What is a migraine emergency?

What is a migraine emergency?

Two years ago I was doing some last-minute shopping the night before Thanksgiving day.  I started experiencing a prolonged aura that could have been the early signs of a stroke.  After an hour of progressively worsening symptoms, my husband took me to the local ER for evaluation. All the tests were clear, so I was sent home with instructions to return if the symptoms recurred. Fortunately they never did.  Even though it was a “false alarm”, that’s one ER trip I will never regret. Knowing the signs of a true migraine emergency is essential for every migraineur and caregiver.


People who say “Migraines don’t kill” have obviously never heard of these life-threatening complications, any one of which can be deadly if not diagnosed early and treated aggressively. We get so accustomed to tolerating the pain that it’s easy to forget how dangerous migraine can be sometimes. We take for granted that “…at least it’s not fatal” when we should be much more vigilant.

Migraines can kill.

There are four potentially life-threatening complications of migraine. Even though they are rare, learning to recognize the symptoms is essential for every migraineur. Knowing what to look for helps determine when it is appropriate to seek emergency help.

If you do end up in the ER with these symptoms, it is critical that you (or your caregiver) be able to clearly explain the symptoms that you are experiencing so that you get fast response to either rule out problems or get emergency treatment right away.

  1. Status migrainosus
  2. Migrainous infarction
  3. Persistent aura without infarction
  4. Migraine aura-triggered infarction

Status migrainosus

Any migraine attack that lasts longer than 72 hours should be evaluated by a doctor. Even if you are able to sleep through the attack or get temporary relief from taking medication, you still need to get it checked out.  Doctors will want to rule out stroke and administer treatments to break the cycle. Sometimes long-lasting migraine attacks are caused by other problems such as medication overuse headache. However, status migrainosus must be ruled out first.

Persistent aura without infarction

Anytime we have an aura that lasts for 1 week, we should get it checked out. Again, your doctor should rule out stroke before giving this diagnosis. On rare occasions, persistent aura without infarction can last for years.

Migrainous infarction

This is what doctors are trying to rule out in order to make a diagnosis of persistent aura without infarcition. It appears like a typical migraine with aura except that the aura lasts for longer than 60 minutes. When tested, an MRI or CT scan will show evidence of a stroke. This is distinct from the increased risk of stroke in younger patients (under 30) with migraine with aura.

Migraine aura-triggered seizure

The name is pretty self-explanatory. It is a seizure that is triggered by a migraine attack and typically occurs within the first hour during or after a migraine attack. Patients with epilepsy often experience migraine-like headaches just as the seizure is ending. When a seizure follows a migraine attack, is it commonly referred to as “migralepsy”, although the more accurate diagnosis is migraine aura-triggered seizure.

Of the four complications of migraine, only status migrainosus is seen in patients with migraine without aura. The other three are only seen in migraine with aura. Since none can be accurately diagnosed without at CT scan or MRI and time may be critical, the ER is best equipped to determine the level of your emergency, rule out life-threatening issues, and provide the right interventions should you experience one or more of these migraine complications.

Print off this article.
Memorize these symptoms.
One day your life may depend on it.

 

In addition to the situations listed above, please ensure that you discuss any symptoms that are new or different with your physician or a healthcare professional. While migraine symptoms can change over time, it is essential to rule out any other underlying causes for your symptoms.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. The International Classification of Headache Disorders, 3rd edition (beta version), Cephalalgia 33(9) 629–808. Reprinted with permission from International Headache Society, 2013. DOI: 10.1177/0333102413485658.

Comments

View Comments (10)
  • helenb
    1 month ago

    Re:Rebound headaches; I had to go to the emergency dept. because of rebound headaches. The Dr. gave me a shot in the hip for this. I can’t remember what the name of the medicine was, but it stopped them. 🙂

  • Lind3aA
    3 months ago

    What about a migraine that does not respond to any meds in the arsenal at home? I have at times wondered how much suffering is necessary to justify seeking immediate medical attention.

  • algebra
    12 months ago

    I had a hemiplegic migraine in 1984. Scared me so much I have been taking low-dose aspirin ever since. Wonder if anybody else is doing this?
    I was post-Partum at the time. Years later when I went through menopause I had a migraine 24/7 for years. Finally stopped after 6 weeks on Effexor, prescribed for hot flashes. Didn’t do anything for the hot flashes but the migraines stopped.
    Personality changes from the SSRI made me stop the Effexor. Now I use tofu and shrimp to boost my serotonin levels.

