Migraine and Severe Headache
Reading time: 5 minutesUpdated April 2026
Most headaches are benign (tension-type, migraine). But a few red flags signal serious conditions requiring urgent assessment.
Common headache types
- Tension-type: bilateral, pressing, mild-moderate, no nausea
- Migraine: unilateral throbbing, photo/phonophobia, nausea, aura in ~25 %
- Cluster: severe one-sided orbital pain, tearing, rhinorrhoea, 15 min to 3 h episodes
- Medication-overuse: daily headache in patients taking analgesics >15 days/month
Call 112 or go to ER for "thunderclap" or red-flag headache:- Sudden, maximal-intensity headache ("worst ever", seconds to minutes)
- Headache with fever and stiff neck (meningitis)
- Headache with focal weakness, speech difficulty, visual loss (stroke)
- Headache after head injury
- New severe headache over age 50 (giant cell arteritis)
- Headache with confusion, seizure, altered consciousness
First measures at home
- Rest in a dark, quiet room
- Ibuprofen 400 mg or paracetamol 1 g early in the attack
- Caffeine sometimes helps (strong coffee) if not contraindicated
- Cold compress on forehead
- Hydrate
What DoktorAkut can do on site
- Clinical history and neurological examination
- Blood pressure check (hypertensive headache)
- Triptan injection (sumatriptan 6 mg SC) for severe migraine attack — faster and more reliable than oral
- IV metoclopramide + analgesic infusion for intractable migraine
- Rule out red flags; refer to hospital if needed
- Private prescription for triptan or other abortive/preventive medication
FAQ
Can I get a triptan injection at home?
Yes. Subcutaneous sumatriptan works in 10–15 minutes and is highly effective for severe migraine.
How do I know it's not a stroke?
FAST: Face drooping? Arm weakness? Speech difficulty? Time to call 112. Any of these + headache: emergency.
General information only. Emergency: 112.
Sources: DGN migraine guideline, AWMF.