When Should One Go to the Emergency Room for Migraine?

Introduction:

Migraine headaches are generally managed at home. Sometimes, it should be addressed if certain symptoms accompany it. These symptoms may indicate the need for emergency care. This may be due to the seriousness of the medical condition.

What Is Migraine?

Migraine is a medical condition characterized by a severe headache that is throbbing and pulsating pain. It is a neurological condition that may cause pain that lasts for days. It may be accompanied by many symptoms.

Migraine is considered to be a genetic disorder and is estimated to affect about 12 percent of individuals worldwide. Research has shown that migraine is the sixth most disabling disease in the world.

Migraines may be different for different people. Its severity, symptoms, and triggers also vary from one to another. Research done in 2015 estimated that around 19 percent of females and 9 percent of males are affected by migraine. Episodes of migraine may occur at any age but are more common among 18 to 44 years of age.

When Should One Consider Migraine an Emergency?

Migraine is managed easily 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: An affected person may experience difficulty speaking, confusion, and migraine headaches, which may be a neurological problem.

Meningitis: If an affected person has a fever and stiffness of the neck with 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 headache persists for almost more than 72 hours. This condition is known as migraines. This condition may lead to dehydration.

Other signs of migraine that may need emergency care include,

• Experiencing sudden and severe headaches.

• 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 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.

It is not necessary to visit the ER (emergency room) every time a migraine headache appears; instead, consultation is to be done with the neurologist. The track of headaches is to be kept so that it helps in the treatment plan.

What Are the Tests Done in the Emergency Room for 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 know whether the symptoms are due to migraine 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 migraine that have provided relief till now.

Tests that are advised include,

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

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.

What Is the Treatment of Migraine in the Emergency Room?

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.

Those with migraines without any unusual symptoms should visit the ER. They may be asked a few questions related to headaches, and medications may be given until the person reaches the regular doctor.

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.

• Sumatriptan as an injection can be given.

• Antiemetics like Chlorpromazine, Metaclopromide, Prochlorperazine, or Ondansetron may 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.

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 migraine, associated unusual symptoms, when to visit the ER, and the management in the ER. Knowing helps in managing life-threatening complications that may occur due to migraine.