Emergency Care for Migraine

Introduction

What’s the first thing that pops into your mind when someone says migraine? A bad throbbing headache? Yes, you are right. But did you know it’s just not the pain? It can come with other symptoms, too. Migraine is considered to be a genetic disorder and is estimated to affect about 12 percent of individuals worldwide. Migraines may be different for different people. Its severity, symptoms, and triggers also vary from one to another. Episodes of migraine may occur at any age but are more common among 18 to 44 years of age. Sometimes, you can handle it at home, but other times, it gets out of control! So, when do you think you need to rush to the urgent care of the ER? Let’s find out.

When Should You Seek Emergency Care for a Migraine?

Migraine can be easily managed at home with the help of medications, rest, and lifestyle changes. In some situations, the migraine or headache becomes serious and an emergency when certain unusual symptoms accompany it. This may indicate a serious underlying condition.

The unusual symptoms of migraine that need emergency care include,

• Stroke or Brain Hemorrhage: When the migraine is severe and sudden, healthcare providers consider it an emergency. Affected individuals with this type of headache consider it to be the worst headache of their lives. This may be a sign of a stroke or brain hemorrhage.

• Aneurism: A bulge present in the blood vessels in the brain may burst and cause a type of stroke.

• Neurological Conditions: The affected person may experience difficulty speaking, confusion, and migraine headaches.

• Meningitis: If the affected person has a fever, neck stiffness, and a severe headache, it is considered meningitis, a life-threatening infection.

• Concussion: If migraine occurs after a head injury, it may be considered a complication called concussion. This condition may need proper attention.

• Migrainosus: This is a condition in which headaches persist for more than 72 hours. It is also known as migraines, and it may lead to dehydration.

Other signs of migraine that may need emergency care include,

• Experiencing sudden and severe headaches (thunderclap headache).

• A type of headache that is considered the worst headache in life.

• Change in mental status.

• Disturbances of vision that are not related to migraines with auras.

• Experiencing numbness or weakness.

• Presence of seizures.

• Presence of fever and stiff neck.

• Presence of headache after head injury.

• Experiencing migraines for more than 72 hours.

• Signs related to dehydration.

• Experiencing loss of consciousness or uncontrolled nausea or vomiting.

• The headache gets worse while coughing or with a sudden movement.

• If the age of an affected person is 50 years or more.

• If the person faces difficulty standing even after holding a chair or a railing.

• If pupils are of different sizes.

• If one of the eyelids droops.

Guess what? You don’t have to visit the ER (emergency room) every time a migraine headache appears; instead, consultation can be done with the neurologist. Keeping track of the headaches can help with the treatment plan. But, sometimes, when your headache becomes bad but not super dangerous, lasts for days, or makes you feel like throwing up, get some urgent care.

What Happens in the ER for a Migraine?

Once the affected person reaches the ER, the tests are advised. The person seeking an ER must carry a pillow, dark glasses, and earplugs to avoid the bright light and noise present in the hospital. In the ER, they check for any underlying condition that is considered serious. They may give initial treatments to ease pain and other symptoms.

Doctors present in the ER try to determine whether the symptoms are due to migraines or not. Hence, the affected person should be told about-

• All the symptoms that are being experienced.

• About the medications and supplements being used.

• Regarding the treatments for migraines that have provided relief till now,

Tests that are advised include,

• Neurological Examination: Here, the doctors check your sensory and motor reflexes to see if there is any problem with the nerve.

• Eye Examination: This test is prescribed if any changes in the vision of an affected individual are observed.

• Vital Signs: Heart rate, blood pressure, and temperature are all checked.

• Blood Test and Urine Test: These tests are done to rule out diabetes, thyroid problems, and any other infections responsible for causing headaches.

• Computed Tomography (CT) Scan: This is done to check the brain's detailed view by using a set of brain X-rays.

• Magnetic Resonance Imaging (MRI): In this type of scan, magnetic fields and radio waves are used to view detailed images of the brain and its blood vessels.

• Spinal Tap: In this test, the fluid from the spinal cord is tested for any bleeding, tumor, or infection that may be responsible for causing headaches.

Migraine Treatment in the ER: What to Expect?

Emergency care involves evaluating and treating the condition urgently. When the affected person with migraine and unusual symptoms visits the ER, certain tests are advised to rule out stroke or aneurysm. The medications for migraine are given either intravenously (IV) or intramuscularly. If necessary, intravenous fluids are given for hydration purposes.

Medications include:

• Nonsteroidal anti-inflammatory drugs like Ketorolac.

• Acetaminophen.

• Corticosteroids like dexamethasone are given.

• If nausea and vomiting are present. Antiemetics like Chlorpromazine, Metaclopromide, Prochlorperazine, or Ondansetron may be given.

• Sumatriptan as an injection can be given.

• A nerve block may be given to ease the pain. This technique is used only when other methods of treatment fail. In this technique, Lidocaine or Bupivacine is injected into the back of the neck at the bottom of the skull. This helps block the pain signals from the nerves.

• Whenever there is a presence of migrainosus or intractable migraine, the drug called Dihydroergotamine (DHE-45) may be given as an injection or through an IV (intravenous) route.

• Opioids are not given for migraines due to the risk associated with them.

• Valproic acid, which is an anti-seizure drug, may be used.

Sometimes, when the migraine is very bad, the doctors may use something called migraine cocktails! Don’t worry, it's not a drink. Instead, it's a mix of different medicines. Here’s what this cocktail contains:

• Pain relief medicines like NSAIDs, triptans, or Acetaminophen.

• Anti-nausea medicines.

• Other medicines include Diphenhydramine, IV fluids, and Dihydroergotamine.

This cocktail combo works by blocking pain, calming down brain inflammation, and reducing vomiting.

But here is an important point: opioids are not given. Why? Because they can cause issues like dependence or misuse. They also don’t work great for managing migraines.

Urgent Care vs. ER for Migraines: Which One to Choose?

Here’s how you will know when you should choose urgent care or ER care for migraines.

Urgent Care:

• When the migraine is not super dangerous.

• When your migraines last for days, especially if you have vomiting.

• They’re faster than visiting your regular doctor,

ER Care:

• When you have really bad headaches (life-threatening situations).

When you have other symptoms like those that mimic stroke or new symptoms that are getting worse, you should also go if you have a high fever with a stiff neck and visit the ER.

• If a pregnant lady gets a severe abdominal migraine, she should also go to the ER.

After Emergency Migraine Treatment: Next Steps

After making it through the visit to the emergency room, the next steps are:

• Rest a lot.

• Stay hydrated.

• Eat well.

• Consider gentle exercises.

• Follow-up with the doctor for long-term plans.

• Identify the triggers.

• Discuss medications.

• Team up with your doctor to manage future attacks.

Conclusion

A migraine is a headache that may be managed well at home through medications. However, if it is associated with unusual symptoms, it should not be neglected, and immediate emergency care should be taken. The ER treatment helps manage the pain, unusual symptoms, and complications that may happen. Hence, it becomes important to know about migraines, associated unusual symptoms, when to visit the ER, and how to manage the ER. This helps in managing life-threatening complications that may occur due to migraine.

Key Takeaway From iCliniq

Migraines are not the same for everyone. They can show up differently, including in frequency, severity, and even triggers. But don’t worry—the iCliniq doctors know how to identify one. They can figure out whether it’s just a regular old headache or a severe migraine attack requiring urgent or ER care.