What Will the ER Give Me for My Migraine? (2022)

Every 10 seconds, someone in the United States develops a migraine headache so severe they go to the hospital emergency room (ER). Given the pain and risks associated with these episodes (e.g., uncontrolled vomiting), ER doctors often opt for migraine treatments that can be administered via injection or IV to have a quick effect.

Emergency treatment for migraine depends on a patient's specific symptoms and overall health and health history. The ER typically administers a combination of medications. The migraine cocktail includes a mix of non-steroidal anti-inflammatory drugs (NSAIDs), magnesium, triptans, and IV fluids.

This article provides an overview of emergency treatments for migraines and headaches, including migraine cocktails and other approaches used in the ER. Individual care may differ slightly from these standard protocols.

What Will the ER Give Me for My Migraine? (1)

When to Seek Care

If you deal with migraines, it's helpful to know that there are solutions if they ever get so bad as to warrant emergency care. But knowing when to seek that level of medical attention is important.

If you would describe your pain as your worst migraine attack (or headache) ever, you should consider heading to the emergency department of the nearest hospital, advises the National Headache Foundation (NHF).

Concerning Symptoms

If your headache is accompanied by any of the following, a trip to the hospital is recommended, according to the NHF:

  • Vision loss
  • Uncontrollable vomiting
  • Head pain that lasts more than 72 hours with fewer than four solid hours of relief
  • Symptoms that are unusual for you or frightening
  • Loss of consciousness
(Video) When a Migraine Warrants an ER Trip, According to a Doctor

Treatment Approaches in the ER

The treatment you might receive in a hospital emergency department for a migraine headache will be based, for the most part, on your symptoms and personal health history. In other words, there's no one-size-fits-all migraine cocktail.

Emergency Department 101

However, there are standards and recommendations. For one thing, medications given in the ER for migraine headaches are typically administered parenterally—in some way other than by mouth, including by subcutaneous injection (a shot just under the skin), intramuscularly (a deeper injection into the muscle tissue), and intravenously (via an IV tube).

These methods allow medications to work more quickly in the body, and they are more effective for someone who's experiencing so much nausea and/or vomiting that keeping down a pill is almost impossible. Many people are also given fluids via IV to prevent dehydration.

In 2016, the American Headache Society (AHS) put together a panel of experts to review clinical trials of the many diverse medications used in emergency settings to treat migraines in adults to determine which truly work best and are safest. The panel considered studies of 28 different medications to come up with recommendations for the acute treatment of migraines in adults.

First-Line Treatments

Based on the results of 68 clinical trials, the AHS panel determined that adults who visit the ER for migraine pain and other symptoms should be offered one or more of these three medications to treat pain and other symptoms, particularly nausea and vomiting:

  • Metoclopramide, an antiemetic (anti-nausea) medication that blocks dopamine receptors in the brain to relieve nausea and vomiting as well as pain
  • Prochlorperazine, an anti-psychotic
  • Sumatriptan, a selective serotonin receptor agonist (SSRI) that constricts blood vessels in the brain and blocks certain substances that cause pain to relieve headache, nausea, and other migraine symptoms

The panel also determined that adults with migraine should receive a dose of dexamethasone, a steroid that lowers the risk that a migraine will recur.

(Video) Navigating an Emergency Room Visit for Migraine - Spotlight on Migraine S3:Ep15

Second-Line Treatments

If for some reason the first-line medications are not appropriate, the panel found that the following alternatives may be offered in a migraine cocktail:

  • Acetaminophen, an analgesic
  • Acetylsalicylic acid, aspirin
  • Chlorpromazine, an anti-psychotic
  • Ketoprofen, a nonsteroidal anti-inflammatory drug (NSAID)
  • Diclofenac, an NSAID
  • Droperidol, an anti-dopamine drug that relieves nausea
  • Haloperidol, an anti-psychotic
  • Ketorolac, an NSAID
  • Valproate, an anti-convulsant that doesn't relieve migraines but may help to prevent a recurrence of one

Medications for Treating Migraines

Medications That Are Not Recommended

Among medications that have commonly been used in the ER to treat migraine headaches are a handful that the panel suggests should not be given because they don't work as well as others or for other reasons. Hydromorphone and morphine, for example, are opioids—a class of drug associated with addiction.

