As both Sydney and Melbourne hospital systems come under strain, here’s some things you can try before going to emergency for help.
If you’re a migraine warrior, no one needs to tell you that a migraine attack can be debilitating, regardless of whether it lasts for a few hours or a few days (or longer!).
Long-time warriors will know the pattern of their migraine well. Usually, years of navigating triggers and treatments will allow you to quickly fall into your action plan. But what happens if your migraine treatment fails or if the symptoms show up differently? Your instinct may be to seek immediate attention at the Emergency Department but, while you may just end up there, there are a few things you can do first.
1. Control your instinct to panic
We often can overthink things in a severe attack, and it doesn’t take much for that self talk to spiral into anxiety. Try to take the mental position that it’s just a bad migraine attack until proven otherwise, rather than thinking of all the things it could be.
Start your normal treatment plan as quickly as you can - the sooner you take your medication, the better. If you’ve missed the critical window, you may have delayed or minimised the medication’s effectiveness, but that doesn’t mean take more of it.
If your symptoms seem different, then it is always worth checking in with a doctor. Can you call your GP? Is there a home GP service you can call? Or do you have a trusted friend with medical knowledge who can just talk through things with you? Often it helps just to list off the symptoms you’re experiencing and assess whether they are worse or different than usual, or it’s just the combination making them feel worse.
Remember that migraine can show up in a variety of ways. Attacks are usually worse with movement which can worsen pain, cause nausea, and increase sensitivity to bright lights and noise.
Many people report an aura or sensations described as shimmering lights, blurry vision, numbness, tingling and even strange smells. If any of these are happening to you for the first time it can be very frightening. Rest assured it’s likely to just be a change to your migraine symptoms, but please do check in with your doctor, and get a COVID-19 test. COVID-19 is sometimes presenting as aura in people with migraine.
2. Try all the things
The best way to deal with migraine is always hard and fast. Most of us know early on that it’s going to be a bad attack, so trust that instinct and don’t hesitate in reaching for your prefered first-line treatments. Combine triptans with ibuprofen, or paracetamol with caffeine, to give it an extra kick. Got stronger drugs? As soon as you’ve hit that 2 hour mark and are sure the triptans haven’t worked, take them.
Here’s our pro-tip: the first thing you will be offered if you go to hospital is paracetamol or ibuprofen, probably by the triage nurse before you see a doctor. The first thing the doctor will (or should) give you is 900mg of aspirin. So make sure you take these things at home first.
Don’t forget to do the other things that help you. Ice pack on the back of the neck, lie down in a dark and quiet room, have a shower - whatever you need to do, do it. Don’t be strong, don’t “push through”, deal with it quickly so it doesn’t get worse.
3. A note for first-timers
If you’ve not had a migraine attack before or haven’t had one for a long time, and you don’t have specially prescribed medicine at hand, you can use a simple painkiller such as aspirin, nurofen and paracetamol. The best option is what we refer to as an aspirin bomb: 900mg of aspirin, plus either an antihistamine (if your attack is food or environment triggered) or an anti-nausea medication (if your attack is visually triggered), followed by a strong coffee or a can of Coke.
Make sure you stop what you are doing and lie down in a dark room. Sleep is the best remedy but not always possible while experiencing pain. Once the symptoms ease, try and get some restorative sleep.
4. When to head for the Emergency Department
While tingling, numbness and weakness are common in some types of migraine attacks, if you experience this for the first time, or you lose consciousness for any period of time, you should head to the hospital.
Equally, if you experience strange sensations that are not typical for you and more severe than any aura you are used to, it’s wise to seek medical attention.
If you are dealing with new or particularly intense aura, please don’t drive. You don’t know how compromised your judgement is. Ask a family member or friend to take you, get a taxi or Uber, or if you need to, call an ambulance. If you are having any trouble walking or are losing consciousness, call an ambulance!
If you aren’t experiencing anything unusual but are in a lot of pain and are not feeling like you're coping, it’s ok to go to hospital for more help. Similarly, if your attack is dragging on a lot longer than usual and nothing you have at home is breaking it, then hospital is something worth considering. As a rule of thumb, if your attacks don’t normally last longer than a day, three days is enough to warrant hospital; if your attacks normally run for a few days, 10 days is probably the longest you should wait before seeking medical help.
If possible, keep a note of the time of onset, the medication you have taken and any symptoms that have occurred so you can share this with the medical staff when you arrive.
5. Special considerations in the time of COVID-19
Obviously with the hospital systems under significant strain the last thing you want to do is add to that burden. But hospitals are still there for you, and you shouldn’t feel guilty about going there if you need to.
There are a couple of extra things you can do in these extraordinary times:
- Call your State’s health advice line, COVID-19 advice line, or your local hospital to find out if you should go to a different hospital than you normally would. It may be that the major hospital you normally go to is overloaded, but a smaller hospital a bit further away is doing ok.
- Use a GP at home service, an extended hours GP or urgent care service. These on-demand GP services won’t be with your normal doctor but can often provide the stronger medications you need. Just google to see if there’s one that services your area.
- Talk to your pharmacist. They may be able to suggest something you haven’t tried - or just be a reassuring voice that you really do need to go to hospital.