Stroke and Headache: Know the Emergency Signs

Section 1

Many headaches are not strokes—but some patterns need emergency care

Headache is common, and many headaches have causes unrelated to stroke. The important message is not to assume that every headache is a stroke. It is also not safe to use a webpage to rule out stroke or bleeding around the brain.

A new headache that is abrupt, unusually severe, or accompanied by a sudden neurologic change needs emergency evaluation. The pattern and accompanying symptoms change the action; they do not tell you the diagnosis at home. [2] [3]

Section 2

Red flags that change the action

Call 911 or your local emergency number now for:

• a severe headache that starts abruptly and reaches its worst intensity quickly;
• headache with new weakness or numbness, especially on one side;
• headache with new trouble speaking, understanding, seeing, balancing, or walking;
• headache with a seizure, fainting, collapse, new confusion, or unusual difficulty staying awake; or
• a sudden severe headache with repeated vomiting or a stiff or painful neck. [2] [3]

These are action signals, not a self-diagnosis checklist. A person may still need urgent care even when the pattern does not match every item above. If you are unsure whether a new symptom is an emergency, call emergency services rather than waiting for a website answer. [1]

Section 3

How headache can occur with stroke

Different stroke types can present differently:

• Bleeding around the brain, called subarachnoid hemorrhage, often raises concern when a severe headache begins abruptly and peaks very quickly.
• Bleeding within the brain, called intracerebral hemorrhage, may cause headache together with weakness, speech or vision changes, vomiting, seizure, or reduced alertness.
• A stroke caused by a blocked artery, called ischemic stroke, can happen with or without headache. No headache does not rule out stroke. [2] [3]

The way a person looks cannot reliably identify the stroke type. Emergency teams use the history, examination, and brain imaging to look for the cause.

Section 4

What emergency evaluation may include

The exact evaluation depends on the symptoms and timing. It may include:

• questions about the exact moment the headache or other symptoms began and how quickly they became severe;
• a neurologic examination;
• a CT scan of the brain;
• imaging of blood vessels in the head or neck; and
• additional testing when the first scan does not fully answer the question. [2]

Not everyone needs every test. The emergency team decides what is appropriate based on the full situation.

Section 5

For recurring or changing headaches without emergency signs

If headaches are recurring, becoming more frequent, changing from their usual pattern, or interfering with daily life, discuss them with a clinician. Keep track of when they occur, how long they last, associated symptoms, and medicines used, but do not delay emergency care to complete a diary.

This page does not tell you whether a headache is “safe,” and it does not provide individualized headache treatment. A clinician can consider the broader range of possible causes and help decide what evaluation or treatment is appropriate.

Section 6

What to remember

• Many headaches are unrelated to stroke, but a sudden severe headache can be an emergency.
• Headache with a new neurologic change, seizure, collapse, or reduced alertness needs immediate action.
• Do not drive yourself or wait for symptoms to improve.
• Symptoms guide the emergency response; they do not establish the diagnosis at home.

This page provides general education. It cannot diagnose a headache, stroke, or brain hemorrhage and does not replace emergency care or advice from your treating clinicians.