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When Is A Migraine An Emergency

When To Go To The Emergency Room For A Headache Or Migraine

Migraine Treatment in the Emergency Room: A Q& A with Dr. Katherine Hamilton

Headache is one of the most common reasons for an emergency room visit. Some people go due to 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. You may seek attention to make sure there is no chance of another problem such as aneurysm or meningitis. A severe headache that starts very suddenly can mean another disorder such as stroke.

New symptoms such as a fever, weakness, vision loss or double vision, or confusion are some of most concerning symptoms. If you have a new symptom and serious, life-threatening medical problems such as liver, heart or kidney disease, are pregnant, or have a disorder that affects your immune system such as HIV infection, an ER visit may be more essential.

For many patients, an ER visit for headache or Migraine happens after a long period of severe headache lasting days or weeks. After long time of experiencing severe headaches, you may reach the last straw and no longer be able to deal with the problem.

ER doctors are not specialists in headache and Migraine, and their goals are to make sure there is no serious, life-threatening problem and help reduce suffering. Different ER doctors have different ways to treat acute headaches and Migraine: there is no universal protocol for emergency treatment of headache disorders.

When going to the ER, be sure to mention:

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Ethics Approval And Consent To Participate

The study conformed to the revised ethical principles of the Helsinki declaration and the Codex rules and guidelines for research. The present study is based on patients who participated in the inpatient assessment and treatment program in the Emergency department San Luca Hospital of Istituto Auxologico Italiano, Milan, Italy and the Ordensklinikum Barmherzige Schwestern, Linz, Austria. During their first appointment all patients participating in the survey provided written informed consent to use their data for the quality control, and to publish the data in anonymized form as part of the quality control process. Therefore, an ethics approval was not obtained for the present analysis.

Items To Bring With You

Aside from always having your migraine kit fully stocked and with you , you should also have the following items in one place and easily accessible somewhere in your home. That way you dont have to look for them when you are in the grips of a debilitating migraine attack and need to get to the emergency room quickly.

  • A letter from your headache doctor explaining your diagnosis, and a full history of your illness. Include your doctors contact information in case the ER doctor has questions for them. If you do not have a headache doctor, make sure the advocate who comes with you is prepared to vouch for you when you describe your symptoms and medical history. It is optimal if your physician documents in the letter what medications you have responded to and tolerated in the past and which drugs have been poorly tolerated or havent worked.
  • A full list of your medications. Try to bring them with you as well.
  • Your headache/migraine diary.
  • An advocate. A trusted friend or family member has a dual rolethey can care for you and ensure you get to the hospital and home again safely. But they can also ensure medical questions are answered fully, remember any important instructions, and can make sure you get the care you need.

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How Do You Know When A Migraine Is 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 can’t move your body. Trouble with speech, confusion, seizures, personality changes, or inappropriate behavior.

An Unbreakable Migraine Attack

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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.

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What Patients Can Expect In The Er And How Can They Can Advocate For Better Treatment And Care

Patients with migraine who begin to experience severe and unusual symptoms should visit the ER to get treatment and seek relief from their symptoms. However, ER physicians do not specialize in headache medicine, so the medication and treatment they provide may not be as effective as a trip to a neurologist or headache specialist. Dr. Katherine Hamilton, Headache Fellow at the Montefiore Headache Center, explains when is the appropriate time for patients with migraine to go to the ER and what they can expect there.

What Causes Migraine With Nausea And Vomiting

The who and why of migraine attacks are already a bit of a mystery, but symptoms can be Clue level head-scratchers. Even though nausea tops the list of migraine symptoms for many people, why this happens is not clear-cut. The good news is experts have a few theories that shed light on the link between migraine and nausea.

A migraine commonly includes things like nausea, but sometimes vomiting and diarrhea too. Jack Schim, M.D., F.A.H.S., F.A.A.N., co-director of the Neurology Center of Southern California, tells SELF that experts think at least part of this is due to migraine affecting different brainstem areas involved in autonomic functionsthe things your body just does automaticallysuch as digestion. The idea is that migraine attacks irritate the nerves that activate this system, triggering those not-so-fun symptoms.

