Does Xarelto cause headaches? A look at the evidence and risk factors

October 8, 2025 •

4 min read

While not a universal side effect, some clinical trial data indicates that headaches were a common side effect for patients taking Xarelto, occurring in up to 1 in 10 individuals. This article explores why rivaroxaban, the active ingredient, may trigger headaches and how to distinguish between a minor symptom and a medical emergency.

Quick Summary

Headaches are a reported side effect of the anticoagulant Xarelto (rivaroxaban). They can be a less serious issue, potentially caused by the drug's vasodilatory effects, or a sign of a more severe problem like internal bleeding. Knowing the cause and symptoms is crucial for safe medication management.

Key Points

Known Side Effect: Headaches are a reported side effect of Xarelto, experienced by some patients in clinical trials.
Underlying Causes: Headaches can be caused by Xarelto's vasodilatory effects or, in more serious cases, be a symptom of internal bleeding in the head.
Emergency Symptoms: A severe or sudden headache, accompanied by symptoms like dizziness, weakness, or vision changes, may indicate a life-threatening bleed and requires immediate medical attention.
Pain Relief Management: For mild headaches, acetaminophen is generally considered a safer option, but NSAIDs and aspirin must be avoided unless approved by a doctor.
Do Not Discontinue: Patients should never stop taking Xarelto on their own, as this can increase the risk of blood clots and stroke.

Xarelto and Headaches: A Known Side Effect

For patients prescribed Xarelto (rivaroxaban) to treat or prevent blood clots, understanding the full range of potential side effects is a crucial part of their treatment plan. A significant number of patients in clinical trials reported experiencing headaches and dizziness. While headaches can stem from many causes unrelated to medication, their appearance while taking an anticoagulant like Xarelto warrants careful attention due to the heightened risk of bleeding.

How Xarelto Can Lead to Headaches

There are two primary ways Xarelto may cause or contribute to headaches, and it is important to distinguish between them as they have different levels of clinical significance.

Vascular relaxation (vasodilation): Some researchers hypothesize that rivaroxaban may have a direct vasodilatory effect on blood vessels. Vasodilation is the widening of blood vessels, and this change in blood flow and pressure could be a potential explanation for headaches and dizziness in some patients. This is a physiological effect independent of the drug's primary function of inhibiting Factor Xa and thinning the blood.
Internal bleeding: The most common and serious side effect of Xarelto is bleeding, which can occur anywhere in the body. A severe headache, particularly when accompanied by other symptoms, can be a symptom of internal bleeding in the head or brain. This is a medical emergency and requires immediate attention. Early symptoms of severe bleeding can include severe headache, dizziness, weakness, or unexplained vision changes.

Distinguishing Between Mild and Severe Headaches

Not all headaches are created equal, and knowing when to be concerned is vital for anyone on an anticoagulant. A mild, temporary headache might be a less serious side effect that subsides as your body adjusts to the medication. However, a severe, persistent, or unusual headache could signal a critical issue.

Warning signs of a severe bleeding-related headache:

A sudden, severe headache, often described as the "worst headache of your life".
Stiff neck.
Numbness or weakness in the face, arms, or legs.
Trouble speaking or walking.
Blurred or lost vision.
Confusion or loss of consciousness.

Any of these symptoms, especially if they appear suddenly, should be treated as a medical emergency. You should seek immediate help and inform medical professionals that you are taking Xarelto.

When to Seek Medical Attention for Headaches

While mild headaches may not be a cause for alarm, it is important to be proactive with your healthcare provider. You should inform your doctor if you experience any bothersome headaches after starting Xarelto. However, in some instances, medical attention is required more urgently.

Call your doctor immediately if:

You experience persistent or worsening headaches.
The headaches are accompanied by other signs of mild bleeding, such as frequent nosebleeds, bleeding gums, or easy bruising.

Call 911 or your local emergency number immediately if:

You experience any of the warning signs of a severe bleeding-related headache mentioned above.
You have other signs of a severe bleed, such as blood in your urine (red, pink, or brown), bloody or tarry stools, or vomiting blood.

Management Strategies for Headaches on Xarelto

For mild, non-emergency headaches, there are safe management options. It is critical to discuss any plan with your doctor first, as many over-the-counter pain relievers can increase the risk of bleeding.

Safe Management Techniques:

Acetaminophen (Tylenol): This is generally considered the safest pain reliever for individuals on anticoagulants. Always follow your doctor's advice regarding its use while taking Xarelto.
Lifestyle changes: Staying hydrated and practicing relaxation techniques can help alleviate some headaches.
Avoid NSAIDs and aspirin: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), are generally prohibited or require specific clearance from a doctor due to their effect on blood clotting.

Comparing Xarelto's Headache Risk to Other Anticoagulants

Different anticoagulants can have varying side effect profiles. Here is a comparison of some of the risks associated with Xarelto and other common blood thinners.


Feature	Xarelto (Rivaroxaban)	Warfarin	Eliquis (Apixaban)
Mechanism	Factor Xa inhibitor	Vitamin K antagonist	Factor Xa inhibitor
Headache Risk	Reported as a common side effect in some studies (up to 1 in 10).	Headaches can be a symptom of internal bleeding, and a risk with any anticoagulant.	Headaches are a reported but less common side effect.
Serious Bleeding Risk	High risk of bleeding, can be serious or life-threatening.	High risk of bleeding, requires regular monitoring.	High risk of bleeding, but generally considered slightly lower than Xarelto.
Management	Generally involves adjusting medication, pain relief with acetaminophen (with caution).	Requires strict diet and medication management, acetaminophen with caution.	Similar to Xarelto, focusing on acetaminophen and symptom management.

Conclusion

In conclusion, headaches are a recognized side effect of Xarelto, with some studies indicating they can occur in a significant percentage of patients. The cause can range from a benign vascular effect to a sign of serious internal bleeding. It is crucial for patients to be aware of the difference between mild and severe symptoms and to seek immediate medical attention for any headache that feels unusual, intense, or is accompanied by other neurological signs. Always communicate any side effects with your healthcare provider to ensure safe and effective management of your condition. For mild headaches, acetaminophen may be an option, but NSAIDs and aspirin should be avoided. Discontinuing Xarelto is not recommended without a doctor's guidance, as this increases the risk of dangerous blood clots.

More information on anticoagulant side effects

For more detailed information on rivaroxaban and its side effects, consult a reliable medical resource such as MedlinePlus: Rivaroxaban: MedlinePlus Drug Information.

Frequently Asked Questions

Headaches were reported as a common side effect in some clinical trials of Xarelto, occurring in up to 1 in 10 patients. However, not every patient will experience them.

Yes, a severe or unusual headache can be a sign of internal bleeding, specifically in the head or brain, which is a medical emergency. Seek immediate medical attention if this occurs.

An emergency headache is one that is sudden and severe, or the "worst headache of your life," and may be accompanied by symptoms like confusion, vision changes, or weakness in the limbs.

Acetaminophen (Tylenol) is often the safest choice for pain relief while on Xarelto, but you must use it as directed by your doctor. You should avoid NSAIDs and aspirin.

NSAIDs, such as ibuprofen and naproxen, can further increase the risk of bleeding when combined with Xarelto. It is crucial to use safer alternatives as recommended by your doctor.

No, you should never stop taking Xarelto without consulting your doctor. Discontinuing the medication increases your risk of forming a blood clot or having a stroke.

Yes, other common side effects of Xarelto include bleeding (bruising, nosebleeds), back pain, abdominal pain, itching, dizziness, and fatigue.