Ask the Migraine Expert: When Should I Seek Emergency Medical Care for Migraine?

When living with migraine, it’s important to know the signs that other medical conditions could be causing your head pain.

At times, it can be hard to distinguish between a true migraine attack and a headache due to a different medical reason.

It can be especially important to know the differences if you experience symptoms such as changes in vision, trouble speaking, or weakness and numbness on either side of your body.

However, there are certain warning signs that can help you decide if you need to proceed to the emergency department for urgent medical attention. As a headache specialist, a mnemonic device that has helped me make this distinction over the years is SNOOP:

Systemic symptoms

If you have headaches associated with systemic symptoms — such as a fever or weight loss — this can be a sign of an active infection such as meningitis. It’s important to have this assessed by a physician, and especially important if you have a suppressed immune system or a history of cancer.

Neurological symptoms

If you experience abnormal neurological symptoms that you haven’t had before, you should seek immediate medical attention. These might include:

• changes in your awareness or thinking
• trouble speaking
• weakness
• numbness
• vision changes

These symptoms can signal a seizure or stroke.

(sudden) Onset

If your headache comes on suddenly and without warning, it may be a sign of bleeding within the brain or a brain tumor. Sudden headaches are typically a reason to seek medical attention or advice.

Older age

Headaches that start when someone is older than age 50 may be due to a problem with the blood vessels within the brain or inflammatory diseases such as temporal arteritis.

Pattern changes

If your headache or migraine attacks suddenly look or feel different, this could indicate another underlying cause of the head pain.

Changes might include:

• how frequently they happen
• how severe they are
• new symptoms

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Other tips

If your headaches mainly occur when you sit, stand up, or lay down, that could signal low or high pressure in the fluid that cushions the brain, also known as the cerebrospinal fluid.

In most cases, if you have any of the warning signs above, your doctor will order pictures of your brain with a CT scan or MRI, check your vision, and perform a full neurological exam.

If an infection in the head is being considered, a doctor might also order a lumbar puncture to obtain the cerebrospinal fluid. An EEG is ordered in some cases to look for signs of seizure.

If you already have a migraine diagnosis, have already had some of the above tests done, and are still having frequent or severe attacks, it’s of the utmost importance that you bring this up with your doctor. You’ll want to discuss different steps you can take to prevent attacks from happening and also create a multi-step plan for treatment when these attacks do occur.

It’s important to note that the emergency room can make a person with established migraine disease feel worse because of the loud noise, bright lights, and stressful nature of being in the ER.

It’s also possible that someone with migraine may be told to have unnecessary testing done or be prescribed inappropriate medications, such as opioids.

The bottom line

It’s important to know the headache signs that may mean more than a migraine attack. You should also alert your primary doctor or neurologist if you see any changes in your regular migraine patterns.

If you’ve already been diagnosed with migraine and the attacks are not managed, a headache doctor can help you figure out a treatment plan you’re comfortable with. This can help keep you out of the emergency room and reduce disability with the disease.