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How to Know When to Go to the ER for Migraine

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When a migraine attack intensifies beyond the familiar threshold, it can leave you questioning: Is this “bad enough” for the emergency room? It’s a tough call to make, especially when past ER visits may have left you feeling misunderstood, your outward composure misrepresenting the severity of your distress.

Recognizing a Migraine Emergency

A migraine attack is not just an intense headache; it can involve a complex array of neurological symptoms. But, certain signs can indicate a more severe condition that requires immediate medical attention.

When to Choose the ER Over At-Home Management

  • Sudden onset of a severe headache that peaks within seconds or minutes (often described as a “thunderclap” headache)
  • A headache that starts after a head injury or other trauma
  • New or unusual symptoms such as confusion, difficulty speaking, or loss of consciousness
  • Migraine accompanied by a fever, stiff neck, or rash
  • Severe nausea and vomiting that prevent you from staying hydrated
  • A migraine attack that is significantly different from your typical episodes
  • Symptoms suggestive of a stroke, such as one-sided weakness or numbness

Risk Factors for Emergency Situations

  • Personal or family history of aneurysms or hemorrhages
  • Known neurological conditions that a migraine attack could exacerbate
  • New or changing migraine patterns if you’re over 50 years of age

The ER Experience for People With Migraine

When a migraine attack propels you to the emergency room (ER), here’s what you can typically expect:

  • Triage: Upon arrival, the ER staff will assess your condition’s severity, a process known as triage. Migraine, especially with alarming symptoms, may be prioritized.
  • Initial assessment: A nurse will likely take your vital signs and inquire about your symptoms, medical history, and the effectiveness of any treatments you’ve tried at home.
  • Waiting time: Be prepared for a wait. ERs prioritize patients based on the immediacy of their medical needs.
  • Medical evaluation: Once a health care provider sees you, they will thoroughly assess you. This assessment may include questions about your migraine history and a physical examination to check for neurological function.
  • Emergency interventions: If deemed necessary, you may receive immediate interventions to alleviate pain and nausea, such as IV medications, fluids for hydration, and sometimes steroids to reduce inflammation.
  • Diagnostic tests: To rule out stroke or aneurysm, you may undergo diagnostic tests like a CT scan or MRI. A lumbar puncture may also be performed if providers suspect an infection.
  • Observation: Post-treatment, you might be observed to ensure your symptoms resolve and that you respond well to the medication.
  • Discharge or admission: Depending on your response to treatment, you may be discharged with instructions and follow-up care, or in more severe cases, you might be admitted for further observation and treatment.

Post-ER Care and Considerations

After an emergency room visit for a migraine attack, your journey to recovery and better management continues. Here’s what to focus on post-ER:

  • Follow-up appointment: Schedule a follow-up visit with your primary care physician or a headache specialist to discuss the ER visit and any changes to your condition or treatment plan.
  • Medication review: Review any new medications prescribed in the ER with your health care provider to ensure they fit into your overall migraine management strategy.
  • Reflect on triggers: Consider what may have triggered the severe attack and discuss potential lifestyle or environmental changes to prevent future episodes.
  • Rest and recuperate: Give yourself time to rest and recover. Migraine attacks and ER visits can be physically and emotionally draining.
  • Update your migraine plan: Based on the ER experience, update your action plan. Updates may include medication adjustments, new preventive measures, or lifestyle changes.
  • Educate yourself: Learn more about migraine management and emergency signs to prepare for future attacks.
  • Specialist consultation: If the ER recommends seeing a neurologist or headache specialist for specialized care, which could include exploring new treatment options or preventive strategies.
  • Mental health support: Consider counseling or support groups to cope with the emotional impact of living with migraine, especially if ER visits are a recurrent necessity.
  • Keep records: Maintain detailed records of your migraine attacks, treatments received, and any side effects or reactions, as this information can be invaluable for ongoing migraine management.
  • Communicate with a care circle: Keep family, friends, and caretakers informed about your condition, what to do if another severe migraine occurs, and how they can support you.

Taking these steps after an ER visit can help improve your long-term migraine management and reduce the likelihood of future emergency visits.

Knowing when to go to the ER for a migraine attack can be lifesaving. It’s vital to understand and recognize the symptoms that warrant immediate care.

Getty image by Caiaimage/Sam Edwards

Originally published: November 13, 2023
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