A Migraine Can Be an Emergency

Patient Expert

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There are times when a Migraine gets to the point where we should seek emergency care. This can be a tricky topic to discuss, but it's important.

Just as we don't want to instill panic when we discuss having Migraine disease increasing the risks of cardiovascular disease and events, this discussion should add to our knowledge, but not cause panic. There is information that we, our families, and others in our lives should know. Knowing when we need to see our doctor or go to the emergency room should be basic information that every Migraineur knows. You can find more information on that in our article When to See a Doctor for a Migraine or Headache.

When a Migraine becomes an emergency:

There are circumstances under which we need to see our doctor or go to the emergency room as soon as possible:

  • When vomiting continues with no relief. This can lead to dehydration.
  • When diarrhea continues with no relief. This too can lead to dehydration.

  • When the Migraine is the "worst ever." Actress Sharon Stone is a Migraineur. A few years ago, she had what she thought was her worst Migraine ever. She called someone to take her to the hospital, but he wasn't home. She drifted in and out of sleep for some time before getting to the hospital. When she got there, it was discovered that she had an aneurysm. If she hadn't reached the hospital when she did, she might well have died. On the Oprah Show, Stone commented, "If you have the worst headache you've ever had, go to the hospital because by the time you get to the hospital, you're as far gone as you wanna be."

  • When the Migraine continues too long. When the pain of a Migraine attack continues for more than 72 hours without a solid, pain-free break of at least four hours, while awake, it's termed status Migrainous. There is some disagreement about this within the medical community. Some doctors say this increases risk of stroke and should be treated aggressively and immediately. Others say steps should be taken to "break" the Migraine, but that it doesn't increase stroke risk.

Given the disagreement on this issue, as well as the experience of someone I knew, it's my opinion that the saying, "better safe than sorry," applies here. Statistically, strokes caused by Migraine attacks aren't very common, but who wants to be on the wrong end of those statistics?

Why status Migrainous concerns me:

In 2001, a young woman named Abi participated in a Wednesday evening online chat session I hosted. Abi was just day's from her 21st birthday, happy in a new job, and engaged to be married. As far as Migraine treatment goes, she was doing all she could do. She had worked with her family doctor and a neurologist without making any progress. She had made an appointment with a Migraine specialist and was waiting for the appointment date to arrive.

When she logged on for the chat, she told us that she was on day five of a Migraine. When we encouraged her to get her parents to take her to the emergency room, her response was disturbing. Her parents had accused her of faking the Migraine for attention and refused to take her. A few days later, I received an email from her mother. On day seven of the Migraine, Abi had collapsed and been taken to the hospital. The doctors told her mother that Abi's Migraine had caused her to have a stroke. Abi "recovered" and was discharged from the hospital. A few weeks later, she got a Migraine and suffered another stroke. This time, she didn't survive the stroke. I still have a copy of an instant messenger conversation with Abi's mother from the hospital. She said, "I can't stop shaking or crying...thats my baby."

Not long after that, Jeff, Abi's fiancé, emailed me. He said he'd been reading Abi's journal, and she must have had a premonition that something was going to happen because she'd written letters in her journal to some people. In his email, he included a note from Abi to me. It said,

"Teri I wanted to take some time to thank you for all you've done for me, and for everyone. You have a tremendous heart, a ton of love and understanding. Your soul is one of a kind. I'm sorry to have worried you, I'm sorry I didn't listen to you and get help right away. God led me to you before I died so I could know and appreciate your spirit. Thank you! Please know that I am not hurting anymore, I am with my Heavenly Father and joyfully wait to see you here in heaven some day. Can you do me a favor? Could you please help others understand about migraine, and that getting immediate treatment is important? I will be with you always. I love you Teri. Please be kind and gentle with yourself. Thank you for everything! Love Abi."

I'm writing this article, in part, to honor Abi's request that I "please help others understand about migraine, and that getting immediate treatment is important."

As I write this, I know a young adult Migraineur who recently asked her parents to take her to the emergency room. They refused, saying, "It's just a headache, it will go away." I hope those parents will read this and realize their error. I hope they'll realize that their daughter has a genetic neurological disease, and that she needs them to learn about it and help her. I hope they never have to face the regret and guilt that Abi's parents faced.

Summary:

If you or someone you care about has Migraines, please recognize that Migraine is a disease and learn about it. Learn to recognize that a not "just a headache," it may not go away. There are times when a Migraine attack is an emergency and needs emergency treatment. Please, don't take a chance in finding yourself in the situation Abi's parents faced.

Related: Take our "Should you see your doctor if..." quiz.

Medical review by John Claude Krusz, PhD, MD

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