The bridge was built for the York, Newcastle and Berwick Railway, and together with Stephenson's Royal Border Bridge at Berwick upon Tweed, completed the line of a London-Edinburgh railway. The bridge was opened to rail traffic, without ceremony, on 15 August 1849. It was officially opened on 27 September 1849 by Queen Victoria; and brought into ordinary use on 4 February 1850.

The total cost of the bridge was £491,153, broken down as follows: The bridge proper cost £243,096, including £112,000 for the metal work, which was produced by Messers Hawks, Crawshay & Co (and subcontractors). The approaches to the bridge cost £113,057, and land and compensation - including to the 650 Newcastle and 130 Gateshead families who were relocated to enable its construction - £135,000.

It is the first major example of a wrought iron tied arch or bow-string girder bridge. It is a fine and long standing engineering solution to a difficult problem; the spanning of 407 m.(1,337 ft.) of river valley, including 156 m.(512 ft.) across water. The High Level Bridge has six river spans of 38 m.(125 ft.)length, sitting on masonry piers, up to 40 m.(131 ft.)in height. There are also four land spans on each side. The single carriageway road and pedestrian walkways occupy the lower deck of the spans, 26 m.(85 ft.) above the high water mark, while the railway is on the upper deck, 34 m.(112 ft.) above the high water mark.

In 1906, construction of the King Edward VII Bridge, some 500 yards to the west of the High Level Bridge, was completed. This second bridge addressed the central operational weakness of the single bridge, which was that trains entering the station from the south had to be reversed back across the bridge when returning in that direction. It also meant that locomotives had to switch ends before a train could head north towards Edinburgh.

Since the newer bridge opened, the High Level no longer forms part of the East Coast Main Line. Instead, it provides a route for trains going towards Sunderland, Middlesbrough and, formerly, the Leamside Line. It is also occasionally used for London trains wanting to turn around as the two bridges are linked on the Gateshead side to form a loop. For this reason, the western track across the bridge is electrified.

Its height and length have made it a landmark of Newcastle and it isListedGrade 1. (See also entries for King Edward VII Bridge and Newcastle Swing Bridge)