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Most of us are no stranger to headaches. When that familiar pulse in your temples sends you searching for the nearest bottle of ibuprofen, it can be anything from annoying to debilitating.
But have you ever had a headache that made you think: Is this bad enough to see a doctor? Or even head to the emergency room? There isn’t always a clear-cut way to know if your headache is call-your-doctor-worthy, especially when everyone experiences pain differently. There are, however, some signs, symptoms and red flags to look out for and help you determine when it’s time to get it checked out.
Different types of headaches
Natalia Murinova, MD, and Ami Cuneo, MD, neurologists and headache specialists at the Headache Clinic at UW Medical Center – Roosevelt, say there are more than 150 different types of headaches that someone can experience.
“Headache specialists use what’s called the International Classification of Headache Disorders from the International Headache Society to make accurate diagnoses,” says Murinova. “It’s possible for a person to have more than one headache type.”
Most headaches are unpleasant but not a serious medical issue. (Note: We’re discussing the difference between headaches that aren’t dangerous, not those that are indications of serious medical issues.)
Here’s what to know about a few common ones:
Migraines
“Migraines are the most common diagnosis in specialty headache clinics — affecting up to 90% of our patients,” says Cuneo. “Migraine attacks are often moderate to severe, can last hours to days, and are associated with nausea, light and sound sensitivity, and disability.”
Migraines can be episodic or chronic and may occur with or without aura (e.g., visual changes like flashing lights or blind spots).
Tension-type headaches
Tension headaches can be triggered by something like stress, muscle tension in your neck or eye strain.
These are the most common headaches overall, affecting up to 90% of people at some point in their life, says Murinova.
"They are typically less intense than migraines and usually not associated with nausea or sensory sensitivity," she says.
Sleep deprivation, dehydration and medication overuse headaches
While not an official diagnosis, dehydration can be a trigger that worsens other headache types — especially migraine and tension-type headaches, says Cuneo. Not getting enough sleep can cause that throbbing head feeling, too.
Also, if you’re taking over-the-counter medication like ibuprofen or acetaminophen every day to treat your headache symptoms, you may experience a medication overuse headache (aka a rebound headache) if you skip a day. If this sounds familiar, chat with your doctor to find other alternatives to treat your chronic headaches.
Primary vs. secondary headaches
Cuneo says while most headaches are benign and not dangerous, some might be your body’s way of telling you that you might be dealing with an underlying medical issue. The former fall into the category of primary headaches, which are caused by normal functional changes in the brain, and the latter are called secondary headaches, which result from underlying structural or medical problems. These types of headaches can result from infections, vascular conditions or medication effects.
Does your headache feel different than usual, or do you think something more might be going on? Let your doctor know. Properly classifying your headache can help get you the treatment (and relief) you need.
Headache red flags
For those headaches that force you into a dark, quiet room for hours until you find relief — an already terrible experience — there are some red flags that can help you determine if your headache is just a “bad headache” or if it’s one that requires medical attention.
Some of these red flags include:
- Your headache is sudden and severe
- Your headache doesn’t respond to over-the-counter medications
- Your headache disrupts daily life or sleep
- The pattern or character of your usual headaches changes
- Your headache is associated with visual changes, confusion, weakness or numbness
- You find yourself using pain relievers more than two to three days per week
“A ‘bad’ headache typically refers to the intensity of pain, such as in a severe migraine, but a high pain intensity alone doesn’t always indicate a dangerous condition,” says Murinova. “A headache that requires medical attention is one that is new, worsening or associated with other concerning symptoms like confusion, neurological changes or other symptoms like fever or unexplained weight loss.”
If you have a headache that comes on suddenly — like a clap of thunder — along with severe pain in your head, it might be a thunderclap headache. These types of headaches are extremely rare, affecting less than 50 out of 100,000 adults each year, but it’s a sign to go to the emergency room ASAP to rule out any life-threatening conditions.
Also, if you have chronic or frequent headaches that interfere with your daily life, that’s not something to ignore. Make sure to bring that up with your doctor, too.
How to describe your headache pain to your doctor
Describing headache pain can feel like an impossible task when you’re, well, focused on the pain. Next time you feel a headache coming on, try making a note of these symptoms and using this language to report back to your doctor:
- Location (e.g., one side or both, behind the eyes, back of the head)
- Quality (e.g., throbbing, pressure, stabbing)
- Severity (on a 0–10 scale)
- Duration (how long each episode lasts)
- Frequency (how often headaches occur)
- Associated symptoms (nausea, sensitivity to light/sound, aura)
- Possible triggers (stress, sleep changes, certain foods, dehydration)
“While there isn’t a headache-specific pain scale, the 0–10 numeric pain scale is commonly used,” says Cuneo. “In addition, tools like the HIT-6 (Headache Impact Test) or a headache diary can help track frequency and impact over time and are useful for both diagnosis and treatment planning.”
At the end of the day, most headaches are harmless, but it’s important to know what to look for so you're prepared if something more serious might be going on.
