That said, the emergency room (ER) isn’t always your best destination for a migraine attack. Some symptoms are obvious red flags that warrant an ER visit, but others are best managed by your regular doctor. You can save yourself a trip to the hospital by knowing what they are.
When you should head to the ER for migraine
The most important reason to go to the ER during a migraine attack — or what feels like one — is to make sure you aren’t having symptoms of a different, potentially more serious condition, according to Cynthia Armand, MD, a neurologist and migraine specialist at the Montefiore Headache Center in New York City. For example, a headache that becomes intensely painful quickly (within a minute) may be caused by a subarachnoid hemorrhage, a type of stroke that’s uncommon but serious. If you experience blind spots in your vision for the first time, you may be experiencing an aura, but it’s a good idea to head to the ER to make sure your visual symptoms aren’t caused by a stroke. Other conditions that cause serious head pain and other migraine-like symptoms include meningitis and brain tumors. Both usually bring on other red-flag symptoms. In the case of meningitis, these include a high fever, neck stiffness, and confusion, while a brain tumor may be accompanied by vision problems, nausea, vomiting, and sensitivity to light. A stroke may lead to numbness or paralysis on one side of the body. “I empower my patients to understand these symptoms so they get a sense of whether something may be not right,” says Dr. Armand. In the case of many of these conditions, especially stroke, timely treatment is critical, she adds. Likewise, a migraine attack so severe that you can’t drink, eat, or keep down medication puts you at risk of dehydration and malnutrition, which may warrant a trip to the ER so you can receive fluids and/or medication intravenously, Armand says. Some signs of dehydration in adults include:
Dark-colored urine or urinating less than usualDizzinessDry mouthDry skinFatigue
Navigating the ER
If you do need to go to the ER, a migraine diary — a log of your attacks, including triggers and symptoms — comes in handy, as does a migraine action plan you have created with the doctor who treats your migraine. This should include a brief history of your disease and the medications that have worked for you in the past. “It’s helpful, because you have everything laid out for you, so the person who’s taking care of you has more information,” says Armand. Even so, ER doctors may want to do CT (computed tomography) scans, a spinal tap, or other tests, so be prepared for those. You also should be prepared to advocate for yourself: Research published in March 2022 found people with migraine face a stigma and invalidation of their symptoms, even from medical providers who aren’t experienced with the disease. Armand suggests bringing a family member who can speak on your behalf, because it can be hard to advocate for yourself when you’re in pain. “I’ve had patients tell me that after advocating for themselves ferociously, a brain bleed was found, when they were kind of shrugged off as ‘just migraine,’” says Armand. “They told me it’s because I told them not to take no for an answer. If you know something’s not right, you have to speak up.”
When you shouldn’t go to the ER for migraine
Even a terrible migraine attack doesn’t necessarily require medical attention. Plus, if you aren’t having a true medical emergency, being in a hospital may actually make your symptoms worse, according to Armand. In that environment, you’ll be exposed to noise and bright lights that can trigger symptoms; you won’t have the same ready access to food, beverages, and other comforts you have at home; and it won’t be easy to relax, turn off the lights, or sleep when you need to, explains Armand. If you’re having a migraine attack that’s typical for you, it’s likely better to call your doctor than go to the hospital, even if your symptoms aren’t responding to your regular treatment or last more than three days, she adds. A migraine attack that lasts this long is called intractable migraine (or status migraine), according to the American Migraine Foundation, and usually requires a combination of treatments, including nonsteroidal anti-inflammatory drugs, anti-nausea meds, and triptans. Your doctor can screen you to make sure you don’t need emergency medical attention and then find the right targeted treatment. “They can give you medication that will keep you out of the emergency room,” says Armand.
