A migraine is a severe headache, often causing throbbing pain on one side of the head. This intense pain can be accompanied by symptoms such as nausea, vomiting, and heightened sensitivity to light, sound, and smells. While many individuals experience migraines, certain presentations can signal a more serious underlying condition. This article guides readers in understanding when an emergency room visit is necessary.
Urgent Signs for Emergency Care
A sudden, severe “thunderclap” headache, peaking within seconds or minutes, warrants immediate medical attention, as it can indicate a brain hemorrhage. Migraines with new neurological symptoms also require urgent evaluation. These include weakness on one side, numbness, difficulty speaking, vision changes not typical of a migraine aura, or confusion.
A migraine with fever, stiff neck, rash, or changes in mental status could indicate a brain infection like meningitis. Experiencing a migraine after a head injury is another red flag, potentially indicating internal bleeding or trauma. The “worst headache of your life,” especially if new or different from previous migraines, should prompt an immediate ER visit.
Persistent vomiting or diarrhea accompanying a migraine can lead to severe dehydration, which may require medical intervention. If a migraine does not respond to usual treatments and has worsening symptoms not typical for you, seeking emergency care is advisable.
Assessing Your Migraine’s Uniqueness
Understanding your typical migraine pattern is important for deciding if emergency care is needed. A migraine significantly different from your usual experiences in severity, pain location, or accompanying symptoms warrants careful consideration. For instance, a first-time severe headache requires professional evaluation to rule out other causes.
New aura symptoms, such as motor weakness or difficulties with speech, that you have not experienced before with your migraines are concerning signs. While some aura symptoms are common, new or unusual neurological deficits require assessment. If your usual migraine medications are proving ineffective and your symptoms are escalating or causing significant distress beyond your typical experience, this change in pattern is also a reason for concern.
Your ER Visit
Upon arrival at the emergency room for a severe migraine, you will undergo triage. Medical staff will evaluate your symptoms and check vital signs to determine urgency. An ER physician will take a detailed medical history and perform a neurological examination to assess reflexes, strength, coordination, and mental status.
To rule out serious conditions like stroke, hemorrhage, or meningitis, diagnostic tests may be performed. These include a CT scan or MRI of the brain, and sometimes, a lumbar puncture to analyze cerebrospinal fluid.
ER treatment aims to alleviate acute symptoms. This often includes intravenous (IV) fluids for hydration, anti-nausea medication, and pain relievers. Specific migraine abortive medications may also be given intravenously or intramuscularly.
The goal of ER treatment is to reduce the pain to a manageable level, allowing you to go home and rest, rather than achieving complete pain freedom. After initial treatment, the ER staff may provide recommendations for follow-up care, often suggesting a consultation with your primary care doctor or a neurologist for ongoing management.
When to Seek Non-Emergency Medical Advice
Not every severe migraine warrants an emergency room visit. There are situations where contacting your primary care doctor or neurologist is the more appropriate course of action.
If you experience increased frequency or severity of typical migraines, contact your primary care doctor or neurologist to adjust your treatment plan. If current medications are no longer effective, your doctor can explore alternatives.
New or worsening side effects from migraine medications should prompt a call to your healthcare provider. To explore new treatment options or preventative therapies, schedule a non-emergency appointment.
If migraines significantly impact your daily life or quality of life, a doctor can help devise strategies. Concerns about migraine triggers or management strategies not acute emergencies are best addressed during a routine medical consultation.