Another theory according to Medhat Mikhael, M.D., pain management specialist and medical director of the non-operative program at the Orange Coast Medical Centers Spine Health Center, is that migraine decreases serotonin levels in the brain, which is believed to contribute to nausea. Serotonin is generally known as the happy chemical keeping our mood on an even keel . So, its no surprise that a decrease in our feel-good chemicals could have noticeable side effects. Dr. Mikhael also says that a decrease in serotonin can trigger motion sickness, another uneasy feeling.

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Going To The Emergency Department

Going to the emergency department is usually a difficult experience. This may be the worst place on earth for a person with migraine . Strong lights, noises, smells. Uncomfortable chairs. Long wait times. A migraine attack might not be a priority when people are there with broken bones and heart attacks. Still, it should be treated with empathy and appropriate care. Its not always the case.

Severe attacks can force a person with migraine to go to the Emergency. Here are a few comments on this tough situation.

When To Visit The Emergency Room For A Migraine Attack

Migraine: Presentation & Diagnosis â Emergency Medicine | Lecturio

Patients are often confused as to whether or not they should visit an emergency room for their symptoms. A migraine may not constitute an emergency in some cases, but it is important to know when to visit the emergency room. At Express ER in Abilene, we encourage patients to seek emergency care if they dont know what to do about their symptoms.

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What Is Migraine Headache

A migraine is an intense headache that is often characterized by a pulsing or throbbing pain in one place and it often lasts for several hours or a few days. The pain may also be accompanied by vomiting, nausea, or sensitivity to light and sound, and it may be preceded by tingling in the arms or legs, blind spots or flashes of light.

Some people are hesitant to visit an emergency room for migraine or a bad headache, but it can be debilitating and extremely painful. If you are suffering from a severe headache, you may need medical attention from an emergency room physician.

Migraines can cause severe pain or painful pulsing sensation. It normally occurs on one side of the head and is often accompanied by vomiting, sensitivity to light and sound, and nausea.

Migraine attacks can last anywhere from hours to days and the pain could be so severe that sufferers are unable to function during the attacks.

Whats A Migraine Kit You May Ask

You may be eloquent and have no problem telling your doctor any issues you may be experiencing or your most recent symptoms. However, what happens if you experience a particularly bad migraine, visit the emergency room and have to explain your symptoms or medical history while in severe pain? This may affect your ability to describe your past or present treatments or symptoms.

An emergency migraine kit containing all the important information helps you and healthcare providers unfamiliar with your case to assist you without exerting yourself.

So, what goes into a migraine ER kit?

Start with a binder that contains all relevant and important information, including:

  • Your doctors name and contact information

  • A list of your allergies

  • A list of past and current medications

  • Your treatment protocols

Additionally, pack tinted glasses to help obstruct the harsh lighting commonly used in waiting rooms, earplugs for the noise, and a bottle of water, to stay hydrated.

You should also have someone, be it a friend, family member, or your partner, with you in the emergency room. Having them there will not only make you feel better its also practical. They can help you take notes if you cannot and share any information or symptoms you may have experienced. They can also help you get home safely.

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Severe Migraines Deserve An Er Visit

Go to the ER if you are experiencing severe migraine symptoms, or symptoms such as confusion, fever and vision changes, neck stiffness, trouble speaking or numbness or weakness, even if other symptoms of migraine are present . Always go to the ER if a headache begins suddenly and reaches maximum intensity within a minute or two. If you recognize your symptoms as those of a typical migraine attack, you may be better served to treat yourself at home, based on the treatment plan you and your headache specialist have drafted together. If you dont have a rescue plan, then speak with your physician to develop one so that you can avoid going into the ER. A trip to the ER may even exacerbate a migraine or provide only temporary relief only to have the pain roaring back within hours after leaving the ER.

What Triggers A Migraine

Migraine: Presentation &  Diagnosis  Emergency Medicine ...

