Migraine in the Emergency Department: When to Go to the ED for Migraine

While some attacks are so painful that the emergency department may seem like the only option for relief, most migraine symptoms don’t need to be treated in the ED. Learn what the ED can do for a migraine attack and which migraine symptoms require a trip to the ED.

Migraine attacks can cause not only head pain but also light and sound intolerance, dizziness, nausea and vomiting, and sometimes visual disturbances. When your migraine symptoms feel particularly unmanageable and continue for an especially long time, it may feel like the only option left is a visit to the emergency department.

We spoke with Alison Thaler, MD, neurologist and assistant professor at the Icahn School of Medicine at Mount Sinai Hospital, to understand what emergency medicine doctors can do for a migraine attack, when headache pain may be dangerous and when urgent care may be a better option for addressing migraine symptoms.

What can the ED do for a migraine attack?

ED doctors play two primary roles in treating migraine: providing a diagnosis for severe or unusual symptoms and treating acute migraine symptoms. Dr. Thaler says if you’re experiencing severe and sudden-onset headache pain, or if your symptoms feel drastically different from what you’re used to during an attack, then the ED will be able to determine whether these are signs of a more serious underlying issue. Depending on your specific symptoms, ED physicians may perform a head scan, do blood work or check your spinal fluid.

ED doctors can also help with pain management. The emergency department can give you intramuscular or IV medication, which can be more effective than what your doctor prescribes, and these medicines tend to kick in a little bit faster. However, Dr. Thaler emphasizes that a visit to the ED during a migraine attack will not be a complete cure-all for your symptoms.

“The goal is to take pain down a notch to make it tolerable so [a patient] can get out of the emergency department, go home and hopefully get some rest, and then go to their headache doctor to get on a better treatment plan,” she says. “[You’re] usually not going to walk out of the emergency department pain free.”

What medications might the ED give to treat migraine?

You may have heard that the emergency department can give you a combination of migraine medications to put an end to particularly bad attacks. While ED doctors can administer medications that kick in faster than the ones your doctor prescribes, “there’s really no standard definition for the perfect migraine medication combination.” Dr. Thaler says. “Even at the same hospital and in the same emergency department, different patients may receive different combinations of medications depending on the patient’s symptoms and other medical conditions.”

In addition to administering intravenous fluids, migraine medications may also include an anti-inflammatory medication, magnesium, and an anti-nausea medication to help stop vomiting and dehydration, all of which are typically given through an IV.

When should you go to the ED for a headache?

There are certain “red flag” symptoms that may indicate a potential medical emergency. If you experience any of these symptoms during what otherwise seems like a migraine attack, you should go to the hospital immediately.

The first “red flag” is a thunderclap headache. “This is a severe headache that reaches maximal intensity within one minute,” Dr. Thaler says. If you are experiencing this type of headache pain for the first time, you should visit the ED. A thunderclap headache could be benign, but it may also be a sign of a serious underlying condition such as an aneurysm rupture.

You should also visit the ED right away if you experience any new and sudden-onset neurological symptoms, including weakness on one side of the face or body, numbness, the inability to speak normally, vision changes, unusual dizziness, or trouble walking. You may be used to experiencing some of these symptoms with migraine, and if they come on as a typical part of an attack then there is no need to go to the ED. However, if you’re experiencing any of these symptoms for the first time—or they feel different or last much longer than usual—you should go to the ED.

Another possible “red flag” is experiencing a high fever and/or neck stiffness alongside what seem like typical migraine symptoms. These can be signs of meningitis, and you should visit the ER immediately to rule out potential underlying issues and infection.

If you do end up going to the ED for any reason, make sure to update your headache specialist or neurologist.

When to Go to Urgent Care Rather Than the ED

If you are dealing with an uptick in your typical migraine symptoms (nothing new, and nothing disabling), going to urgent care is often a better option than going to the ED. Like the ED, urgent care might give you stronger, faster-acting pain relief medications through an IV. Additionally, the environment at urgent care can be a bit less chaotic than in the ED and more suited to acute treatment of headache pain. “It’s just a little bit of a quieter, easier environment to handle while you’re feeling absolutely terrible,” Dr. Thaler says.

Keep in mind that while urgent care can help you manage especially severe migraine symptoms, they are usually not set up to diagnose serious medical emergencies. If you have thunderclap headache symptoms, or new or worsening neurological symptoms, you should go to the ED.

Reasons Not to Go to the ED During a Migraine Attack

When it comes to migraine treatment, the best approach is to be in touch with your headache specialist so migraine attacks don’t become unmanageable in the first place. “One of the goals of outpatient neurologists is to keep patients out of the emergency room for acute treatment,” says Dr. Thaler.

The truth is, the ED can be one of the worst places to be when you’re in the middle of a severe migraine attack. “Usually in an emergency department, there are tons of bright lights and loud noises and smells—all of these are perfect migraine triggers,” she notes. “The ED is not a great place to take pain from one hundred to zero, unless it’s absolutely necessary.”

If you notice that your medication or treatment plan isn’t working as well as it used to, contact your doctor right away. “I always encourage patients to reach out earlier rather than later, because there are things I can do—medications I can prescribe and simple procedures I can perform in my office—to break up particularly bad migraine cycles and allow the patient to avoid the emergency department, if I have a little bit of notice,” Dr. Thaler says.

If you’ve ever been unsure about whether to go to the ED for a migraine attack, you are not alone. The vast majority of migraine symptoms are best treated with your headache specialist rather than at the ED, so be sure you have a doctor you feel comfortable going to with concerns about your migraine.

For help finding a headache specialist in your area, check out our Find a Doctor tool.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. Together, we are as relentless as migraine.