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Can You Go To The Doctor For Migraines

Causes & Risk Factors

The Migraine Guy – What to Expect at the ER

Migraine can be caused by a number of different biological mechanisms and environmental factors. The biology behind migraine is complex and not fully understood. It involves the activation of trigeminovascular pathways and central parts of the brain including the brain stem . The trigeminovascular system controls sensation in your face and jaw which is why trigeminal disorders cause head pain. The brain is thought to be in an altered state of excitability, which can also lead to disruptive symptoms like nausea, light sensitivity and aura .

Neurotransmitters are chemical messengers that communicate between neurons. These play a very important role in brain function . When the brain is more sensitive, neurotransmitters can become overactive and trigger pain signals.

Neurotransmitters also control things like hunger, wakefulness, anxiety and focus. This causes many of the prodromal symptoms , and also causes nausea, photophobia, and phonophobia during an attack. The difficulty in migraine treatment arises because there are often many different neurotransmitters active during an attack. Some patients may be more responsive to treatment that addresses their serotonin neurotransmitters, while others might find treatment more effective if it inhibits calcitonin gene-related peptides .

What Questions Should I Ask My Healthcare Provider

  • Will my child grow out of their migraines?
  • What medications do you recommend for me?
  • What should I change about my lifestyle to prevent my migraine headaches?
  • Should I get tested?
  • What type of migraine do I have?
  • What can my friends and family do to help?
  • Are my migraines considered chronic?

A note from Cleveland Clinic

Migraine headaches can be devastating and make it impossible to go to work, school or experience other daily activities. Fortunately, there are some ways to possibly prevent a migraine and other ways to help you manage and endure the symptoms. Work with your healthcare provider to keep migraines from ruling your life.

Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.

References

They Say Theres Nothing More You Can Do

Ill never forget hearing an interview at the Migraine World Summit with neurologist David Dodick, MD. He said it would take a lifetime for migraine patients to truly run out of treatment options.

With new medications and neuromodulation devices coming out recently, options for people with migraine are expanding rapidly.

If a doctor tells you that youve tried everything and theres nothing more that can be done, all that means is theres nothing more that they can do for you.

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See Your Doctor As Soon As Possible If You Experience Any Of These Troubling Symptoms

We all get headaches from time to time. They can be brought on by annoying but manageable reasons such as stress, dehydration or your menstrual cycle, or they could be the result of an ongoing medical issue, such as migraines.

But how can you tell when a headache is a symptom of an even more serious or life-threatening problem? Here are some signs to look for.

How Do You Prepare For Contingencies Concerning Transient Aphasia

So true! It is exhausting to get a new doctor for this ...

Living with migraines can be unpredictable for many people, even more, if you experience aura symptoms like transient aphasia which can interrupt your life.

You can do a little planning in case of an attack:

  • Prepare and create a simple text or text signal you can give to a trusted support person when you start to have symptoms.
  • Identify a few of your loved ones or friends who are capable of helping you. Contact them in case of emergencies and make sure they know how they can help. Do this before youre in the middle of transient aphasia symptoms.
  • Include in your plans what to do if youre not at home.

Living with migraine with aura symptoms like transient aphasia is very complicated and at times very scary. Coordinate with your doctor to rule out other conditions with similar symptoms and to obtain a treatment plan. Once seizures and stroke are no longer an issue after a complete check-up, then we can reach the diagnosis of migraines with aphasic aura.

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I Am Due To Get My First Vaccine Next Week And I Am Worried That I Might Have My Typical Migraine Later That Evening Will I Be Able To Treat It With My Usual Medications

It is always a good idea to have a treatment plan in place should a migraine attack strike. There is no reason to suspect that any migraine-specific medications such as triptans , ditans , or gepants would reduce the vaccines effectiveness. But this combination has not been studied. We dont recommend that you take over-the-counter medications such as acetaminophen or aspirin, alone or in combination with caffeine , or ibuprofen , before or within 24 hours after receiving the vaccine since these medications may decrease the immune response to the vaccine. Similarly, certain prescription anti-inflammatory medications or those that combine acetaminophen or aspirin with butalbital and caffeine may also reduce the effectiveness of the vaccine.

As always, check with your healthcare provider for advice regarding treatment options.

What Medications Are Used To Relieve Migraine Pain

Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine.

Three over-the-counter products approved by the Food and Drug Administration for migraine headaches are:

  • Excedrin® Migraine.
  • Advil® Migraine.
  • Motrin® Migraine Pain.

Be cautious when taking over-the-counter pain relieving medications. Sometimes overusing them can cause analgesic-rebound headaches or a dependency problem. If youre taking any over-the-counter pain medications more than two to three times a week, report that to your healthcare provider. They may suggest prescription medications that may be more effective.

Prescription drugs for migraine headaches include:

Triptan class of drugs :

  • Butterbur.
  • Co-enzyme Q10.

Drugs to relieve migraine pain come in a variety of formulations including pills, tablets, injections, suppositories and nasal sprays. You and your healthcare provider will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.