Some people find that migraines are triggered by certain things, including:

  • missing meals this is the strongest dietary trigger
  • eating certain foods, such as cheese, chocolate, citrus, red wine and food additives
  • altered sleep patterns too much or too little sleep
  • changes in the weather
  • hormonal changes, such as menstruation, and the oral contraceptive pill for women
  • alcoholic drinks

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D Assessment Of Methodological Quality Of Individual Studies

The Cochrane Collaboration Risk of Bias tool will be used to assess the internal validity of the randomized controlled trials and nonrandomized controlled trials.20 The tool examines six domains and categorizes the overall risk of bias. Each separate domain is rated âyes,â âunclear,â or âno.â

Blinding and incomplete outcome data will be assessed separately for subjective outcomes and objective outcomes . âOther sources of biasâ will include stopping early for benefit and comparability of groups at baseline. The overall assessment is based on the responses to individual domains. If one or more individual domains are assessed as having a high risk of bias, the overall score will be rated as high risk of bias. The overall risk of bias will be considered low only if all components are rated as having a low risk of bias. The risk of bias for all other studies will be rated as unclear. In addition to assessing the risk of bias, we will record funding sources for each included study.

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 .

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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.

What If I Require Tests

Headache (Emergency Medicine) â Emergency Medicine | Lecturio

Many urgent care facilities offer a wide range of diagnostic services, such as digital X-rays, laboratory testing , and electrocardiography .

If the emergency medicine physician deems that you require specialized care or further investigation, they can help to coordinate your care with a neurologist or pain management specialist, who can devise a treatment plan that can mitigate your migraine attacks.

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Which Injectable Medications Should Be Considered First

Acetaminophen

We identified three studies of IV acetaminophen .- In one class 1 study, in which 60 patients were randomized to acetaminophen 1000 mg or placebo, a comparable number of patients were pain free at 2 hours. In the acetaminophen arm, 4/30 patients had minor adverse events.

In a class 2 study, in which 200 patients were randomized to acetaminophen 1000 mg or dexketoprofen 50 mg, pain scores were comparable 15 and 30 minutes after medication administration. There were no adverse events in either group.

In a class 3 study of 148 patients, propacetamol 1000 mg, a prodrug of acetaminophen, outperformed rizatriptan 5 mg PO at 60 minutes, though not at 30 or 120 minutes. In this study, adverse events were not reported.

Acetylsalicylic Acid

We identified four randomized studies of intravenous acetylsalicylic acid.- A class 2 study randomized 275 adults to 1 gm acetylsalicylic acid, sumatriptan 6 mg SC or placebo. Sumatriptan and acetylsalicylic acid both outperformed placebo. Sumatriptan also outperformed acetylsalicylic acid. However, the latter was tolerated as well as placebo, with significantly fewer adverse events than sumatriptan.

A class 2 study randomized 40 adults to 1 gm of lysine acetylsalicylic acid or 800 mg of valproic acid. Pain relief at 1 hour and sustained pain freedom for 24 hours were comparable between the groups. No adverse events were reported in either arm.

Chlorpromazine

Dexamethasone

Dexketoprofen

Diclofenac

Dihydroergotamine

Diphenhydramine

When To Go To The Emergency Room For Migraines

Its common to think that emergency rooms are filled with people who want to saw their legs off or have a tree branch stuck in their chest cavity . Not to say that these bizarre situations have no chance of happening in real life theres always a probability that something may happen.

However, you may be shocked to know the most common reason for emergency room visits are headaches, or more specifically, migraines.

When you think of headaches, you may think of a dull pain in your head that may sometimes be caused by fatigue, hunger, or dehydration. Migraines, however, can be very intense and may result in vomiting and nausea, sensitivities to sound and light, pain, and vertigo. These arent your typical headaches that go away on their own.

Visiting emergency rooms with severe migraine may be discomforting. However, when you experience migraine problems or chronic headaches that do not go away even after treatment, you probably should go to the emergency room. Theres even more reason to if you have experienced any new or unusual symptoms.

Keep in mind that a serious headache that starts suddenly could mean a stroke. So, having your symptoms checked to rule out a stroke or other issues isnt necessarily a bad idea.

How do you know, though, when you need to go to the emergency room for a severe migraine?

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