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When Should You Go To The Hospital For A Migraine

What Are Migraine Headaches

The Migraine Guy – The ONE Thing You Should Do If You Go To The Emergency Room

Migraine headaches are severe headaches that cause intense pain. They can start suddenly and get worse quickly. A migraine headache typically lasts from 4 hours to 3 days if not treated. Migraines are thought to run in families.

Symptoms of a migraine headache can include:

  • A severe headache, often with throbbing on one side of the head
  • Sensitivity to light or sound
  • Nausea and vomiting
  • Difficulty doing physical activities like walking or climbing stairs

Do You Really Need Urgent Care For Migraines

You may still be wondering if you need urgent care for migraines. For many, going to the urgent care for migraines is their last option.

This is because persons tend to seek out other means of getting rid of a migraine. Be it tea, getting hydrated, getting rest, meditating, exercising, dieting or just trying to wish it away. Many have tried it all until there is nothing left to do.

When you finally make that trip to an urgent care facility, be sure to mention your symptoms and any medications you are currently taking. Be sure to say whether or not you are presently chronically ill, about to have a baby or diagnosed with a sexually transmitted disease, plus other details that your urgent care provider will be sure to ask.

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.

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What Is Happening During A Migraine

A migraine can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. Its often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

What To Tell Your Doctor About Your Headaches

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According to the headache expert Peter Goadsby, MD, PhD, a professor of neurology at the UCLA Goldberg Migraine Program in Los Angeles, a valuable tool in diagnosis is your headache history.

A thorough history, aided by your detailed notes, can pinpoint causes, triggers, and even potential solutions. Make careful notes about your headache experiences before you go to the doctor. Include the following:

  • When the headaches occur
  • What, if anything, makes them feel better or go away
  • Whether sound, light, or noise bother you during headaches
  • Whether there are any changes in your vision before or during headaches, such as blurriness, black spots, or flashes of light
  • How well you slept the night before your headache
  • If you are a woman, when your headaches occur in relation to your menstrual cycle
  • Any unusual weather at the time of your headaches
  • Food or drink that you have consumed in the 24 hours before the headache
  • Activities you were engaging in when the headache began or just prior to it
  • Previous headache diagnoses and treatments youve tried

Dr. Goadsby recommends using a monthly calendar so that the pattern of headache days is clearly visible to you and your doctor.

If you are having severe or disabling headaches, dont wait a full month to call for an appointment make notes about what you recall or are experiencing and see a doctor as soon as you can.

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When Does A Headache Need To Be Seen At The Hospital

As a neurosurgeon, I encounter a lot of people who are concerned with ruptured brain aneurysms . Ruptured brain aneurysms typically present with severe headache. I am incessantly asked, When is a headache more than just a headache? When should I go to the hospital?

A headache is considered to be pain located anywhere in the region of the upper neck or head. It is one of the most common locations of pain in the human body and can have many difference causes. There are three major categories of headaches which include primary headaches, secondary headaches, and cranial neuralgias which can be associated with facial pain.

  • Primary headaches include tension, migraine, and cluster headaches.
  • Secondary headaches are those due to something affecting the underlying structure of the head and neck. Causes include bleeding in the brain, tumors, meningitis, and encephalitis.
  • The third type of headaches which involve neuralgias and facial pain are usually caused by inflammation of the nerves in the head and neck.

Migraine headaches are the second most common type of primary headache and are also more common in women than men. They are associated with unilateral headache, nausea, vomiting, and sensitivity to light.

Headaches are treated differently depending on the type, cause, and nature of the headache.

When should a headache be treated?

Why should a headache be treated?

Chaim Colen is a neurosurgeon. He can be reached on Twitter .

I Had Side Effects With Something They Gave Me What Can I Do To Avoid That In The Future

Some medications used in the ER can cause side effects :

  • Anti-emetics acting on dopamine: somnolence, restlessness, dystonic reactions , low blood pressure
  • Cortisone: restlessness, insomnia
  • Opioids: somnolence, constipation, muscle spasms

Sometimes, drugs are given to make the person sleep, and somnolence can last for hours. Driving may not be safe when you leave the ER. Consider finding a safe way to get back home.

