When Should You Go to the ER for a Migraine?

Migraines can be debilitating. According to the American Migraine Foundation, at least 39 million Americans live with the neurological disease.

Worse than your traditional headache, migraines can include moderate to severe head pain that causes throbbing or pounding. And you may experience other symptoms like nausea, vomiting, fatigue, dizziness and sensitivity to light, noise and certain smells.

To top that off, most migraines can last between four hours and several days. And the pain can affect your overall quality of life, impacting your both personal and professional life. So, when you’re hit with a migraine you may be tempted to race to the ER.

But is that always the best move?

Neurologist Payal Soni, MD, explains when you should go to the ER for a migraine and what to expect when you’re there.

When should you go to the ER with a migraine?

While the pain of a migraine can be very severe, a migraine itself can’t cause something as serious as death.

However, in some cases, a severe headache might be a sign of a more serious underlying condition like a stroke, a hemorrhage or an infection.

If you’re experiencing new symptoms or a new level of pain, you should head to the ER.

Signs of a medical emergency accompanied by a migraine

Typically, you should work with your primary care doctor or a migraine specialist to figure out a rescue or preventative plan when it comes to managing your migraines.

But there are some red flags that migraine sufferers should watch out for that warrant immediate emergency care. These red flags include:

You’re experiencing the worst headache of your life

Sure, you’ve had headaches before. But if you’re having the worst headache of your life that doesn’t respond to or continues to worsen after treatment, it may be time to head to the hospital.

You develop a thunderclap headache

What’s a thunderclap headache? It’s an intensely painful headache that develops in less than a minute, versus a gradual worsening of a headache over several hours. You may also experience vomiting, nausea and fainting in addition to pain. A thunderclap headache could be a sign that something’s wrong, so it’s important to get it checked out.

You have a headache with neurological problems

If you have a headache that’s associated with new neurological problems, like weakness on one side of the body, balance problems, dizziness, confusion, loss of vision or slurred speech, it’s time to head to the ER.

You get a headache after a head injury

When you get a concussion, it’s common to get a headache. But after your head injury, if you experience another headache within seven days, you could have a post-traumatic headache. This type of headache is typically accompanied by trouble concentrating, mood and personality changes and dizziness.

You have a headache and you have a serious medical condition

You should be extra cautious when it comes to migraines if you have medical conditions like heart disease, liver disease, kidney disease or a history of strokes. Migraines or unusual headaches may point to a life-threatening change in your health.

Should you go to the ER for a migraine while pregnant?

Some people experience a reduction in their migraine attacks during pregnancy.

But for others, they may experience migraines for the first time or not see a reduction in their attacks.

A study shows that people who are pregnant and have migraine attacks may be more likely to experience certain complications, including:

• Developing high blood pressure while pregnant, which may lead to preeclampsia.
• Delivering your baby at a low birth weight.
• Having a cesarean delivery.

It’s important to talk to your doctor about any migraines you experience, which most likely can be treated at home with medications (it’s important to know what you can and can’t take during your pregnancy).

But if you’ve never had a migraine before, have a headache that won’t go away, have a headache with high blood pressure or have a headache with vision changes, you should head to the ER.

Migraine treatment at the ER

If you head to the ER for migraine treatment, the medical team will run tests to make sure there isn’t a more serious condition. Those tests can include an eye exam, blood or urine tests, a CT scan, MRI or spinal tap.

They will ask about your symptoms, medications or supplements you’ve taken recently and if you’ve used any migraine treatments before to relieve your pain.

You may also receive medication through an IV to help with your pain and any other symptoms. Medications can include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen and corticosteroids.

What is a “migraine cocktail”?

You may have heard of a “migraine cocktail.” This may be used during your ER visit to help alleviate pain and discomfort.

A “migraine cocktail” is a combination of different medications, which are typically given through an IV. Medications that can be included in a “migraine cocktail” can include:

• Triptans.
• Antiemetics. 
• Ergot alkaloids.
• NSAIDs.
• IV steroids.
• IV magnesium.

“Migraine cocktails can help to break up a headache cycle not responding to typical at-home rescue treatment, also called ‘status migrainosus,’” says Dr. Soni.

Overall, while migraines can be painful and disrupt your life, you should be able to treat most attacks at home and avoid an ER visit.

But it’s important to listen to your body and what symptoms you’re experiencing. If the pain is severe and accompanied by new symptoms, then it’s time to head to the ER.