What to Do About a Migraine Emergency

Should you go to urgent care or the hospital ER?

Migraines can usually be managed with prescription medications that you can take on your own. But if you have a migraine that persists for days or is associated with neurological symptoms such as vision loss or motor weakness, you need to get medical attention. When you have this type of severe migraine attack, you may be on the fence between going to the emergency room, going to urgent care, calling your doctor, and waiting for your symptoms to get better.

Here are some tips to help you recognize a migraine emergency and decide what to do.

When is migraine an emergency
Illustration by James Bee, Verywell

When a Migraine Is an Emergency

There are several types of migraine emergency, all of which can be overwhelming. A migraine emergency usually feels different from a regular migraine, and your symptoms may feel unfamiliar and confusing.

Migraine emergencies include:

  • A severe migraine headache that lasts for three or more days without responding to standard migraine treatment: This is called status migrainosus, and it often requires medical intervention with intravenous (IV) medications that are not used for standard migraine treatment at home.
  • Migraine accompanied by intense nausea and vomiting: These symptoms may be significant enough to prevent you from taking medications by mouth and may even cause dehydration.
  • Migraine associated with new or prolonged neurological symptoms: Neurological symptoms, including vision changes, weakness, difficulty speaking, and diminished sensation can precede a migraine and are called migraine aura. When those symptoms occur for the first time or are prolonged, a prompt medical evaluation is needed.
  • A major change in your symptoms or the worst head pain of your life: This could be due to something else besides a migraine, including a serious condition such as a brain tumor or a brain hemorrhage.
  • Headaches accompanied by a fever and/or stiff neck: Meningitis, an infection of the lining around the brain, can cause the same symptoms as a migraine. Meningitis is often characterized by a fever (above 100.4 degrees F) and neck stiffness, which are not symptoms of a migraine.
  • Migraine-induced stroke: The symptoms of migraine aura can be exactly the same as those of this rare migraine complication. You could be at a higher risk of having a migraine-induced stroke if you have heart disease, vascular disease, or a blot-clotting disorder.

Overall, it is not a good idea to ignore unusual migraine symptoms. While there is a strong chance that you may not be experiencing a serious medical event, it is best to have a professional medical evaluation.

ER vs. Urgent Care

If you don't know what to do about your symptoms, you have a few choices. You might call your doctor's office to ask for advice. But if you need immediate medical care, keep in mind that your doctor's office is not equipped to give you the kind of medical attention you may receive at an urgent care clinic or in the emergency room.

Keep in mind that once you are seen in urgent care or in the ER, the medical staff will evaluate you and take action to medically stabilize you as needed. If you need to be transferred to a setting with facilities that can handle more serious medical issues, then you will remain under medical care throughout that process. Do not stress too much about making the "right" choice—just get medical attention as promptly as possible.

Migraine Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Man

Similarities

There are similarities between urgent care and emergency room approaches to migraine.

Often, when symptoms are concerning, unusual, or severe, going to the urgent care or emergency room is the best thing to do.

Type of care: Urgent care and emergency rooms are both prepared to administer treatments such as intravenous (IV) fluids and antiemetics, and to closely monitor your vital signs.

Triage: When you go to seek medical help in urgent care or an emergency room, the amount of time that you have to wait depends on the urgency of your situation more so than factors such as whether you called ahead. If your condition is not deemed urgent and you are out of network, then you may be given the option to leave at this time, rather than incurring a high out-of-pocket cost.

Hospitalization: The doctors in the emergency room and in the urgent care will be able to determine whether you need to be admitted to the hospital. Staff in either setting can begin to coordinate the arrangements for your admission.

Payment: Most health plans have clear policies about coverage for urgent care and emergency room visits, including your shared cost or copay amounts, and will provide you with details regarding which locations are in your network.

If you have to pay for your emergency room or urgent care services out-of-pocket, then it is much more difficult to estimate the cost ahead of time, because it will include the cost of the physician or extended care provider evaluation, nursing care, IV fluids, medications, diagnostic tests, and the cost of using the bed itself. The overall cost to you can add up in the tens of thousands within a few hours.

Differences

When you have a migraine emergency, differences between urgent care and emergency room care include:

Transportation: If you can't drive, have fallen, have had convulsions, or are experiencing a decreased level of consciousness or weakness in one side of your body, you need an ambulance to transport you. An ambulance will take you to the emergency room, not to urgent care.

Waiting time: While this isn't a hard-and-fast rule, urgent care tends to be less crowded, and the patients there are not usually as sick as patients in the emergency room. This often results in shorter waiting times, because the patients ahead of you are not likely to have a major medical crisis (such as a car accident) and they are usually discharged faster than patients in the emergency room.

Noise level: In general, emergency rooms, and even emergency room waiting areas are louder than urgent care settings. The sound of ambulances arriving, overhead emergency announcements, and patients being transported for procedures can be disruptive if you have a migraine.

Imaging: Computerized tomography (CT) scans and magnetic resonance imaging (MRI) are usually available in the emergency room rather than in urgent care, even though exceptions to this exist.

Deciding where to go for medical attention can be tricky. If you are having nausea and vomiting, or if your migraine is lasting for days, then you do not need to go to an emergency room and you can get the help you need at urgent care. However, if you have a fever, stiff neck, or neurological symptoms such as weakness, speech difficulty, or convulsions, then you need to be seen in an emergency room.

A Word From Verywell

Headaches account for about 3 percent of emergency room visits and about 5 percent of urgent care visits. About 90 percent of the time, headaches that bring people to the emergency room are not caused by anything dangerous or life-threatening, but about 10 percent are caused by something serious, such as an infection or a stroke.

The best way to avoid a migraine that prompts you to seek urgent care or emergency care is to use preventative strategies, including avoidance of triggers, talking to your doctor about whether you need prophylactic medication, and learning about medication overuse headaches.

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