Neurology and Neurosurgery

Should you go to the emergency department for a headache or migraine?

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A young professional woman sits at her desk at work holding her head from a headache or migraine.


Headache and migraine prevention and treatment strategies can help you avoid the emergency department when head pain strikes; but also know when to get emergency medical care for a headache


By Hida Nierenburg, MD, Neurology and Headache Medicine, Nuvance Health


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.


Do you suffer from migraines? Book now with a neurologist.


How people with migraine can avoid the emergency department

A headache specialist will work with you to develop effective migraine management strategies.


How to prevent migraine

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
  • Dehydration
  • Hormonal changes
  • Irregular sleep patterns
  • Medications
  • Stress
  • Weather changes


Related content: Migraine and weather triggers: Tips to manage your symptoms


How to reduce migraine symptoms

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
  • Dizziness
  • Fatigue
  • Nausea
  • 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.


When to get emergency medical 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


Related content: How to tell the difference between headaches and migraines


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.


Learn more about headache and migraine care at the Nuvance Health Neuroscience Institute.