How do I know when to go to the ER for a headache?

Most of the time, a headache isn’t an emergency. But in general, you should seek help if it’s the worst headache of your life, or if it’s severe and unlike others you’ve had before.

An extreme headache can be the first sign that you have a cerebral aneurysm, which is a weak area in the wall of a blood vessel in your brain, and it has begun to leak. An MRI or CT scan can detect this problem. It requires immediate medical attention, and possibly surgery, because a leak might lead to a rupture, which can be life-threatening.

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You should also watch out for a headache that comes with any numbness or facial weakness, as these are symptoms of a stroke. If you’ve recently hit your head, get to the ER if you start vomiting or your headache worsens; that could mean you have a concussion.

Finally, head throbbing plus neck stiffness and fever could indicate meningitis, an infection of the membranes around your brain and spinal cord. If it’s bacterial, you’ll need antibiotics.

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Health‘s medical editor, Roshini Rajapaksa, MD, is assistant professor of medicine at the NYU School of Medicine and co-founder of Tula Skincare.