Going To The Er For Migraine Is Not The Best Choice
Medical Review:David Watson, MD
A hot topic just about anywhere Migraine is discussed is going to the ER for Migraine treatment. The discussions generally arent positive, and thats not on the shoulders of the Migraine patients. They are simply trying to get help.
One problem that adds to problems with emergency room treatment is that too many people are essentially using the ER in place of their family doctors. Faced with a busy schedule, rather than take time during a weekday to go to the doctor, they wait and go to the ER. Especially during times such as flu season, this can mean that the ER is flooded with patients who could have been treated by their family doctors.
The goal of Migraine treatment should always be the best relief in the shortest time with the fewest problems. Thus, the ER is not the best choice.
There are many reasons to not go to the ER for Migraine:
Any of us can get to the point of having to go to the ER with a migraine on rare occasions, but for most of us with Migraine, theres no reason to have to go even a few times a year if we have a good treatment regimen. A good treatment regimen has three types of treatments:
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.
What Are The Symptoms
The main symptom of a migraine is a throbbing headache on . You also may feel sick to your stomach and vomit. Activity, light, noise, or odors may make the migraine worse. The pain may move from one side of your head to the other, or you may feel it on both sides at the same time. Different people have different symptoms.
Some people have an before the migraine begins. When you have an aura, you may first see spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb. The aura usually starts about 30 minutes before the headache. But most people don’t have auras.
Recommended Reading: How To Beat Migraines Naturally
When To Worry About A Migraine & Seek Emergency Medical Attention
If you have a diagnosis of migraine and the headache that you are experiencing is similar to your previous headaches, there is likely no need to seek medical attention unless you are unable to cope with the pain or to relieve it with strategies used at home. However, if your migraine persists for more than 72hrs, it is appropriate to contact your Headache physician or, if unavailable, to seek treatment in the Emergency Department for a condition known as Status migrainosus. Status migrainosus is defined as a migraine lasting greater than 72hrs without a pain-free interval. Status migrainosus tends to be treated differently than shorter migraines and often requires intravenous treatments that are administered in an infusion center or hospital setting.
It is important to recognize that, even if you have a diagnosis of migraine, it is possible for you to experience other headaches. If your headache is different from your migraines, then it is usually best to bring the new headache to medical attention. In cases where you experience a different headache that is also severe or has alarming features, an emergency visit for your migraine may be warranted.
Sequence And Combination Of Therapies
Stepped care within attacks is a treatment plan in which medications are added depending on patient response. Stratified care based on severity is a treatment plan in which all of the anticipated medications are given up front. Patients have improved outcomes with stratified care.
Until we have further evidence to guide our medication combinations, treating the patient with multiple medications that have independently been found to be efficacious at the onset of his or her ED visit is recommended over stepped care .
Read Also: Va Rating For Migraine Headaches
First: Is There A Dangerous Cause
Is the headache similar to their prior headaches in character, location, magnitude, timing, associated symptoms? Are there concerning features ? Was it maximal at onset ? I find it helpful to ask: what were you doing when it started? how bad was it when it started? when was it the worst? and only after listening for a while, I backdoor into whether it is typical for them . Ive gotten myself in trouble by asking up front if its the same as usual or worst headache of your life even if they dont mean to, patients sometimes seem like they are trying to validate why they came to the ED . Of course, none of these questions are black and white and theres a lot of room for clinical judgment one minor deviation from typical headache does not mandate imaging. Patients come to see us for our expertise and often find it reassuring that weve listened and examined them and arent concerned.
Understand What Treatments You Have Tried For Migraines
If you have any particular preferences for treatment, be sure to express those to your emergency care provider. For example, you may have received treatments that have been effective in the past, or you may not want to get an intravenous line. If you have received medication for migraines in the past and have experienced side effects from this medication, you should make this known. It will be important to make your care provider aware of these details, so that they can choose a treatment option that you are comfortable with and that is safe.