On the AHS list of drugs that are best avoided for treating migraine in the ER are:

  • Diphenhydramine, an antihistamine
  • Hydromorphone, an opioid
  • Lidocaine, an analgesic
  • Morphine, an opioid
  • Octreotide, a medication often given to cancer patients to control diarrhea

Caution for Pregnant Women

Some medications used in the emergency treatment of migraine headaches are known to cross the placenta of women who are expecting and cause possible harm to a developing baby. These include:

  • NSAIDs: These are not considered safe for women in the third trimester of pregnancy, at which time these drugs can interfere with the healthy development of a baby's lungs, cause low levels of amniotic fluid, or slow or stop labor during childbirth.
  • Dihydroergotamine: Also known as an ergot alkaloid, this drug is on a long list of medications cited by the AHS panel as having too little available information to recommend or not recommend for pregnant women. Brand names in this class include D.H.E. 45 and Migranal.
  • Opioids: Both oxycodone and morphine are opioid medications that carry a high risk of abuse and addiction. Studies have shown that opioids are also less effective at terminating migraines than the antiemetic, metoclopramide.
  • Valproate: This anti-seizure drug is sometimes ordered to prevent recurrent migraines. Valproate is considered highly teratogenic, and is banned in many countries for use in pregnant women and women of childbearing age.

Using Migraine Medications During Pregnancy

A Word From Verywell

Treating a migraine headache that's severe enough to require emergency care can be tricky. Many medications have been used to relieve pain, nausea, vomiting, and other symptoms—some more successfully than others. And despite the AHS recommendations of the most effective and safest protocols for managing an acute migraine in an emergency setting, the treatment a patient receives in one hospital ER may differ from that offered by another.

(Video) Migraine Treatment in the Emergency Room: A Q&A with Dr. Katherine Hamilton

The most important thing to remember if you go to the ER for migraine (or any other emergency) is that you need to be an advocate for yourself or make sure someone is with you who can fill that role. This means being forthright and thorough when answering questions about your current health and any medications you take, including over-the-counter products, supplements, and recreational drugs. Your honesty will help the doctors caring for you hone in on the migraine medications most likely to relieve your pain as quickly as possible.

Frequently Asked Questions

  • Can you go to the ER for a severe migraine?

    Yes, you can go to the ER for treatment of a migraine. However, it isn’t necessary unless it is a severe migraine or associated with the following symptoms:

    • Confusion
    • Fever
    • Numbness
    • Stiff neck
    • Weakness
    • Vision changes

    Seek immediate medical attention for a headache that comes on suddenly and reaches maximum intensity within a few minutes.

    (Video) What's like to go to the Emergency Room for a migraine

  • What is a migraine cocktail at the hospital?

    A migraine cocktail is a combination of medications used to treat migraine in the ER. This can include an NSAID, dihydroergotamine, anti-nausea medication, an antihistamine, magnesium, and fluids.The exact combination of medications will vary from person to person.

  • Can I make a migraine cocktail at home?

    Yes, a common at-home migraine cocktail includes 250 mg of aspirin, 250 mg of Tylenol (acetaminophen), and 65 mg of caffeine. These are also the ingredients in Excedrin.Research shows most migraines respond to this drug combination within two hours.

    (Video) The Migraine Guy - What to Expect at the ER

FAQs

What do they give you at ER for migraine? ›

Nonsteroidal anti-inflammatory drugs, antiemetic medications, diphenhydramine, dexamethasone, and intravenous fluids all have shown benefit for treating acute migraine in the ED. Their effect is greater when they are all administered up front as opposed to being delivered in a stepwise pattern throughout the ED stay.

Why do er give Benadryl for migraines? ›

Benadryl can block histamine circulation and prevent migraine from occurring. Additionally, by blocking histamine, Benadryl can help calm the nervous system.

