A migraine is a neurological condition often characterized by severe headaches that can be accompanied by other debilitating symptoms. While many individuals experience migraines regularly, not every migraine attack necessitates emergency medical attention. Understanding the distinct signs and circumstances that warrant immediate care is important for effective management and to rule out more serious underlying conditions.
Understanding Typical Migraine Symptoms
A typical migraine attack often begins with a throbbing or pulsating headache, usually on one side of the head, though it can affect both. Individuals frequently experience heightened sensitivity to light (photophobia) and sound (phonophobia), which can make ordinary environments feel overwhelming. Nausea and vomiting are also common accompanying symptoms.
Some people experience an “aura” before or during a migraine, involving temporary sensory disturbances. These can manifest as visual changes, such as flashing lights, zigzag lines, or blind spots. Other symptoms include tingling sensations in an arm or leg, or difficulty with speech. These symptoms develop gradually and last less than an hour.
Immediate Emergency Symptoms
Certain migraine-like symptoms require immediate medical evaluation, as they may indicate a more serious condition. A sudden, extremely severe headache that reaches peak intensity rapidly, often described as the “worst headache of your life,” is a “thunderclap headache” and requires urgent assessment. This can signal a subarachnoid hemorrhage or other serious neurological events.
A headache accompanied by a fever, a stiff neck, or an altered mental state (confusion or disorientation) warrants immediate medical attention. These combined symptoms could point to meningitis or encephalitis, serious brain and spinal cord infections. New neurological deficits with a migraine, such as weakness or numbness on one side, difficulty speaking, or new vision changes different from typical aura, also require emergency care. These may suggest a stroke or TIA. Seizures with a headache also require immediate medical evaluation.
When to Consult Your Doctor
While not every migraine requires an emergency room visit, specific situations warrant consulting your doctor. If your migraines are increasing in frequency, becoming more severe, or significantly impacting daily life despite your current treatment, discuss these changes with your provider. This may indicate a need to adjust medication or explore new preventive strategies.
If you experience a new type of headache different from your usual migraines, or if typical migraine medications no longer provide relief, consult your doctor. These changes may suggest a shift in your headache pattern or an underlying issue needing investigation. Your doctor can differentiate between benign changes and those requiring further diagnostic evaluation.
What to Expect at the Hospital
Upon arriving at the emergency department for severe migraine symptoms, medical staff will conduct a thorough physical examination, including a detailed neurological assessment. This evaluation identifies signs of neurological impairment that may suggest a more serious condition. The medical team will ask about your headache history, including onset, characteristics, and associated symptoms.
To rule out conditions like stroke, hemorrhage, or brain infections, diagnostic tests may be performed. These can include a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan, which provide detailed images of brain structures and soft tissues. Depending on initial findings, a lumbar puncture (spinal tap) may be considered to analyze cerebrospinal fluid, especially if meningitis or encephalitis is suspected.