Here’s How to Get the Migraine Support You Need If You’re Admitted to the Emergency Room

A trip to the emergency room (ER) may be necessary but triggering with migraine. Bring support or advocate for yourself by keeping your records and care plan on hand and asking your specialist to call ahead.

If you experience migraine, you might be familiar with debilitating pain. That pain may even lead you to the ER.

However, the ER may not always bring the relief for a migraine attack that it should.

Want to ensure you have the knowledge and tools to navigate the ER if you find yourself heading there during a migraine attack?

Read on for steps you can take to get the treatment you deserve.

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The ER and migraine attacks don’t always mix

“The ER can be brutal,” says Lindsey de los Santos, patient advocate and founder of Migraine Road. “It causes people with migraine to avoid it sometimes at all costs.”

Adil Niaz, DO of the Hackensack Meridian Neuroscience Institute Migraine Center, empathizes. He notes the ER can be incredibly uncomfortable if you’re experiencing an intense migraine.

“The ER is often crowded and busy with long wait times,” says Niaz. “The environment itself is also noxious to a patient suffering from a migraine: loud beeping machines, bright fluorescent lights.”

What’s more, Niaz says that people with migraine may be “triaged” or prioritized lower because those with life threatening conditions receive precedence. As a result, you may have to experience a triggering environment for longer.

Despite the inherent challenges, de los Santos says the ER can be a “last line of defense.” That’s why advocacy is critical, whether for yourself or from a supportive loved one.

“Your voice and the support of others may be what gets you the right treatment,” says de los Santos.

There’s no shame in getting emergency care for migraine

A 2019 survey involving more than 400 participants showed that primary headache disorder was the most common reason people sought emergency department care for a headache, with migraine being the most common.

However, there’s another reason why people experiencing a migraine attack may be hesitant to get help in the ER: the notion that it’s “just a headache.”

This is both unfair and untrue.

“Headache is just one symptom of migraine disease and a migraine attack,” says Cannon Tekstar Hodge, the director of social media for Neura Health.

Hodge experiences high frequency chronic migraine with migraine with unilateral motor symptoms (MUMS).

“Headache is just one of the symptoms outlined in the ICHD-3 [International Classification of Headache Disorders] diagnostic criteria for migraine,” she says. “We need to reframe the way we think about migraine so that we can better understand that migraine is disabling and not just a bad headache.”

Hodge points out that migraine should be considered more akin to epilepsy or asthma.

“People with epilepsy have seizures, and people with asthma have asthma attacks — they don’t have epilepsies or asthma,” she adds.

One patient advocate who also experiences chronic migraine, Nicole Safran, MPH, says symptoms that may lead to an ER trip include:

• persistent nausea and vomiting, which can lead to dehydration
• trouble speaking, numbness, or weakness
• a sudden onset of severe pain
• a stiff neck, a fever, or new vision changes
• confusion
• your first or worst headache

As a professional, Niaz points out that the ER can be an essential part of treatment during a migraine attack.

People “should not feel bad about coming to the ER to get treatment for their migraine,” Niaz says. “When at-home medications fail, the ER is often the best place to get rapid, reliable relief.”

Migraine in the ER: A personal experience

Hodge calls her first trip to the ER “frightening.”

“I was new to migraine disease and did not fully understand what was going on or why my symptoms had escalated the way that they had,” she says. “No one had taken the time to explain that the reason my pain had reached this point was due to peripheral sensitivity and central sensitization. No one had ever explained that migraine was a neurological disease or dysfunction of the nervous system.”

Instead, professionals referred to Hodge’s migraine as “headaches.”

While she didn’t fully comprehend migraine, she knew what she was experiencing.

“I was in the most pain I ever had experienced — more than when I was kicked in the head by a horse, more than when a doctor reset my broken arm without anesthesia,” Hodge says. “At the time, my limited acute medications had done nothing to address the pain that was spiraling out of control.”

Her aunt met her in the ER, but the two didn’t receive answers.

“I recall bright, glaring lights,” Hodge says. “I recall being wheeled into a CT scan. I recall being told that my CT scan came back just fine. I recall feeling underwhelmed by ‘fine’ test results because something had to explain the extraordinary pain I experienced, and a ‘fine’ CT scan wasn’t satisfactory.”

