When to Seek Emergency Care

For most people, migraine attacks can be managed at home or with the help of a GP. But in some cases, a migraine attack can escalate into a crisis requiring emergency medical intervention. Understanding when and how to seek help during a migraine crisis is critical for ensuring your safety and well-being.

What is Migraine Crisis?

A migraine crisis occurs when symptoms become severe or unusual, surpassing the threshold of what can be managed at home. In many cases, this requires having a good understanding of what is a typical migraine attack for you, so that you can clearly identify when something is different. While migraine attacks vary in intensity and duration, certain signs indicate the need for urgent medical attention.

When to Access Emergency Care

In the context of migraine attack, "red flags" are warning signs that suggest the symptoms you are experiencing may be due to another serious condition rather than migraine. Recognising the red flags of a migraine crisis can save lives.

Seek immediate medical attention if you experience:

• Sudden onset of severe head pain, especially if you are over 50 years old.
• A change in the type or pattern of headache you would normally experience in a migraine attack.
• Neurological symptoms such as weakness, vision changes, difficulty speaking, or seizures that are not normal for you.
• Your symptoms come on faster than usual, or you are unable to manage them with your normal medications.
• Your symptoms are much more intense than usual, particularly if you are experiencing uncontrollable vomiting or losing consciousness.

These symptoms could indicate conditions like stroke, aneurysm, or other neurological emergencies. Prompt evaluation is crucial.

It is also appropriate to seek help from Emergency or Urgent Care if your migraine attack has persisted for longer than usual, particularly longer than 72 hours (three days). Read more about Status Migrainosus.   

When Should You Consider Calling An Ambulance

If you are experiencing a migraine crisis and do not have someone who can take you to the hospital, it is always ok to call an ambulance. 

If you are experiencing any stroke symptoms, like facial droop, muscle weakness, or difficulty talking, and these are not normal for you, please call 000 immediately and request an ambulance. 

There are situations where a migraine attack is not presenting with red flags but it is no longer manageable at home, and calling an ambulance can become essential. These situations can include:

• If your symptoms are making it difficult to stand or walk.
• Uncontrollable nausea and vomiting, leading to dehydration.
• Symptoms that prevent normal functioning or daily activities.
• Aura symptoms that persist longer than usual or are unusually severe.
• Loss of vision - even if this is normal for you, an ambulance is likely to be the safest way to get to hospital.

If in doubt, err on the side of caution and seek emergency assistance. Delaying care could worsen the condition or lead to complications.

Complications of Migraine

In rare cases, migraine can lead to serious complications that require urgent medical care. These include:

• Status migrainosus: A debilitating attack lasting more than 72 hours.
• Persistent aura without infarction: Aura symptoms that persist for over a week without evidence of brain damage on imaging.
• Migrainous infarction: Aura symptoms associated with an ischemic brain lesion detected on imaging.
• Migraine aura-triggered seizures: Seizures occurring during or after a migraine with aura.

These complications highlight the importance of seeking emergency care during a migraine crisis.

Preparing for a Hospital Visit

For many people with migraine, the idea of visiting a hospital—often bright, noisy, and bustling—can be daunting. However, being prepared can help make the experience more tolerable and ensure you receive effective care.

• Bring comfort items: Pack earplugs, noise-cancelling headphones, an eye mask, dark glasses, and/or a pillow for neck support and comfort.
• Bring a list of your current medications: you will always be asked in detail what medications you are currently taking, so it helps to have an accurate record of them with you.
• Communicate openly: Share all your symptoms, even those that may seem unrelated. Be specific about:
  • Medications, supplements, and treatments you’ve tried (regular or irregular).
  • Past treatments that have worked for you.
  • Recent changes in your health or migraine patterns.
  • Any other medical conditions you have.

Don’t downplay your symptoms—full transparency helps medical staff provide the best care possible.

What to Expect at the Hospital

Once you arrive at the hospital, medical staff may perform tests to rule out other causes of your symptoms and guide treatment. These may include:

• Imaging tests such as CT scans or MRIs to check for brain abnormalities.
• Blood and/or urine tests to identify systemic issues.
• A physical exam to check for muscle weakness, numbness or loss of coordination.

Depending on the symptoms you are experiencing, the doctors may request other tests, such as an EEG (electroencephalogram) to evaluate for seizures, or a lumbar puncture (spinal tap) to test for infection. .

These evaluations help ensure that your symptoms are appropriately diagnosed and treated.

Treatment Options

The primary goal of hospital treatment during a migraine crisis is symptom relief and stabilisation. Common interventions include:

• Rehydration via IV fluids to address dehydration caused by nausea or vomiting.
• Sumatriptan injection, a migraine-specific medication.
• Antiemetic medications to help treat nausea and/or vomiting (e.g., metoclopramide, prochlorperazine).
• Medications administered through IV, such as:
  • NSAIDs (e.g., diclofenac) or paracetamol for pain relief.
  • Corticosteroids to reduce inflammation.
  • Chlorpromazine (largactil) for nausea, vomiting and pain relief. 

• Advanced treatments for severe cases, such as nerve blocks or other specialized IV medications.

It is important to note that emergency medical staff may avoid opioid pain relief due to the risk of medication overuse headache. These interventions are tailored to the severity of your symptoms and your medical history.

What if I’m Not taken Seriously?

If you encounter migraine stigma, and any doctors or nurses are dismissive or imply that you shouldn’t be at hospital, try not to become upset. Clearly and firmly, but respectfully, request to speak to the nurse in charge, and explain your concerns that you do not feel you are being treated appropriately. Remember that most of the medical professionals we encounter were taught that migraine is a headache, and they’re all doing their best to provide care in an underfunded and understaffed health system. 

You can also familiarise yourself with your state’s process for escalating your concerns and requesting a clinical review if you do not feel you are being cared for appropriately. Most states in Australia either have, or are currently developing, a formal process for this, since the successful implementation of Ryan’s Rule in Queensland in 2013.

https://vimeo.com/534248322

• Queensland - Ryan’s Rule
• NSW - REACH
• Western Australia - Aishwarya’s Care Call
• South Australia - You’re worried, we’re listening
• ACT - CARE

In Victoria, Tasmania or the Northern Territory there is no system as yet. Ask to speak to the nurse in charge or a Patient Liason Officer.

Take Action

A migraine crisis can be frightening, but help is available. If you or someone you know is experiencing severe or unusual symptoms, don’t hesitate to call an ambulance or seek emergency care.

Migraine Australia is developing a Migraine Management and Management Plan (MiMAP) which includes an action plan to help you plan for migraine crisis, so you can decide with the help of your GP or other support what steps you will take, and at what point you should go to hospital. Read more about the MiMAP here.