How can I prove my migraine? ›

There's no specific test to diagnose migraines. For an accurate diagnosis to be made, a GP must identify a pattern of recurring headaches along with the associated symptoms. Migraines can be unpredictable, sometimes occurring without the other symptoms. Obtaining an accurate diagnosis can sometimes take time.

Can you go to the ER for a severe migraine? ›

Severe Migraines Deserve an ER Visit

Go to the ER if you are experiencing severe migraine symptoms, or symptoms such as confusion, fever and vision changes, neck stiffness, trouble speaking or numbness or weakness, even if other symptoms of migraine are present (e.g. light sensitivity, nausea).

What are the 3 migraine injections? ›

There are four options currently available for injectable migraine treatment:
  • eptinezumab (Vyepti)
  • erenumab (Aimovig)
  • fremanezumab (Ajovy)
  • galcanezumab (Emgality)
17 Feb 2021

Can you be admitted to hospital for migraine? ›

If a patient is sticking to their medication regimen and going regularly to their outpatient visits with consistent follow-up and their migraine is still getting worse, they can also ask their specialist about voluntary hospitalization through elective admission.

How long does Toradol shot last for migraine? ›

Its effects can last up to 6 hours, and its full impact is usually felt after about 1 to 2 hours. Toradol is often prescribed for acute migraines and post-surgery pain. Toradol is often a single-time injection, but some people may get it every 6 hours.

How much Benadryl is in a migraine cocktail? ›

For migraine relief, administer diphenhydramine (Benadryl) 25 mg IV followed by prochlorperazine (Compazine) 10 mg IV. If the headache does not resolve in 15-30 minutes, giveketorolac (Toradol) 30 mg IV or 60 mg IM.

What happens if a migraine cocktail doesn't work? ›

If the migraine cocktail does not appear to be working, doctors may try other medications, such as valproic acid, an epilepsy drug that also works for severe migraine pain in around 10–15 minutes.

Do migraines show on MRI? ›

What does migraine look like on an MRI? In some people with migraine, MRI scans of the brain may show white spots or areas. These are caused by lesions or irregular areas in the white matter of the brain. White matter tissue is deep in the brain and is mostly made up of nerves.

Which painkiller is best for migraine? ›

Which OTC drugs are commonly recommended to treat migraine headaches? NSAIDS — or nonsteroidal anti-inflammatory drugs — are the first line of treatment when it comes to migraines. These include ibuprofen, which is known by the brand names of Motrin and Advil; and naproxen, which is known as Aleve.

Can you see a migraine on a CT scan? ›

Medical professionals will not use a CT scan to diagnose migraine headaches. If a person is experiencing migraine, a CT scan will rarely show the cause of the pain. However, a doctor may order a CT scan or similar imaging test to rule out other causes of a person's headaches.

How long is too long for a migraine? ›

How long is too long? If a migraine headache lasts longer than 72 hours without responding to regular migraine medication, the person may need additional treatment. Anyone who has experienced this pain for longer than 3 days should speak with a doctor as soon as they can.

How do you treat a severe migraine? ›

Many people who have migraines find that over-the-counter painkillers, such as paracetamol, aspirin and ibuprofen, can help to reduce their symptoms. They tend to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease your symptoms.

When is a migraine serious? ›

Headache accompanied by any symptoms such as: weakness in the face, arm or leg; numbness or coordination problems; visual impairment; language or speech problems; vertigo; confusion; altered wakefulness; or seizures. If those symptoms occur, call 911.

What triggers the migraine? ›

Bright or flashing lights can induce migraines, as can loud sounds. Strong smells — such as perfume, paint thinner, secondhand smoke and others — trigger migraines in some people. Sleep changes. Missing sleep or getting too much sleep can trigger migraines in some people.

What is the newest drug for migraines? ›

The Food and Drug Administration approved the most recent, atogepant (Qulipta), in September 2021. Lasmiditan (Reyvow) is a separate type of treatment that targets the serotonin receptors on brain nerve endings to halt migraine attacks as they occur.

