By Dr. Hida Nierenburg, Director of Headache Medicine, Nuvance Health
Although an emergency department for migraine might seem like the right choice, working with a neurologist on prevention and treatment strategies is a better option
Migraine is painful, often debilitating and estimated to affect over 36 million Americans. Migraine is a common neurological disease that people do not need to manage on their own, but they may not know where to turn. That is why when the pain of an acute migraine strikes, some people’s initial response is to go to the emergency department (ED). In fact, headache is the fourth leading cause of ED visits with 1.2 million encounters annually in the United States.
As a headache specialist, I aim to help my patients reduce the frequency and duration of migraine and in turn reduce trips to the ED. In most cases, the ED is usually not the ideal place for people with migraine because:
- It can be loud and bright with fluorescent lighting, which may worsen migraine symptoms.
- Migraine-specific treatment may not be available.
- When it comes to head pain, doctors are extremely cautious and may order imaging tests. Migraine does not show on imaging such as MRI scans, which is why they can sometimes be difficult to diagnose or why many people go without a diagnosis and suffer in silence.
- There is a stigma among medical professionals with migraine patients given that their neurological workup, imaging and exam are usually normal and there is a common belief that someone’s migraine pain may be exaggerated or not real.
When to see a headache specialist
Migraine is one of the 10 most debilitating conditions in the world. The 2016 Global Burden of Disease study conducted by the World Health Organization ranks migraine second amongst all causes of years lost to disability because people with migraine oftentimes cannot get out of bed, work or participate in activities they enjoy.
Mostly everyone gets headaches that improve on their own or with over-the-counter medication. See a headache specialist if you have:
- Headaches often
- Headaches that last for more than a couple days
- Severe head pain that disrupts your life
- Other symptoms in addition to head pain
Untreated acute migraines can progress to chronic migraine. Chronic migraine is when someone has more than 15 headache days per month for three consecutive months, with migraine attacks on eight of those days.
Related article: Headache or migraine, how you can tell the difference
How people with migraine can avoid the emergency department
A headache specialist will work with you to develop effective migraine management strategies.
There are varieties of medications that may prevent migraine from occurring, including:
- Oral or intravenous (IV) medications
- Botulinum toxin injections
- Nerve blocks and trigger point injections to deliver numbing medication to tight head and neck muscles
- Alternative treatments such as acupuncture and massage
Identify and avoid migraine triggers. Common triggers include:
- Alcoholic or caffeinated beverages
- Bright lights, loud noises or strong smells
- Certain types of foods
- Hormonal changes
- Irregular sleep patterns
- Weather changes
Related article: Migraine and weather triggers, tips to manage your symptoms
Reduce how long migraine lasts
Recognize symptoms early to start treatment sooner. Symptoms may vary but commonly include:
- An intense headache that worsens from regular activities, such as working on the computer
- Sensitivity to light, sound or smells
- Visual disturbances
Not all migraines are the same, which is why it is important to find the right kind of treatment for you. Treatment options may include:
- Oral rescue medications
- Alternatives to medications such as wearable devices
In addition to treatments, it is also important to know which interventions will help reduce migraine symptoms, such as staying in a dark, quiet room.
Related article: Woman receives “life-changing” migraine care at Nuvance Health
When to get emergency care for a headache
Some headache symptoms warrant an ED visit because they could be a sign of a life-threatening condition. Seek immediate care if you have:
- A severe headache unlike any you have ever had in your life
- A headache that becomes severe suddenly and peaks in intensity within seconds (called a thunderclap headache)
- No history of headache or migraine and suddenly develop a severe headache
- Sudden onset of very intense or unusual head pain
- A headache that occurs after a head injury
- A headache with other neurological symptoms such as confusion or stroke-like symptoms including slurred speech or numbness or weakness on one side of the body
- A severe headache with other symptoms including fainting, nausea, vomiting, fever, chills or you have a condition that suppresses the immune system
The bottom line: The emergency department is not an ideal place for individuals who have migraine. Seek care from a headache specialist to determine if you have migraine or another headache disorder. If you have migraine, work with your neurologist to minimize frequency by recognizing triggers; and minimize duration by recognizing symptoms early and treating it with the right kind of treatment.
Dr. Hida Nierenburg is double-board certified in neurology and headache medicine. She completed her fellowship in headaches at Mount Sinai Roosevelt Headache Institute in New York City, and her residency in neurology at Georgetown University Hospital in Washington D.C. Dr. Nierenburg is at the forefront of migraine treatment and can discuss advances with electroceuticals and infusion therapy.
Headache support group
If you get migraines or headaches, you are not alone! Millions of Americans suffer with headache disorders that affect their quality of life. Dr. Nierenburg is leading a support group for people with headache or migraine concerns. The support group meets virtually at 5:30 p.m. the last Thursday of each month. To register, call 845-214-1922. There is no cost to register.