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Can You Be Hospitalized For Migraines

But a migraine that lasts for more than 72 hours is called status migrainosus. To treat it, you may need to go to the hospital to get help relieving the pain and dehydration from vomiting. A typical migraine can sometimes turn into status migrainosus if: You dont get treatment early enough after the attack starts.

How Long Is Too Long For A Migraine

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How long is too long for a migraine? A typical migraine lasts between four and 72 hours. If a migraine lasts longer than 72 hours, it is paramount to consult with a doctor. Also, if a person experiences 15 or more headache days per month, a doctor may diagnose this individual with chronic migraines.

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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

When To Go To The Er For A Headache Or Migraine

When to Go to the ER

Everyone gets an occasional headache. In most cases, you can get rid of it by taking an over-the-counter pain killer, drinking water, or taking a nap. Even those who suffer from frequent migraines dont need to run to the hospital every time they feel one coming on.

However, there are instances when a headache may be a sign that there may be something significantly wrong with your head. How can you recognize some of the symptoms, and when is it time to go to the Emergency Room?

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What Will They Do For Me There

First, the physician will evaluate you and check that there is no other cause for the severe headache. If tests are needed they can be done.

Many treatments have been studied for migraine in the Emergency Room context. The advantage of the ER is to use IV medicines. Some medications used include:

  • Hydration with IV fluids
  • Anti-emetics: Gravol, metoclopramide, prochloperazine, odansetron
  • NSAIDs: ketorolac can be given IV
  • Cortisone can be used, usually to prevent recurrence
  • DHE
  • Opioids should be avoided but are still used too frequently

Some physicians in the ER can also do nerve blocks to treat the attack. Occipital nerve blocks may work for some people.

If the situation is very difficult, a neurology consult can be required.

Should I Go To The Hospital To Get Rid Of My Migraine Until I Can Get To The Doctor

When Should You Go to the ER with a Migraine (With images ...

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When Should I Call An Ambulance

Most headaches are not serious. But headaches can also be a sign of a serious illness, such as a stroke or meningitis.

  • it comes on suddenly, is very severe, or has made you lose consciousness
  • you have suffered a head injury
  • you have trouble seeing, walking or speaking
  • your arms or legs feel numb
  • you have nausea or vomiting
  • you have a high fever
  • you are sensitive to light and have a new rash

See Your Physician Immediately Or Go To An Emergency Department If:

  • You are having the worst headache ever
  • You are having your worst migraine attack ever
  • Your headache is accompanied by the following symptoms: Unresolved loss of vision Loss of consciousness Uncontrollable vomiting The pain of your headache lasts more than 72 hours with less than a solid four-hour pain-free period while awake You experience a headache or a migraine attack that presents unusual symptoms that are abnormal for you and frightening
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Signs Of A Tension Headache

A tension headache is the most type of headaches. It involves a mild to moderate pain around your head that can be managed with over-the-counter medications. They usually involve a dull pain or sensation of pressure across your forehead or the sides of your head and they are relatively short in duration.

Tension headaches may also be chronic if you get them frequently. If they are manageable with ibuprofen and rest, you generally wont have anything to worry about but if they last for hours and you get them almost on a daily basis, you should schedule an appointment with your doctor to rule out a more serious condition.

What If I Require Tests

Headaches – Should I Go To The Emergency Room

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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What Is A Migraine Headache

This often severe, throbbing type of headache is different from other types of headaches. Symptoms other than pain can occur with a migraine headache. Nausea and vomiting, lightheadedness, sensitivity to light , and other visual changes are common. A migraine headache may last from 4 to 72 hours.

Migraines are also unique in that they have distinct phases. But not all people have each phase. The phases of a migraine headache may include:

  • Premonition phase. A change in mood or behavior may occur hours or days before the headache.
  • Aura phase. About one-third of people who have migraine headaches describe having an unusual feeling or aura before the headache. The aura phase includes visual, sensory, or motor symptoms that occur just before the headache. Examples are hallucinations, numbness, changes in speech, visual changes, and muscle weakness. Migraine sufferers may or may not have an aura before the start of the headache.
  • Headache phase. This is the period during the actual headache. Throbbing pain occurs on one or both sides of the head. Sensitivity to light and motion is common. So, too, are depression, fatigue, and anxiety.
  • Headache resolution phase. Pain lessens during this phase. But it may be replaced with fatigue, irritability, and trouble concentrating. Some people feel refreshed after an attack, while others do not.

