The prospect of going to the emergency room for migraine can be enough to intimidate any patient, even if you are equipped with records of your medical history, an extensive migraine toolkit to manage symptoms or pain, and the latest guidelines for migraine treatment in the ER. Therefore, it is critical to be aware of the possible signs of an emergency migraine attack or when it may be a more serious condition, so you are able to seek immediate and proper treatment.

An Abnormal Migraine Attack

Is my pain and any other symptoms new or extreme?

Although a migraine attack often yields unpleasant and even debilitating symptoms, certain symptoms may be immediate signals that require emergency medical attention. Many doctors recommend visiting the ER for what you might describe as “the worst headache of your life.” How a patient defines that will vary and could be influenced by numerous factors such as new or dangerous symptoms, severity or duration of pain, abruptness of an attack, or ineffectiveness of medications, among others. Headache symptoms may not even be associated with migraine at all, but rather a more serious condition such as brain aneurysm or concussion. Symptoms to watch for include:

• Confusion, memory loss, trouble speaking or slurred speech
• Extreme dizziness
• Fever
• Numbness, paralysis, weakness, loss of balance
• Stiff neck
• Persistent vomiting or diarrhea
• Respiratory issues
• Loss of consciousness
• Loss of vision (not related to aura) or other extreme changes in vision
• Worsening pain that doesn't respond to medication or normal relief techniques

Always document your symptoms and keep written records of what is "normal" for your migraine attacks so that you can share them with your doctor. It is important to remember that symptoms often differ from one attack to the next and the presence of a new symptom or trigger does not necessarily indicate something more dangerous, but you still want to be mindful when there are abnormalities.

Signs of Another Serious Condition

Are other circumstances or conditions causing my head pain?

Occasionally, an episode might seem like a migraine attack but may actually be related to another condition or triggering event. Some examples include:

Physical Injury or Trauma
If you have recently experienced trauma to the head—regardless of severity—it is possible you may have suffered a concussion or traumatic brain injury (TBI); this could very well cause of any associated head pain. Even injuries that seem mild at the time may still have long-term consequences for the brain. If you have experienced any type of vehicle accident or fall, it is always best to have a doctor check for non-visible injuries, particularly any involving your head. Certainly, if any of your symptoms are extreme or persist, then you should consider going to the emergency department.

Stroke
Migraine (especially hemiplegic migraine) and stroke can share similar symptoms—such as headache, numbness on one side of the body, dizziness, and loss of vision—which may make it difficult to distinguish between them. Specific migraine subtypes have also been linked to higher rates of stroke, further blurring the line these two conditions. In cases where stroke-like symptoms present themselves, especially if they are new or severe, it is always best to exercise extreme caution and call the emergency department.

Pregnancy
Although natural physical changes and hormonal swings are common with pregnancy-related migraines, severe headaches may actually signal life-threatening birth conditions such as preeclampsia. This pregnancy complication results in high blood pressure that may place both mother and child at risk for organ failure. You should seek medical attention for any abnormal head pain during pregnancy.

Medication Reactions
Migraine severity may also be affected by medication changes. Although most safely switch to new medication with minimal side-effects, some experience allergic reactions. These reactions may begin with head pain and mild symptoms, but if ignored these signs can quickly worsen. Always consult your doctor and discuss potential side effects and reactions before taking a new drug.

An Unbreakable Migraine Attack

Am I having a prolonged attack that is unresponsive to medication?

Attacks that last for days and do not respond to medication can be especially terrifying, and stopping the pain—even if it is not deemed abnormal or severe—can constitute an ‘emergency’ for many patients. Most rely on abortive medication, the first line of medications intended to be taken at the beginning of an attack. However, if these stop working it may become necessary to seek medical attention or, in cases of extreme pain or symptoms, go to the ER. Some experts have suggested that first contacting your doctor or utilizing a local urgent care may be worthy alternatives in instances where an attack may be prolonged but is not considered life threatening. We recommend working with your doctor or specialist to develop a plan for dealing with these scenarios, which may include alternative medication options, after hours contact information for your doctor, as well as nearby emergency or urgent care centers that are able to provide appropriate treatment.

Read the Latest Migraine Treatment Guidelines in the ER ➜