Drugs to relieve nausea are also prescribed, if needed.

All medications should be used under the direction of a headache specialist or healthcare provider familiar with migraine therapy. As with any medication, its important to carefully follow the label instructions and your healthcare providers advice.

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Not All Hospitals And Emergency Rooms Are Alike Some Are Lifesavers

Although it’s a fairly common complaint among ER patients, the space and process are designed to prioritize and treat life-threatening conditions, not Migraine. And to be fair, sometimes they do everything right.

“I have been to our local hospital here several times for a migraine. Couldn’t have been better cared for. The nurses turned the lights off and gave me a cool cloth to put over my eyes while I waited for the Dr. He gave me a shot of Imitrex and I have been taking the pills ever since. Changed my life. I was told that I would never have to wait out in the waiting room, there was always a cool dark room to wait in. Also, when I get the chills as I often do with migraines, they bring me heated blankets.” Roberta C.

“They know me, and someone way back must’ve educated the ER staff I’ve only had 1 bad experience on the 16 years I’ve been having these. It happened to be a just awful nurse that was showing her need to retire ” Hollyanna C.

“Luckily I get treated pretty well at the ER for migraines. Give me some meds and a drip and 5 mins later I feel great. With all the other “patients” that go to the ER they know I’m for real. Around here it’s a lot of people who think they are pregnant, or have a toothache that go to the ER. Mainly because they don’t have insurance.” Meg W.

“My last visit to the ER for migraine was very straightforward and helpful. Checked out, IV fluids, Toradol, Compazine actually was a good experience .” June B.

Getting The Most Out Of Your Appointment

How to Prevent Your Migraines

The first time you visit your doctor to talk about your headaches, he or she will probably want to know:

  • details of your headaches and any other symptoms
  • what aggravates the headache
  • how often you have attacks
  • what brings them on
  • when you first started having these symptoms
  • if there is anyone else in your family who gets similar headaches
  • what treatments you have tried.

To get the most out of your appointment, try to:

  • give your doctor as much information as possible about your condition. It may help to keep a migraine diary, or at least to write some information down before the appointment.
  • keep a record of the impact your migraines are having on your life, both during and in between attacks. The doctor will only understand how disabling the condition is if you tell him or her.
  • remember that migraine is a very individual condition. There is a wide range of treatment options available, and with perseverance you will hopefully find the right one for you.
  • help your doctor to help you, by keeping him or her up to date with advances in management and treatment of migraine .

Many people with migraine get the condition for years migraine is a long-term condition. Many doctors will appreciate patients who ask questions, give feedback, provide information, and try to self-manage their condition.

Read Also: What Is A Migraine Headache

What Will This Summary Cover

This summary will cover:

  • Medicines to treat severe migraines in the ER
  • What researchers have found about how well the medicines work
  • Possible side effects of the medicines
  • Things to talk about with the ER doctor

Note: This summary does not cover what researchers found about treating migraines at home or ways to prevent migraines. It only covers what researchers found about treating migraines in the ER.

Should You Go To The Emergency Room For A Migraine

Headache is one of the most common reasons for an emergency room visit. Some people go due chronic headache or Migraine problems that do not go away with treatment, and in other cases, headache is a symptom of another medical problem. The best reason for an ER visit is for unusual symptoms that are new to you.

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When Should I Go To The Emergency Room For A Headache

You may have a headache emergency if you are experiencing the following:

  • severe headache with sudden onset
  • headache pain that feels like an explosion or thunderclap
  • severe headache that is clearly your worst-ever headache
  • headache pain that is becoming worse and won’t go away
  • persistent headache after an injury to the head
  • headache accompanied by any of these symptoms: a stiff neck, severe pain when bending over, confusion, convulsions, loss of consciousness, or persistent, severe vomiting

Where Does The Information Come From

When You Go to the Doctor for Help but He Cant See ...

Researchers reviewed studies on medicines to treat migraines in the ER. These studies were published through January 2012. The researchers were funded by the Agency for Healthcare Research and Quality , a Federal Government research agency.

The researchers wrote a report on what they found, and this summary is based on that report. The report was reviewed by doctors, researchers, other experts, and the public. You can read the report at www.effectivehealthcare.ahrq.gov/migraine-emergency.cfm.

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Treatment Of Migraine In The Er

The primary role of an ER is to evaluate and treat conditions urgently. If you go to the ER for a migraine and have any unusual symptoms, the ER doctor will likely order brain imaging to rule out a stroke or aneurysm.

If you dont have any unusual symptoms, you may not need any diagnostic imaging tests. Your ER doctor will instead ask you questions about your headache and the medications you currently take.

If needed, your ER doctor can provide medications to help temporarily alleviate your migraine until you can see your regular doctor.

