When to Go to the Emergency Room for Migraine
Migraine affects an estimated 14 to 15 percent of the world's population. It is a leading reason why people decide to go to the emergency room. Keeping track of your regular symptoms will help you recognize any signs that should prompt a trip to the emergency room. These signs may include:1-3
- Sudden severe pain
- Confusion
- Trouble speaking (if this is a new symptom)
- A stiff neck
- Numbness or weakness
- Changes in vision (if different from your typical migraine-related vision changes)
- Numbness or weakness
- Fever
There are four serious complications of migraine that these signs may point to:3
- Status migrainosus
- Migrainous infarction
- Persistent aura without infarction
- Migraine aura-triggered seizure
This or That
Have you gone to the emergency room for migraine?
What is status migrainosus?
Status migrainosus is a migraine that lasts more than 72 hours. The symptoms can be similar to typical migraine symptoms, but they are often more intense. People who have status migrainosus might have higher rates of disability. The recurrence rate of status migrainosus is high and can lead to chronic migraines.4,5
Having migraine symptoms for so long can affect your physical and mental health. If nausea and vomiting are among your symptoms, you can become dehydrated. You may feel depressed if you believe there will be no relief from your pain and suffering.4,5
The exact cause of status migrainosus is not clear. Some triggers that may cause symptoms include:4,5
- Lack of sleep
- Skipping meals
- Stress
- Medicine changes
What is migrainous infarction?
Migrainous Infarction is when a stroke due to a blood clot happens during a migraine. Experts do not know whether the migraine causes the stroke or vice versa.6,7
Migrainous infarction always takes place with aura. Aura is a sensory disturbance that sometimes precedes a migraine. About 25 percent of people with migraine experience aura. Aura can include:6,7
- Blind spots
- Flashes of light
- Changes in vision or vision loss
- Numbness
- Weakness
- Difficulty speaking
- Tingling in your face or hands
If you have migraine with aura, you are about twice as likely to have a stroke in your lifetime compared to those without migraine. However, the overall risk linked to migraine is still very low. You are far more likely to have a stroke because of risk factors like high blood pressure or smoking. An MRI or CT scan will show evidence of a stroke.6,7
What is persistent aura without infarction?
Aura symptoms that last more than a week without signs of a stroke are called persistent aura without infarction. Stroke should be ruled out by an MRI or CT scan. Persistent aura without infarction is rare, but it can last months or even years.8
If you have new, odd, or frightening symptoms, tell your doctor. This is particularly important with persistent aura without infarction because symptoms can be similar to a stroke.8
What is a migraine aura-triggered seizure?
Seizures that take place during or within 1 hour of a migraine with aura are called migralepsy. These are rare events, and it can be hard to know for sure whether you have one. A seizure in the occipital lobe of the brain can have visual symptoms similar to a migraine with aura. Make an appointment with a neurologist if you are concerned about migraine aura-triggered seizure.5,9
What happens when you visit the emergency room?
The three main goals of treating migraine in the emergency room include:5
- Relieving pain
- Relieving other symptoms related to migraine
- Helping you return to normal functioning
The doctors in the ER will work toward a full resolution of your symptoms – or as close as possible. The ideal is to lower the risk of migraine attacks recurring or turning into chronic migraine. For some people with migraine, only a modest relief of migraine symptoms is possible.5
If your doctor suspects you have had a stroke, they will order an MRI or CT scan.5
What treatments are typically used in the ER?
The most highly recommended drugs used in the ER to treat migraine include:5
- Acetaminophen, like Tylenol
- Nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil
- Triptans
Triptans work by aiding blood flow in the brain. Triptans also affect how part of your brain releases neurotransmitters, which are chemicals that nerve cells use to communicate with each other. This can limit pain signaling. Triptans are typically given by IV, by injection, or under the skin (subcutaneously).5,10
The American College of Emergency Physicians recommends avoiding the use of opioids or barbiturates for migraine at the ER. The use of these drugs has been linked to many negative outcomes.5
It is common to give intravenous (IV) fluid in the ER along with these other treatments. However, it is unclear whether IV fluids improve outcomes.5
What should you do at home after an ER visit?
Your ER doctor may give you a prescription for a drug that can be used at home during future attacks. They also might suggest a few lifestyle changes, including:5
- Improving sleep habits
- Reducing alcohol consumption
- Staying hydrated
- Limiting caffeine
- Meal planning to avoid hunger
- Increasing weekly exercise
Doctors often recommend keeping a symptom diary to identify triggers for migraine. A diary can also help you figure out what actions or habits might protect against migraine.5
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