Since then, Hodge has learned more about advocacy.

“People with migraine want their symptoms and condition to be taken seriously by their medical provider, even if that provider is in the emergency room,” she says.

Tips for getting support

You deserve prompt, compassionate care during a migraine attack.

Safran says advocacy can transform the experience.

“It’s the difference between feeling supported or dismissed like you’re an inconvenience,” Safran says.

Here’s how to advocate for yourself to receive informed and compassionate migraine care in the ER.

Have an ER action plan

A written plan can empower you to advocate for yourself and help you do less explaining — a potentially welcome break during a migraine attack.

Hodge suggests outlining an ER protocol with a doctor and having them sign it. To help you cover several bases in advance, save it to your phone and MyChart account and print it.

“Emergency rooms don’t have a unified migraine protocol, and every person has individual needs,” she says. “Additionally, due to migraine stigma, some ER staff don’t take migraine seriously enough to recognize the protocols that someone may need.”

Know your history

In addition to a treatment plan, having a written document outlining your medical history on your phone, chart, and in print is also helpful.

“In the middle of a migraine attack, it might be very difficult to relay your medical or migraine history to the ER staff,” Niaz says. “This is especially helpful if you experience migraine aura, which may cause you to have neurologic deficits on examination that would normally be a cause for further workup.”

De los Santos says this information can include medications you take.

Have a kit

Having a few items on hand can reduce the sensory challenges the ER might present.

These include:

• earplugs
• an eyemask or beanie to cover your eyes
• an ice pack
• essential oils
• magnesium or other supplements
• a water bottle or electrolyte beverage

If you don’t have an eye mask or ice pack on hand, de los Santos recommends asking the staff to give you a washcloth for your eyes.

Call your regular specialist

Safran says her best experience in the ER came after calling her headache specialist in advance to let them know she was on her way there.

“My headache specialist called ahead and collaborated with the ER providers on my care,” Safran says. “I went to the same hospital system where I was seen [by my specialist], so they had access to my medical chart and knew my entire medical history.”

Niaz also recommends taking this step.

Your specialist may be able to provide guidance for your ER treatment plan, he says.

Avoid downplaying symptoms

Niaz knows the stigma of migraine as “just a headache” can get in the way of people receiving care.

“It’s important to be clear about how disabling this condition is for you,” he says. “Describe the symptoms you’re having, especially if there are any new symptoms. Don’t leave anything out — it’s your health.”

If possible, Hodge suggests using medical terms.

“I’ve learned that ER staff take me and my symptoms more seriously when I use terms like ‘paresthesia’ instead of ‘pins and needles’ and ‘ataxia’ instead of ‘clumsiness,’” she says.

Your regular specialist can help you get a handle on the most accurate terms for your symptoms and diagnosis.

Ask for more treatment

If your first-line treatment doesn’t help alleviate symptoms, you can ask for more support.

“If your headache has not been treated completely, ask for further treatment like an additional infusion or a short course of medication — steroids, for example — to be taken at home over the next few days,” Niaz says.

Change your environment

You can’t change the inherent nature of the ER with the noises and lights. However, you can change how much you experience them once you leave the waiting room.

“Ask for the lights in your room to be turned off and the door to be closed if possible,” Niaz says. “After getting an infusion, it is probably helpful to try and sleep for a bit and then head home to recuperate.”

This is another instance when a tool kit with earplugs and an eye mask can come in handy.

Bring a support person

One thing de los Santos, Niaz, Safran, and Hodge all have in common? They recommend showing up to the ER with support if you can.

“It can be helpful to have an extra set of ears to take in information from the doctor and someone to help answer questions when you’re in pain,” de los Santos says.

Moreover, the person can provide a ride to and from the hospital.

“You may also be given medication that doesn’t allow you to drive [safely],” de los Santos says.

Takeaway

The lights and noises in an ER can make a migraine attack worse, and it can be challenging to advocate for yourself while in pain.

There’s no shame in getting help — or advocating for yourself. With the right support, the ER can be an important solution during a migraine attack.