Most headaches are not dangerous, and severity alone is a poor guide - migraine hurts far more than many serious causes. What matters is the pattern: how fast it came on, whether anything about it has changed, and whether there are neurological symptoms alongside it.
Most headaches are not dangerous, and severity alone is a poor guide - migraine hurts far more than many serious causes. What matters is the pattern: how fast it came on, whether anything about it has changed, and whether there are neurological symptoms alongside it.
A headache reaching maximum intensity within about a minute, sometimes called thunderclap, needs emergency assessment the same day regardless of how it settles afterwards. So does a headache with fever and a stiff neck, or with any new neurological symptom: weakness, numbness, speech difficulty, double vision, or a seizure. A first severe headache after roughly age fifty deserves assessment. So does a headache that is clearly progressive over weeks, one that is consistently worse lying flat or on coughing and straining, and one accompanied by visual loss or new confusion.
The same headache carries different weight depending on context. A new headache in someone with cancer, HIV or on immunosuppressive treatment is investigated sooner. So is one in pregnancy or just after delivery, where specific causes need excluding. A headache after head injury, particularly in someone taking anticoagulants, needs prompt assessment. A headache that wakes someone from sleep, or is present on waking every morning, is worth reporting. And any headache that has changed in character rather than simply recurred deserves a fresh look.
This is the part patients find counterintuitive. Migraine and cluster headache produce genuinely severe pain and are not dangerous in the structural sense. Meanwhile some serious causes present with a headache that is moderate and unremarkable, distinguished only by being new, or by an accompanying sign. So the questions clinicians ask are about onset speed, change from a previous pattern, and associated features, rather than about a score out of ten. Pain intensity carries far less information than people expect.
Where the pattern is reassuring, the work is diagnostic rather than exclusionary: establishing which headache disorder is present, since migraine, tension-type, cluster and cervicogenic headache respond to quite different treatment. That is done from the history and examination. Imaging is directed by the features above rather than by frequency or severity, and it is arranged at an imaging centre when indicated. Adults 18 and older are seen at both offices.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: headache; American Academy of Neurology; National Institute of Neurological Disorders and Stroke.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.