- Orr SL, Aubé M, Becker WJ, et al. Canadian Headache Society
- systematic review and recommendations on the treatment of migraine pain in emergency settings. Cephalalgia 2015 35:27184.
- Colman I, Rothney A, Wright S, Zilkalns B, Rowe BH. Use of narcotic analgesics in the emergency department treatment of migraine headache. Neurology 2004 62:1695700.
- Sumamo Schellenberg E, Dryden DM, Pasichnyk D, Ha C, Vandermeer B, Friedman BW, Colman I, Rowe BH. Acute Migraine Treatment in Emergency Settings. Comparative Effectiveness Review No. 84. AHRQ Publication No. 12- EHC142-EF. Rockville, MD: Agency for Healthcare Research and Quality. November 2012
- DAmico D, Moschiano F, Bussone G. Early treatment of migraine attacks with triptans: a strategy to enhance outcomes and patient satisfaction? Expert Rev Neurother 2006 6:108797.
You May Like: Piercing For Migraine
What Are The Possible Side Effects Of Medicines Given In The Er To Treat Migraines
Researchers found that the side effects from these medicines are usually minor and temporary. Some of the medicines can cause drowsiness, so you may not be able to drive right away. More information is listed below for each type of medicine when it is taken a single time in the ER for a severe migraine.
- Neuroleptics/Antiemetics: Restlessness in the legs or body is a common side effect. A possible serious side effect is uncontrollable muscle movements, such as tics and tremors.
- Sumatriptan: The most common side effect is pain or swelling at the place where the shot was given. Other side effects can include redness in the face and neck, a burning feeling, feelings of tightness , and drowsiness.
- NSAIDs: Side effects are not common with these medicines.
- Opioids: Tiredness and drowsiness are common side effects.
- Dihydroergotamine: The most common side effects include pain or swelling at the place where the shot was given or where the IV needle was put in, drowsiness, stomach problems, nausea and vomiting, and an irregular heartbeat.
- Dexamethasone: Side effects were not common with this medicine in the research studies. But, possible side effects can include nausea, headache, dizziness, and trouble sleeping.
Note: There are other possible side effects of these medicines. The side effects listed here are the most common side effects when the medicines are taken a single time in the ER for a severe migraine.
What Can Cause A Migraine
Doctors are not sure what exactly causes migraines. But, many things can trigger a migraine. Different people have different triggers, which can include:
- Stress or anxiety
- Changes in hormones
- Bright lights, loud sounds, and strong smells
- Certain foods, such as chocolate, cheese, salty foods, or processed foods
- Food additives such as MSG or aspartame
- Not getting enough to eat
- Not getting enough sleep
- Some medicines
Recommended Reading: Can You Get A Fever With A Migraine
You Have To Prove Your Pain And That You’re Not A Drug Addict
The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that’s escalating annually. ERs are trained to screen us all the same: hmmm, could you be one of the 36 million opioid abusers worldwide?
That complicates the problem of Migraine as an invisible illness for which there’s no scan or blood test to easily prove your diagnosis. The stigma continues.
“They think you are there because you are a “druggie”, ask you a million and one questions that you can’t answer because of the migraine fog.” Jaselle H.
“They assumed I was a drug addict because I was in my mid-twenties and writhing in pain with “no discernible reason”. Then I got an IV and froze for a few hours before going home.” Lorenzo T.
“I’m allergic to normal migraine meds and when I told them that, the doctor stormed out, came back with a syringe, gave it to the nurse and told me that he’d give me Demerol this time to help get rid of the headache but that I’d better never come back again because he was never giving me that med again. He said if I wanted it, I’d have to get it from someone else. It was the first and only time I’d gone to the ER for a migraine. I was so insulted and demeaned, I would never go back again. I couldn’t believe it.” Andi S.