What is the fastest way to cure a migraine? ›

Try these tips and get to feeling better fast.
  1. Try a Cold Pack. If you have a migraine, place a cold pack on your forehead. ...
  2. Use a Heating Pad or Hot Compress. ...
  3. Ease Pressure on Your Scalp or Head. ...
  4. Dim the Lights. ...
  5. Try Not to Chew. ...
  6. Hydrate. ...
  7. Get Some Caffeine.

Which type of headache is considered a medical emergency? ›

Symptoms such as a headache with fever and a stiff neck, a headache that starts with a thunderclap, a headache following a head injury, a headache with loss of vision or numbness of the arms or legs, or a headache with a fever (not caused by the flu) are emergent medical conditions.

How long should I wait to go to the hospital for a migraine? ›

Migraine emergencies include: A migraine that lasts for three or more days without responding to standard migraine treatment: This is called status migrainosus, and it often requires medical intervention with intravenous (IV) medications that are not used for standard migraine treatment at home.

When should I go to ER with headache? ›

Seek emergency care if:

The headache is accompanied by high fever, confusion, stiff neck, prolonged vomiting, slurred speech or numbness or weakness, especially on one side of the body. Headache medication does not relieve chronic or excruciating pain.

Will Toradol get rid of a migraine? ›

Toradol is approved by the Food and Drug Administration (FDA) to treat moderately severe short-term pain. It is also used off-label to treat migraine pain.

What happens if Toradol doesn't help headaches? ›

NSAIDsToradol (ketorolac) is most often used in the ER to treat status migrainosus. There are numerous studies to support its effectiveness, which can be as high as 80%. The typical dose is 60 mg via IV. When toradol fails or is not available, 75 mg of diclofenac is another option.

How strong of a painkiller is Toradol? ›

Because Toradol isn't addictive, it's not regulated as a controlled substance. However, Toradol is very powerful and is only used for short-term pain relief — five days or less. It comes in injections and tablets, or it can be given intravenously (by IV).

What should I put in a migraine kit? ›

What should be in a migraine kit?
  1. Prescription or over-the-counter pain medication. ...
  2. Water bottle. ...
  3. Hydration supplement. ...
  4. Instant hot and cold packs. ...
  5. Sunglasses or eye mask. ...
  6. Earplugs or headphones. ...
  7. Essential oil roller. ...
  8. Ginger.

Why won't my migraine go away even with medication? ›

The most common trigger that makes patients difficult to treat is medication overuse. A patient who is taking an over-the-counter medication that contains caffeine on a daily basis, may not get better. The very medicine they take to relieve their pain triggers their next headache as it wears off.

How do you get rid of a migraine if medicine isn't working? ›

If your OTC medicines haven't worked, your doctor may prescribe stronger medications called triptans, including:
  1. Almotriptan (Axert)
  2. Eletriptan (Relpax)
  3. Frovatriptan (Frova)
  4. Naratriptan (Amerge)
  5. Rizatriptan (Maxalt)
  6. Sumatriptan (Imitrex)
  7. Zolmitriptan (Zomig)
11 Nov 2021

Why won't my headache go away with medicine? ›

Taking OTC pain relievers too often, or at a higher dose than advised, could cause more problems. Once the drug wears off, withdrawal symptoms start. This leads to more head pain and the need for more medicine. Doctors call this a rebound headache.

Is migraine a disability? ›

Can you apply for disability if you have chronic migraine? Yes, you can apply for disability. The fact is, migraine is the second most common cause of disability in the world. In the United States, you may have the option of short- or long-term disability.

What happens to brain in migraine? ›

One aspect of migraine pain theory explains that migraine pain happens due to waves of activity by groups of excitable brain cells. These trigger chemicals, such as serotonin, to narrow blood vessels. Serotonin is a chemical necessary for communication between nerve cells.

What does a migraine look like in the brain? ›

Researchers believe the cortical depression may be the cause of the visual auras that some people with migraine experience. These auras result in people seeing dark or colored spots, sparkles, or other visual disturbances.

