Abstract The Manchester Triage System (MTS) has made a significant impact on emergency care globally, effectively prioritizing patient care. Its widespread adoption has improved workflow and safety in emergency settings. However, it faces challenges in handling severe headaches, such as migraine and cluster headache, which require quick, decisive care.MTS classifies urgency primarily based on symptoms, which can underestimate the severity of conditions like migraine, where symptoms are less apparent but critically debilitating. On the other hand, it can lead to misclassifications, where serious conditions are not given the priority they require, resulting in longer wait times and potentially worsening outcomes. For example, cluster headache, known for its extreme pain, may not receive immediate care, significantly affecting patient well-being.Moreover, MTS often overlooks psychological factors associated with migraine sufferers, such as anxiety, which can exacerbate the condition because of a substantial wait for the patient to be seen by the physician. Thus, a more holistic approach is needed to assess these patients accurately. Given these challenges, refining the MTS to better recognize and prioritize patients with headache is crucial. In conclusion, while MTS has enhanced emergency care globally, its approach to headache emergencies needs careful reevaluation to ensure timely and effective treatment, reflecting the complex needs of these patients and improving overall emergency care outcomes.