Headaches are classified as with or without aura.

How Are Migraines Treated In The Er

Many medicines are used to treat severe migraine headache pain in the ER, including those listed on the next page. The ER doctor may also give you other medicines for nausea and may treat you for dehydration .

Medicines for Pain Relief

Researchers found that the medicines listed below work to lessen or stop migraine pain. Nearly all of these medicines are given as a shot or through an intravenous tube in your arm. Some NSAIDs can also be taken by mouth.

  • Metoclopramide
  • Prochlorperazine
Neuroleptics and antiemetics are medicines that change the way certain chemicals act in your brain. Some of these medicines may also treat nausea and vomiting.
SumatriptanSumatriptan is a headache medicine that narrows the blood vessels in your brain.Note: People with heart problems, such as narrowing or hardening of blood vessels in the heart, should not take this medicine.
NSAIDsNSAIDs are medicines that relieve pain.
Opioids

  • Nalbuphine
  • Tramadol
Opioids are medicines that relieve pain. But, these medicines are rarely used for migraines because of possible side effects and the fact that other medicines work well to relieve migraine pain.Note: Taking opioids repeatedly to relieve pain can lead to overuse. Opioids can be addictive.
DihydroergotamineDihydroergotamine is a headache medicine that narrows the blood vessels in your brain.

Medicines To Stop the Migraine From Coming Back

The doctor may also give you a medicine to help stop the migraine from coming back within the next day or two.

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Reasons To Seek Emergency Help

Getting emergency medical help may be a good option if youre experiencing new and unusual symptoms. Another reason is if your headache doesnt respond to or worsens with your regular treatment.

Most times, people who decide to go to the ER experience a new level of pain thats more severe than a previous migraine.

Seek immediate medical attention if your migraine is accompanied by the following:

  • sudden onset headache or a sudden change in baseline headache
  • neck stiffness
  • confusion or changes in awareness

A migraine headache that comes on within seconds, particularly if youre , is a sign that you need to get emergency medical help.

Sometimes, headache and associated symptoms could indicate a more serious underlying medical emergency, such as a stroke.

If you have a history of stroke, heart disease, or diseases of the liver or kidneys, consider taking extra precautions. A new or changing headache could indicate a life threatening emergency.

Migraine with aura may increase your risk for stroke in the future. This type of migraine includes vision changes or neurological symptoms that usually occur before the actual headache.

If you have regular migraine with aura, talk to your doctor about emergency medical symptoms to watch for.

Prepare To Face The Stigma

When Should You Go to the ER with a Migraine?

Unfortunately, those who end up in the emergency room for their migraine are sometimes greeted with hostility instead of empathy and compassion. It is not uncommon to hear of migraine patients being treated disdainfully, as if they are exaggerating their symptoms. Their invisible pain is often not taken seriouslysome are even accused of being drug seekers, inventing their condition to score medication. Dont let this discourage you. Be your own advocate and remember: Migraine is a disabling disease, and you deserve proper support and treatment.

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What Are The Signs And Symptoms Of Migraines

Migraines, which are considered a neurological disorder, are distinct from tension or cluster headaches. Some people with migraines report warning symptoms. This is known as migraine with aura. Warning symptoms may include blurred vision, seeing stars, or other odd sensations like unpleasant smells before the onset of an attack.

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..

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What Happens To Your Brain During A Migraine

But during a migraine, these stimuli feel like an all-out assault. The result: The brain produces an outsize reaction to the trigger, its electrical system firing on all cylinders. This electrical activity causes a change in blood flow to the brain, which in turn affects the brains nerves, causing pain.

Stress Tension Or Exertion

When to Go to the Emergency Room for Headache Symptoms

Stress, anxiety, and tension are common causes of headaches. The exertion from strenuous workouts or jogging can also bring on headaches. These type of headaches can often be treated with over the counter medications, but if they persist, they could indicate bleeding in the brain, tumors, or other severe conditions. Visit an emergency room for a medical evaluation.

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