When to See a Doctor for Your Migraine? Or the ER?

With Migraines, there are times when one of our more difficult decisions can be whether we need to see a doctor.

Or maybe we need to go to the emergency room? When we're in pain and / or having other awful symptoms, the last thing we want to do is to go somewhere. There are times, however, when we really do need to play it safe and be seen by a doctor, either or own doctor or an ER physician.

Statistically, the headache and/or other symptoms of a Migraine are usually painful and disruptive, but not truly dangerous. However, headache and some other Migraine symptoms can also be symptoms of other conditions, some of them pretty benign, some more serious. We need to be sure that any symptoms we have aren't symptoms of another condition that could need immediate medical care.

I want to approach this methodically and logically, so I'm going to start with circumstances that indicate that we need to seek medical care. Then, I'll go on to whether we should call our own doctors or head to the hospital.

WHEN?

We should consult our doctor if:

• our Migraines are severe or begin suddenly.
• we have more than the occasional Migraine or headache.
• we have Migraines or headaches accompanied by any of the following (and haven't discussed them with our doctor previously):
  • confusion;
  • dizziness;
  • fever;
  • numbness;
  • shortness of breath;
  • slurred speech;
  • stiff neck;
  • persistent vomiting;
  • unexplained symptoms affecting our ears, nose, throat, or eyes;
  • unremitting diarrhea;
  • vision loss;
  • weakness; or
  • paralysis.
• we have a Migraine or headache that keeps getting worse and won't stop.
• our Migraines interfere with our normal activities - not just work, but family and social activities as well.
• we find ourselves taking acute medications for our Migraines more than two days a week or if the recommended dosage isn't adequate.
• coughing, sneezing, bending over, or sexual activity cause headaches or trigger a Migraine.
• our Migraine symptoms change.

We should see our doctor or seek emergency care immediately if:

• we're having our worst Migraine or headache ever.
• our Migraine is accompanied by:
  • unresolved loss of vision,
  • loss of consciousness, or
  • uncontrollable vomiting.

WHERE?

Should we see our doctor or go to the ER?

It pays to discuss these issues with our doctors in advance. Whenever I begin treatment with a new doctor, I ask these questions at my first appointment:

• Are there particular symptoms that indicate that I should call your office?
• Are there particular symptoms that you want me to treat as an emergency?
• If these symptoms occur during office hours, what should I do?
• If these symptoms occur after hours, on a weekend, or on a holiday, what should I do?

If you haven't asked your doctor those questions, write them down so you can ask them at your next appointment. Your doctor should be willing to help you set up a plan for what to do under various circumstances. If he or she isn't, it's time for a new doctor.

Let me make a point here. Emergency rooms are for emergencies. They are not a replacement for our own doctors. When we're having symptoms that make us wonder if we need to see our doctor, we shouldn't wait to see if they stop or wait until it's convenient. We shouldn't wait until evening or the weekend, then end up going to the ER for something that should have been handled by our own doctors. One reason the wait is so long in emergency rooms is that too many people put off calling their own doctors or use the ER in place of their own doctors.

There are other reasons to see our own doctors rather than going to the ER when our doctors can handle the situation:

• Our doctors know us and our medical history. The can provide us with better and more complete care than the ER doctors can.
• Our own doctors will understand that we're having a Migraine, bypassing the whole "maybe this patient is a drug seeker" problem.
• We don't face the long wait in our own doctor's offices that we would in the ER.
• There are most likely fewer patients with contagious illnesses for us to be exposed to in our own doctor's offices than in the ER.

That said, there are times to go to the emergency room. Most doctor's offices don't have imaging equipment, so your doctor may recommend the ER for your "worst Migraine ever" so an imaging study can be performed to rule out other issues. Many doctor's offices don't keep the medications needed to treat a long or severe Migraine in their offices. This is something we can know in advance by asking our doctors before the situation arises.
DON'T ASSUME

So many of the symptoms we can experience with a Migraine can also be symptoms of other medical issues, some of them severe and potentially dangerous. As I said above, statistically, the symptoms of Migraines are unlikely to be dangerous, but that's not always the case, and none of us wants to be on the wrong end of those statistics. Consider a couple of real-life examples:

Subarachnoid hemorrhage:

Several years ago, I watched an interview with actress Sharon Stone on The Oprah Show. Stone shared a truly frightening experience. In September of 2001, she developed a terrible headache. She thought it was a Migraine but was concerned because she'd never had one that bad before. She tried to call a friend to take her to the hospital, but he was out, so she left him a message and curled up on her sofa. When she finally got to the hospital, doctors discovered that she had a subarachnoid hemorrhage. If she hadn't gotten to the hospital when she did, it probably would have been too late. On Oprah, Stone said, "If you have the worst headache you've ever had, go to the hospital because by the time you get to the hospital, you're as far gone as you wanna be."

Stroke:

Also in 2001, I was hosting an online live chat, and a 21-year-old woman I'd been trying to help joined the chat. She was on day three of a severe Migraine, and we all urged her to get off the computer and get her parents to take her to the ER. She explained that her sister was having serious problems, and her parents had accused her of faking the Migraine to get their attention. Two days later, she had a Migrainous stroke. A few weeks after that, she had another Migraine that caused a Migrainous stroke that was fatal. You can read more about this horrible even in I Still Remember Abi and Her Last Migraine.

In the end, it's best to plan ahead, and don't take chances.

I realize the decisions of when to seek care and whether to go to our own doctors or the ER can be tough decisions. Migraines vary so much from one person to the next that we really can't outline clear-cut "rules" for what to do when. This is another reason to learn as much about our Migraines as possible and work as treatment partners with our doctors. The knowledge and working relationship with our doctors will help us make good decisions.