  • seagypsy
    2 years ago

    I have intractable migraine (2nd round for me, now going on nine months). I’ve been to the ER and the CT scan was normal. According to the doc, it was just “really bad stress” from work. I wanted to smack the man. I lost my job the following Monday because this stress headache had caused me to pass out at work from the worst migraine pain in my life and I got a very expensive ambulance ride to that ER. That was last September. I had worsening symptoms so my neurologist required another MRI that showed a Chiari Malformation I, and I was off to see a neurosurgeon. It was not “bad enough” to require surgery. It has been six months since I lost my job, nine months since the intractable migraine started, and I cannot leave my house because the symptoms basically make my life intolerable.

    My PCP and neurologist don’t know what to do and refuse to do anything about the pain. I’m going to be 49 in a few weeks and tried to self-harm earlier this week. So, I don’t qualify as having any of the four migraine emergencies, but migraines can certainly kill you… Even if it works months instead of moments.

  • Newdancerco
    1 year ago

    I wish I had seen this months ago. I am in a similar position, job loss and all. My Neuro is also at a loss (for me, after years of worsening chronic migraine) and I have been basically housebound for months.
    I just want you to know you are not alone. And thank you for letting me know I’m not, either!

  • Deby
    1 year ago

    I also have Chiari 1, and I lost my job too. I was also told that it wasn’t bad enough for surgery, but it was bad enough to make me lose my job. I am 61 years old and have gone to different neurologist and finally they told me it was nothing more they could do for me. I live on Imitrex, migraine Excedrin and Vicodin. I’m waiting for pot to be sold in this state, it’s already legal but not for sale yet. I’m anxious to try the CBD and see if it works for me. You should check into that , Hopefully there’s a miracle out there for us somewhere. Prayers going out for you.

  • mason1776
    2 years ago

    The article says migrainous infarction only occurs in patients who experience an aura with their migraine. I beg to differ! I’ve had migraines since age 10. Never had an aura. Two months after my 40th birthday, I had a stroke caused by my migraines.

    Clearly their are exceptions to every rule. Guess I must be one. Been hospitalized a couple of times since my stroke because my neurologist was concerned about another migraine-induced stroke. Bottom line: Always and Never statements can be misleading!

  • Lisa Riley
    2 years ago

    I have auras that last for hours. They often hit 6-8 hours before the pain, and last until the pain arrives. If I were to go to the ER every time I had an aura, I’d live in the ER, as it happens 15-20 times a month; sometimes more if the weather is very active. As far as status migrainosus and no aura…I still have aura. I am an odd case, and I realize that. But I live in a place with not many neurologists, and fewer who treat migraines. You do what you do, and you go on.

  • LillieLynne
    3 years ago

    Last Wed was D day for me. I have been hospitalized due to severe migraines six times this year alone. My blood pressure is always extremely high as in 270 over 149,and numbers close to this. I will typically have a seizure. And it is always combined with vertigo. MARV or MAV. I cant take the heat nor the sun. We have been to the beach 2 times because my husband works and I am on Disability due to 6 TIAS from the migraines. He loves the beach, I hate it. The glare of the sun on the water is too much it will always trigger one. I get them often enough and severe enough that my cardiologist and my Neuro now say I am a danger on the road and my license has been suspended. Each time I was hospitalized this year I had minor strokes and we have been told that one day I will have one that will kill me. So, believe the article when it says they can be deadly. Most people think that its just a head ache or you are just being a baby, but that’s not so. They have no real idea of the pain and damage that they can and due cause. Im currently getting botox treatments and I do not feel that I see any change. I encourage you to never let it get so bad that you do not go in, I think they do not need to see me weekly. But I often have to go for infusion therapy at the neuros office, if I can make the trip due to the vertigo. They have come very close to killing me 3 times this year. Be vigilant tell your doctor of unusual symptoms, keep a journal.

  • Trena Anderson
    3 years ago

    WOW! Just, WOW! I think that your response just answered why, and what type of stroke I had at the age of 36. I knew that my migraines and recent diagnosis of seizures were closely related but your comments have answered many questions for me. Thank you! I’m very sorry that you are suffering so terribly! My neurologist hasn’t even discussed just how serious, or possibly deadly, this can be. I always refuse to go to the ER. After reading this article and your experiences I believe I may look at my situation differently. Thank you for sharing your experiences.

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