How do you get instant relief from migraines? ›

Advertisement
  1. Turn off the lights. Light and sound can make migraine pain worse. Relax in a dark, quiet room. ...
  2. Try temperature therapy. Apply hot or cold compresses to your head or neck. ...
  3. Sip a caffeinated drink. In small amounts, caffeine alone can relieve migraine pain in the early stages.

Does Xanax help with migraines? ›

No, Xanax (alprazolam) does not help with headaches. A potential side effect of Xanax is its ability to cause headaches, which might end up making a pre-existing headache or migraine even worse.

What is the strongest over-the-counter headache medicine? ›

For OTC pain relief, a mixed medication like Excedrin Migraine, which contains acetaminophen, aspirin, and caffeine, is one of the most effective migraine medications.

How does a neurologist test for migraines? ›

An electroencephalogram (EEG) measures your brain waves. Your neurologist will put electrodes, which are small metal discs, on your scalp. This will help your doctor look at your brain activity to see if your pain is from a brain disorder, brain damage, brain dysfunction, or sleep issues.

Will an MRI show why I have headaches? ›

Imaging tests rarely help.

Doctors see many patients for headaches. And most of them have migraines or headaches caused by tension. Both kinds of headaches can be very painful. But a CT scan or an MRI rarely shows why the headache occurs.

What blood tests are done for headaches? ›

Using blood tests to diagnose headaches

A complete blood count (CBC), thyroid function, and erythrocyte sedimentation rate (ESR) are basic tests that are helpful in evaluating some headache patients. A basic metabolic panel should include glucose, electrolyte and fluid balance, and kidney function.

How long does it take to sleep off a migraine? ›

Many migraine headaches gradually fade in intensity. Some people find that taking a 1- to 2-hour nap is enough to relieve their symptoms. Children may only need a few minutes rest to see results. This is known as the resolution phase.

Does sleep help a migraine? ›

Changes in sleep patterns can trigger migraine attacks, and sleep disorders may be associated with increased migraine frequency. Furthermore, migraine patients and their doctors very consistently report that sleep relieves already established migraine attacks.

Why have I had a migraine for 3 days? ›

But a migraine that lasts for more than 72 hours is called status migrainosus. To treat it, you may need to go to the hospital to get help relieving the pain and dehydration from vomiting. A typical migraine can sometimes turn into status migrainosus if: You don't get treatment early enough after the attack starts.

What is an abortive migraine medication? ›

Abortive medications stop a migraine when you feel one coming or once it has begun. Abortive medications can be taken by self-injection, mouth, skin patch, or nasal spray. These forms of medication are especially useful for people who have nausea or vomiting related to their migraine, and they work quickly.

What is the ER migraine cocktail? ›

A migraine cocktail administered in the ER may contain medications like nonsteroidal antiinflammatory drugs (NSAIDs), magnesium, triptans, and IV fluids. It may contain other medications as well, as there is a range of possible medications that can be administered in the ER for severe migraine.

Should I go to the ER for migraine? ›

Go to the ER if you are experiencing severe migraine symptoms, or symptoms such as confusion, fever and vision changes, neck stiffness, trouble speaking or numbness or weakness, even if other symptoms of migraine are present (e.g. light sensitivity, nausea).

Why does throwing up relieve migraines? ›

According to a 2013 review paper, vomiting may help with migraine headache symptoms, because it: changes blood flow to reduce pain or inflammation. releases chemicals that ease pain, such as endorphins. occurs toward the end of a migraine episode, leading to a reduction in symptoms.

Does Toradol work for migraines? ›

Toradol is approved by the Food and Drug Administration (FDA) to treat moderately severe short-term pain. It is also used off-label to treat migraine pain.

How do you treat a severe migraine? ›

Many people who have migraines find that over-the-counter painkillers, such as paracetamol, aspirin and ibuprofen, can help to reduce their symptoms. They tend to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease your symptoms.