Signs & Symptoms Of Serious Headaches
It can be difficult to decipher whether or not you should seek ED care for a headache. Some headache features are considered red flags, in that the symptoms and signs associated can indicate a serious underlying cause for the headache. On the other hand, experiencing a red flag symptom does not necessarily mean that the headache is life-threatening or that you are in need of ED attention. In some circumstances, the presence of one of these red flags may warrant an immediate ED visit, while in others, it may be best to address your concerns with your primary care provider or your Headache physician. It is not possible to provide specific advice about where to seek care for each possible scenario. If you are unsure, you can always call a health information line for advice.
Physicians often use the acronym SNOOPY to keep track of headache red flags . If your headache is different from your typical migraines and has one of the red flag features described in the acronym, it is reasonable to seek medical attention. Some of the features to be concerned about when experiencing a headache include the following:
N: Neurologic symptoms & signs: If you have neurological signs or symptoms with your headache, you should seek medical attention. Examples of concerning neurologic signs or symptoms include: Seizures, trouble with vision, lack of coordination or new clumsiness, impairment in strength on one side, impairment in level of consciousness or persistent vomiting.
Don’t Miss: Excedrin Migraine For Back Pain
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 paineven if it is not deemed abnormal or severecan 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.
When Is A Migraine Serious
The following headache symptoms mean you should get medical help right away: A sudden, new, severe headache that comes with: Weakness, dizziness, sudden loss of balance or falling, numbness or tingling, or cant move your body. Trouble with speech, confusion, seizures, personality changes, or inappropriate behavior.
Also Check: How To Beat Migraines Naturally
Why Is This Medication Prescribed
Sumatriptan injection is used to treat the symptoms of migraine headaches . Sumatriptan injection is also used to treat the symptoms of cluster headaches . Sumatriptan is in a class of medications called selective serotonin receptor agonists. It works by narrowing blood vessels in the brain, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, and other symptoms of migraine or cluster headaches. Sumatriptan does not prevent migraine attacks or reduce the number of headaches you have.
What Are The Side Effects Of Ed Pills
The most common side effects of ED drugs, in order of most to least common are headache, flushing, upset stomach, nasal congestion, vision problems, diarrhea, dizziness, and rash. A man who has an erection that lasts four hours or more needs to get to a hospital or risk permanent damage.
None of the ED drugs is safe to take with cardiac drugs called nitrates because it could cause a dangerous drop in blood pressure. Drugs that many men take for urinary symptoms, called alpha blockers, can also lower blood pressure, so take them at least four hours apart from ED drugs. Your doctor may start you on a smaller dose of the ED drug if you already take an alpha blocker or may recommend the alpha blocker tamsulosin , which affects blood pressure less.
Also Check: Does Aspartame Cause Migraine Headaches
Where Does The Information Come From
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.
Limit The Use Of All Pain Medicines
- Do not use prescription pain medicine for headaches for more than nine days in a month.
- Do not use non-prescription pain medicine for more than 14 days in a month.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
Read Also: What Is Wrong With Excedrin Migraine
The Symptoms And Triggers Of Migraines
You may not be sure if the severe headaches you are experiencing are, in fact, migraines. Unfortunately, many migraine sufferers go undiagnosed for an extended period of time, primarily because they believe they are simply dealing with very bad headaches.
However, there are some distinguishable symptoms of migraines that may make you a candidate for infusion therapy, such as:
- A headache that induces severe radiating or throbbing pain
- Nausea and/or vomiting
- Visual auras
- An aversion to sound, light, and movement
While there are many triggers that can contribute to your migraine episodes, the most common include:
Diagnosing Migraines In The Er
If you are ultimately diagnosed with a migraine during your visit, it is also reasonable to ask the healthcare provider if there are any infusion centers available in the community for the next time that you experience a severe migraine that does not resolve with treatment at home . Along the same lines, if you do not have a community provider to look after your migraines, you can ask the healthcare provider for a referral to a specialist, or for resources in the community to help you optimally manage your migraines in the long term.
If you are a patient who frequently develops migraines, or who often has headaches, it may be worth asking the physician if steroids would be beneficial for you. In some patients, steroids have been shown to be beneficial at preventing a rebound or bounce-back headache within the days following discharge from the ED.
Also Check: What Triggers Migraines With Aura