Headache medications can be given intravenously or intramuscularly. These include:

  • antiemetics to help relieve nausea and pain
  • dihydroergotamine, which is specifically used for prolonged migraine treatment
  • nonsteroidal anti-inflammatory drugs and steroids to reduce inflammation and pain
  • sumatriptan, which provides urgent migraine relief
  • valproic acid, an anti-seizure medication used for headache relief

Sometimes, an ER doctor may prescribe you opioids, but this is rare. This is because of potential side effects and risk of dependence.

In addition to pain-relieving medications, your ER doctor may provide fluids via IV if youre experiencing dehydration.

Should I Go To An Emergency Room For A Migraine

If you are having nausea and vomiting, or if your migraine is lasting for days, then you do not need to go to an emergency room and you can get the help you need at urgent care. However, if you have a fever, stiff neck, or neurological symptoms such as weakness, speech difficulty, or convulsions, then you need to be seen in an emergency room.

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Can Migraines Be Prevented Or Avoided

Medicine to prevent migraines may be helpful if your headaches happen more than 2 times a month. You may want to consider this medicine if your headaches make it hard for you to work and function. These medicines are taken every day, whether you have a headache or not.

Preventive medications for migraines can include prescription drugs often used to treat other ailments. Anti-seizure medicines, antidepressants, medicines to lower blood pressure, and even Botox injections are some of the preventive medications your doctor may prescribe. Calcitonin gene-related peptide inhibitors can also help prevent migraines. They do so by blocking a gene-related peptide in your sensory nerves. This peptide is known to increase during a migraine attack, so blocking it can help prevent migraines.

There are also a number of non-medical treatments designed to help minimize migraine pain and frequency. One is an electrical stimulation device, which has been approved by the FDA. It is a headband that you wear once a day for 20 minutes to stimulate the nerve linked to migraines. Another non-medical treatment is counseling aimed at helping you feel in more control of your migraines. This counseling works best when paired with medical prevention of migraines, as well.

What Else Can I Do To Prevent Migraines

When To Consult A Doctor About Headaches

While there are no sure ways to keep from having migraine headaches, here are some things that may help:

Eat regularly and do not skip meals.

  • Keep a regular sleep schedule.
  • Exercise regularly. Aerobic exercise can help reduce tension as well as keep your weight in check. Obesity can contribute to migraines.
  • Keep a migraine journal to help you learn what triggers your migraines and what treatments are most helpful.

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Headache Red Flags: When To See Your Doctor

Although painful and often disabling, the vast majority of headaches are not due to worrisome underlying problems. However, the presence of certain symptoms suggests the need to be evaluated by your doctor. These headache red flags include:

  • Thunderclap Headache: very severe headache that reaches its maximum severity immediately . Thunderclap headaches require emergent medical evaluation.
  • Positional Headache: headache that substantially changes in intensity in association with changes in position e.g. standing from lying or vice-versa.
  • Headaches Initiated by Exertion: headache starting while coughing, sneezing, and/or straining.
  • New Headaches: especially if older than 50 years of age, or if there are medical conditions that make worrisome headaches more likely .
  • Substantial Change in Headache Pattern: significant increase in headache frequency or significant change in headache characteristics
  • Constant Headache Always in the Same Location of the Head
  • Headache that never goes away
  • Systemic symptoms: including fever, chills, weight loss, night sweats
  • If any of these headache red flags are present, your doctor will want to evaluate you by asking questions about your headaches and general health, and by performing physical and neurologic examinations. Based upon these assessments, your doctor will be able to determine if further tests are needed.

    Todd J. Schwedt, MD, FAHS, Professor of Neurology, Mayo Clinic, Phoenix, AZ.

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    When Do You Need To See Your Doctor For Transient Aphasia

    Transient aphasia symptoms during migraine with aura should reverse entirely on their own and wont cause any permanent damage. However, when you are having difficulty with your speech and language skills for much longer, it can be a warning sign of other severe conditions that require immediate attention.

    What are these conditions that need urgent medical care?

    • Seizures or transient ischemic attack
    • Stroke

    The clear danger here is the possible arrival of a stroke. How do you detect if this is the case?

    • If you develop aphasia that refuses to go away within an hour
    • If it comes on with other symptoms, such as weakness or a facial droop

    If any of these two severe warning signs appear anytime. You should seek immediate medical attention as these are possible signs of an oncoming stroke.

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    There Have Been Recent News Stories That People Who Have Received Facial Fillers Should Avoid The Moderna Vaccine Because They May Have A Severe Allergic Reaction Should I Be Worried About A Similar Reaction If I Get Botox Injections As Treatment For Migraine

    Facial fillers are implants doctors inject beneath your skin to reduce wrinkles. While there have been reports of people who have had facial fillers developing temporary swelling of their face after receiving the Moderna vaccine, its important to note that Botox® is not a facial filler. Please refer to question 5 to learn more about Botox® and the Moderna vaccine.

    People with facial fillers having a reaction is not totally surprising since vaccines work by activating our immune systems so that they can fight infections. In these cases, the vaccine caused the persons immune response to increase and the body started to fight against the fillers which it saw as a foreign substance. As always, check with your primary care or cosmetic doctor before getting the vaccine.

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