Most migraine attacks are treatable at home. However, there are certain times when a person may need to visit the emergency room (ER), such as when a migraine develops to full intensity in just a few minutes.
Migraine typically causes a moderate-to-severe pulsating or throbbing pain, primarily on one side of the head. Additional symptoms may include nausea, sensitivity to light or sound, and visual disturbances.
Read on to learn when a migraine headache is an emergency and when to visit the GP instead of the ER. This article also provides information on how doctors diagnose migraine and more.
Although a migraine headache can be very painful, doctors do not typically consider it to be a medical emergency.
In most cases, people with migraine can manage their condition with appropriate medication, rest, and lifestyle changes.
However, a migraine headache or extreme head pain becomes an emergency when it is accompanied by severe and unusual symptoms that may indicate a more serious underlying condition. These may include:
- Stroke or brain hemorrhage: Doctors consider migraine an emergency when it is sudden and severe. People often describe it as the worst headache of their life. This
could be a sign of a stroke or brain hemorrhage. - Neurological conditions: If a person experiences changes in mental status, such as confusion or difficulty speaking, along with a migraine headache, it may indicate a neurological problem.
- Meningitis: Fever and stiff neck alongside a severe headache
may indicate meningitis, which is a potentially life threatening infection. - Concussion: Migraine after a head injury may
indicate a complication, such as a concussion. This requires prompt attention. - Migrainosus: In some cases, a migraine headache that persists for longer than
72 hours . Doctors call this migrainosus, which can lead to dehydration when the person has not been able to drink fluids or has had frequent vomiting.
A person with a migraine headache may need to visit the ER if they experience any of the following signs or symptoms:
- sudden and severe headache
- a headache that they would describe as the worst headache of their life
- changes in mental status
- visual disturbances that are not related to migraine with aura
- weakness or numbness
- seizures
- fever and stiff neck
- headache after head injury
- migraine attack lasting more than 72 hours
- signs of dehydration
When to see a doctor
If migraine symptoms are consistent with a person’s previous experience and do not include severe or unusual signs, they should not need to visit the ER.
If a person does not experience neurological deficits like weakness, changes in vision, or difficulty speaking, it is less likely to be an emergency.
Also, if the migraine attack is not preceded by a head injury or trauma, and a person has no other concerning medical conditions, they may not need immediate care.
Scheduling an appointment with their primary care doctor or a neurologist is typically the best course of action.
Upon arrival at the ER, a triage nurse will assess the person to determine the urgency of the condition. People with severe symptoms or concerning signs may be prioritized for quicker evaluation and treatment.
The attending healthcare professional — usually an emergency room physician — will take a detailed medical history and perform a physical examination.
They will ask about symptoms, including the characteristics of the headache, and any potential triggers or recent changes in migraine pattern.
Some common tests that an ER doctor
- A physical examination: The doctor will conduct a thorough physical examination, focusing on neurological assessments to check for abnormalities in reflexes, strength, and coordination.
- Blood tests: Blood tests check for signs of infection, inflammation, electrolyte imbalances, or other systemic issues that could be contributing to the headache.
- Imaging studies: In some cases, the doctor may order imaging tests such as a CT scan or MRI scan to rule out other severe conditions, like bleeding in the brain, injury, or structural abnormalities.
- Lumbar puncture, or spinal tap: This test checks for signs of infection or bleeding in the cerebrospinal fluid surrounding the brain and spinal cord.
After checking for possible causes of the migraine attack, ER doctors may prescribe pain medication to try and bring relief.
The American Migraine Foundation warns that many ER doctors may give opioids or narcotics to treat migraine. These medications come with risks and are generally not as effective.
Other treatments they may give include:
- medications to help decrease nausea and vomiting
- intravenous (IV) hydration into a person’s veins
- anti-anxiety medications
- nonsteroidal anti-inflammatory drugs
- triptan medications
Other treatment options will depend on the underlying cause of the head pain.
While the ER may provide some relief for severe migraine attacks, it is not the ideal setting for comprehensive long-term migraine management.
For ongoing migraine care and prevention, it is best to establish a relationship with a primary care doctor or neurologist who can develop a personalized treatment plan and provide regular follow-up care.
Migraine becomes an emergency if accompanied by severe symptoms like a sudden, intense headache, changes in vision, or confusion.
Other concerning signs include fever with a stiff neck, seizures, or head injury preceding the migraine attack.
Diagnosis may involve physical exams, imaging, and lumbar puncture to check for serious causes of intense head pain.
The ER may provide relief with medications, IV fluids, and anti-nausea medications. However, it is best to see a neurologist for ongoing treatment.