More than 1.2 million Americans visit emergency rooms every year because of migraines. If you suffer from migraines, particularly if it’s a chronic condition, you may wonder when or if you should seek assistance at the ER. 

Going to the ER means seeing a physician unfamiliar with your condition and may result in ineffective treatment. However, there are serious signs that should tell you that the problem requires emergency treatment.

Find out when to get emergency treatment for your migraine below.

What Causes Migraines?

Each migraineur has a unique set of triggers, but there are commonalities shared by the migraine community.

Weather can trigger some migraines. As the barometer shifts and the humidity rises or falls, your body can react in ways that increase the chances of a migraine attack. Some are more prone to migraines during stormy weather, while others have difficulties during specific seasons.

Everyone spends a lot of time in front of a screen these days, and eyestrain is another common cause of migraines. Screen brightness, the things you read or watch, and the surrounding light all affect your eyesight. If you spend too much time in front of a computer monitor or looking at your phone, you could set yourself up for a migraine.

Food can trigger some migraines. You can be sensitive to nitrates or sulfates found in certain foods like cured meats, aged cheese, or red wine.

If you suffer from chronic migraines, keeping a migraine diary can help you find those triggers so you can mitigate their impact.

Types of Migraines

Your migraine can be classified according to how and where you experience the pain and other symptoms.

• Abdominal migraines are more typical in children and often include nausea and vomiting.
• Hemiplegic migraines cause weakness or paralysis on one side of the body and can mimic a stroke.
• Ophthalmic migraines include repeated visual disturbances, including partial blindness, before the onset of head pain.
• Menstrual migraines tend to occur in women due to hormonal changes throughout their cycles.
• Status migrainosus is defined as a migraine lasting more than 72 hours.
• Vertebrobasilar migraines include severe vertigo before migraine onset.

Work with your primary care physician or headache specialist to learn about your particular migraine episodes so you can build the best management and mitigation plan possible.

When Does a Migraine Become an Emergency?

If you have suffered from migraines for some time, you likely have a good idea of how your attacks or episodes progress. Most sufferers have a specific pathway from the beginning of a migraine attack to the end.

Any new or unusual symptoms are reasons to seek emergency care, especially severe ones. If your headache doesn't respond to the usual treatment or worsens with treatment, it's time to go to the ER. 

More severe pain than previous migraines is a signal that you might need emergency treatment. 

Symptoms Signaling a Trip to the ER

Experiencing different or more severe symptoms than usual could mean you need additional assistance or something else going on. Unusual symptoms that are new to you could mean the problem isn't a migraine at all.

Sudden onset headaches or a sudden change compared to your baseline headache could signal an issue such as an aneurysm or meningitis. If you experience any of the following and they are worse than usual or different, seek emergency treatment.

• Confusion or changes in awareness
• Vision changes
• High fever
• Neck stiffness
• Trouble speaking
• Numbness, tingling, or muscle weakness
• Convulsions 

Go to the ER even if you have other typical migraine symptoms like nausea or light sensitivity, especially if the headache begins suddenly without warning and reaches maximum pain within a minute or two. It could signal a stroke, particularly in someone over 50.

If you have new or different symptoms and a severe condition such as liver, heart, kidney disease, or an autoimmune disorder like HIV, go to the emergency room. If you are pregnant and suffer sudden severe head pain, you need to go to the ER.

The ER Is a Challenge for Migraineurs

Emergency rooms are ordered chaos, with noises and lights that are the very triggers for someone with a migraine. Expect some discomfort as you wait for treatment.

Emergency room physicians take a deliberate approach to potential neurological problems, so expect testing, CT scans, and perhaps a spinal tap. You have the right to refuse any test that won’t provide useful information, particularly if your migraine is following its customary path. 

Also, the emergency personnel are unfamiliar with your particular case. They may not be well-versed in migraine diagnosis and treatment. For example, the doctor may prescribe narcotics or opioids that you already know don't really help. 

If you have suffered migraines for long, you have the best idea of what works and what doesn’t. Let the staff know what helps you the most to receive effective treatment.

Advocating for Care in the Emergency Room

Your best advocate is you. You know your migraines and the treatments that work. When the medical staff takes your history, be thorough about your typical migraine symptoms and the types of treatments that have worked in the past. If your usual treatment isn't working, tell them. 

After emergency treatment, work with your neurologist or headache specialist to develop a rescue plan to keep you out of the ER. If you haven't identified your triggers, start a migraine diary to determine when you tend to have an attack, how often, the types of symptoms you have, and the duration of each phase of your migraine.

Ask your doctor for a signed treatment plan to take with you if you need emergency migraine care. The emergency room physician can use it as a basis for treatment and get you quickly back on your feet.

Potential Emergency Treatments

The ER provides medications for temporary relief until you can see your headache specialist. Some of these medications are delivered intravenously or intramuscularly. They can include: 

• Anti-emetics for nausea

• Dihydroergotamine for prolonged migraine treatment
• NSAIDs and steroids to reduce inflammation and pain
• Sumatriptan to provide urgent migraine relief
• Valproic acid, an anti-seizure medication used for headache relief

You may receive IV fluids if you are dehydrated.

In Summary

A migraine can be an emergency. Familiarity with your typical condition can help determine when you need to go to the ER. Sudden, severe head pain could signal something other than a migraine, such as a stroke or an aneurysm.

Sometimes you just need a little more help than your rescue plan provides. Obtain a signed treatment plan from your doctor to help the emergency staff determine the best treatment and alleviate the symptoms until you can see your regular doctor.

As always, contact the Migraine Relief Center if you have any concerns or questions.