How long should I wait to go to the hospital for a migraine? ›

Migraine emergencies include: A migraine that lasts for three or more days without responding to standard migraine treatment: This is called status migrainosus, and it often requires medical intervention with intravenous (IV) medications that are not used for standard migraine treatment at home.

When should you go to ER for headache? ›

Seek emergency care if:

The headache is accompanied by high fever, confusion, stiff neck, prolonged vomiting, slurred speech or numbness or weakness, especially on one side of the body. Headache medication does not relieve chronic or excruciating pain.

What is the new migraine injection? ›

Emgality is a prescription medicine used in adults for: The preventive treatment of migraine. The medicine (120 mg) comes in a prefilled pen or syringe and is taken once a month. The treatment of episodic cluster headache.

What is the most effective medication for migraines? ›

NSAIDS — or nonsteroidal anti-inflammatory drugs — are the first line of treatment when it comes to migraines. These include ibuprofen, which is known by the brand names of Motrin and Advil; and naproxen, which is known as Aleve.

Why was Toradol taken off the market? ›

The company cited blood clots traveling to the lungs, lung tissue scarring and allergic reactions as other potential concerns. Ketorolac Tromethamine is used short-term to manage moderate to severe pain “at the opioid level,” Fresenius Kabi said.

How long is too long for a migraine? ›

How long is too long? If a migraine headache lasts longer than 72 hours without responding to regular migraine medication, the person may need additional treatment. Anyone who has experienced this pain for longer than 3 days should speak with a doctor as soon as they can.

How do you get rid of a migraine that won't go away? ›

Long term treatments
  1. OTC treatments, such as acetaminophen or Excedrin.
  2. nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen.
  3. prescription migraine medications, such as triptans, ergotamine, beta-blockers, or calcitonin gene-related peptide antagonists.
19 Aug 2019

What causes severe migraines that last for days? ›

Anxiety, stress, and mood disorders can trigger headaches that linger for more than a day. Specifically, those with panic disorder or generalized anxiety disorder tend to experience prolonged headaches more often than those without.

Which type of headache is considered a medical emergency? ›

Symptoms such as a headache with fever and a stiff neck, a headache that starts with a thunderclap, a headache following a head injury, a headache with loss of vision or numbness of the arms or legs, or a headache with a fever (not caused by the flu) are emergent medical conditions.

What is considered a severe headache? ›

Your headache comes on suddenly and is explosive or violent. Your headache is "the worst ever," even if you regularly get headaches. You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache. Your headache gets worse over 24 hours.

Can a shower help a migraine? ›

Try temperature therapy.

Apply hot or cold compresses to your head or neck. Ice packs have a numbing effect, which may dull the pain. Hot packs and heating pads can relax tense muscles. Warm showers or baths may have a similar effect.

What symptoms will get you admitted to the hospital? ›

Symptoms of a Medical Emergency
  • Difficulty breathing, shortness of breath.
  • Chest or upper abdominal pain or pressure.
  • Fainting, sudden dizziness or weakness.
  • Changes in vision.
  • Confusion or changes in mental status.
  • Any sudden or severe pain.
  • Uncontrolled bleeding.
  • Severe or persistent vomiting or diarrhea.

Why do I have severe migraines? ›

The exact cause of migraines is unknown, but they're thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.

What does an aneurysm headache feel like? ›

Doctors often describe the head pain caused by a burst aneurysm as a "thunderclap." The pain comes on in an instant, and it's very intense. It will feel like the worst headache of your life. A migraine, on the other hand, tends to come on gradually.

Videos

1. My Night as an ER Patient: How My Headache May Have Prevented A Stranger's Bone Marrow Transplant
(Strong Medicine)
2. What happens to your brain during a migraine - Marianne Schwarz
(TED-Ed)
3. Lunch with Lisa: Migraine and the ER
(American Migraine Foundation)
4. Avoiding the Emergency Room for Migraine
(Coalition for Headache and Migraine Patients)
5. A Migraine Sent Him To The Emergency Room
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6. My Migraine Sent Me to the ER
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