache

For a headache without warning signs:

  • Rest in a quiet, dark room and drink water.
  • Put a cool cloth on your forehead.
  • Try relaxation techniques and stretch your neck and shoulders.
  • Acetaminophen, aspirin or ibuprofen can help a tension headache; follow the label. If dengue is possible, use acetaminophen only.
  • Keep a headache diary: when it starts, what you ate or drank, how you slept and what you were doing.

When can a telehealth visit help with headaches?

An online doctor visit can help if you have recurring headaches, think you may have migraines, take pain relievers several days a week, or want to review a treatment you already use. The doctor will ask detailed questions and assess whether you need tests or a specialist. If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances, including opioid pain medicines.

If your headache has any of the warning signs above, do not use telehealth: call 911. A visit costs US$79 and you must be in Puerto Rico.

When do you need an in-person visit?

Get medical care soon if this is your first severe headache and it stops you from doing your usual activities, if it gets worse over 24 hours, if it follows a blow to the head, if headaches are new after age 50, if they come with vision problems, pain when chewing or weight loss, or if you have a history of cancer. See when to go to the ER.

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Frequently asked questions

When is a headache an emergency?
When it starts suddenly like an explosion or is the worst of your life; when it comes with slurred speech, weakness, confusion or vision changes; or when it comes with fever and a stiff neck. Call 911 in those cases.
Can taking pain pills every day cause headaches?
Yes. Taking pain medicine more than 3 days a week on a regular basis can cause rebound headaches. If that sounds familiar, a visit can help you change the plan.
Can I get migraine treatment by telehealth?
If appropriate, the doctor can prescribe medication after assessing you. We do not prescribe controlled substances, including opioids.

Sources

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