What Really Happens When You Go to the ER with Migraine

The Migraine Community Reveals the ER Is Either a Lifesaver or a Pain — and Most Avoid It Due to COVID-19

What do people with migraine hate more than migraine attacks themselves? The ER. Specifically, going to a hospital emergency room in the midst of a severe migraine that just won't stop. Or, even worse, a migraine attack plus a pandemic.

As migraine experiences go, the emergency department has always been one of the most painful. It's not as bad as a job or friend but sometimes it feels close. A survey of nearly 1,000 people with migraine showed that 74% of them were afraid to go to the emergency department when experiencing acute symptoms.

Depending on where you live and how familiar your local hospital is with migraine, it can either be a horror story or a lifesaver. Keep reading to learn from an expert and the community what you can expect. 

What Do They Give You in the ER for a Severe Migraine Attack?

There is no one-size-fits-all migraine treatment, even in the emergency room or urgent care. "An ER gives you symptomatic medications, typically to treat nausea and pain, " says Andrew Charles, MD, director of the Goldberg Migraine Program and professor of neurology at UCLA. "In some places, they will give you migraine-specific therapies if you haven't tried one before going to the emergency room."

What kind of acute migraine treatments can you expect to receive? According to Dr. Charles, a typical rescue approach (also sometimes called a "migraine cocktail") could include:

• An analgesic (pain reliever)
• An anti-nausea agent (like prochlorperazine or metoclopramide)
• An anti-inflammatory medication, such as steroids or nonsteroidal anti-inflammatory drugs
• Magnesium
• Intravenous fluids, especially if you are dehydrated from vomiting
• Anti-seizure medications

For best results, work with your primary care physician or headache specialist to figure out what treatments are most effective for your migraine symptoms before considering the ER.

When to Go to the ER for Migraine

Most people report seeking emergency treatment because of an intractable migraine attack that can't be resolved at home or unusual symptoms that are different or strokelike, requiring further assessment. For others, friends and coworkers insist they get hospital care because they feel scared and helpless watching the migraine (cue vomit, vertigo, partial blindness) unfold.

We're sharing firsthand accounts of what really happens when you seek medical attention for an acute migraine from the ER as told by members in our Migraine Again Facebook community. If you haven't already "liked" our page, take a minute and do so now. It's a great place to discover people just like you who are struggling with the brutal reality of unpredictable pain.

Migraine Community Members Reveal What to Expect When You Go to the ER

You Sit. And Sit. And It’s Not a Migraine-Friendly Place.

We all know that triage rules apply, and migraine isn't a life-threatening condition like a gunshot wound. That doesn't make the long wait any easier.

"I get ushered from one waiting room to the next with more people in each one. The final one is set up as a cubicle style and they talk to you like you're an addict." —Jeannette G.

"Last time I went to the ER, I was charged $500 to sit on a bed in a hallway." –Anna K.

"I HATE BEING IN THE ER with a migraine especially. No one ever seemed to observe the no perfume/scents rule. The fluorescent lights are horrible. The noise is extra, extra noisy." —Laura M.

"I'm sensitive to light, sound, smell, and none of the injections I get ever help so why in the world would I go to the loudest, brightest, smelliest place there is just to sit and be ignored for hours to maybe get meds that don't even help?" —Barbara D.

You Have to Prove Your Pain. And That You’re Not a Drug Addict.

The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that's escalating annually. ERs are trained to screen us all the same: Hmmm, could you be one of the 36 million opioid abusers worldwide?

That complicates the problem of migraine as an invisible illness for which there's no scan or blood test to easily prove your diagnosis. The stigma continues.

"They think you are there because you are a 'druggie,' ask you a million and one questions that you can't answer because of the migraine fog." —Jaselle H.

"They assumed I was a drug addict because I was in my mid-20s and writhing in pain with 'no discernible reason.' Then I got an IV and froze for a few hours before going home." —Lorenzo T.

"I'm allergic to normal migraine meds and when I told them that, the doctor stormed out, came back with a syringe, gave it to the nurse and told me that he'd give me Demerol this time to help get rid of the headache but that I'd better never come back again because he was never giving me that med again. He said if I wanted it, I'd have to get it from someone else. It was the first and only time I'd gone to the ER for a migraine. I was so insulted and demeaned, I would never go back again. I couldn't believe it." —Andi S.

"HAAAAATE being treated like a druggie just for being in pain! It's like we are being punished for being aware of our bodies and knowing when something isn't right with them! Even if I specifically mention a nonsedating, nonopiate medication, doctors look at me like I asked them to shoot me up with a needle full of heroin! The last thing I want is to be sedated even more than I naturally am–I'm just tired of being in pain every day even after all the NSAIDs I shovel down my throat (my poor liver and kidneys!)" —Anna K.

"They thought I was a drug seeker until they took my blood pressure — it was sky-high from the pain. Plus I had my neuro's protocol for administering DHE-45. Not to mention I was covered in puke. I was bawling from lack of care and pain, husband almost got arrested for threatening the staff for not treating me. Yeah. Good times." —Laura S.

They Don’t Know Your History — And You’re in No Shape to Give Clear Direction.

In the midst of an attack, few of us can complete a coherent sentence. The migraine babble and nurse triage questions don't play well together.

"They thought I was a druggie because my speech was confused. It was quite a busy night and they were attending 'more critical' cases first, road accidents victims and all! All I was given was a vomit bag and sleeping tablets! Woke up 5 hours later and decided to go home! —Olè M.

"The 'LAST' time I went to the ER for a migraine I was in SO much pain I couldn't see, I was in excruciating pain, I went in the wheelchair backwards because I just wanted to be in a ball and literally couldn't straighten myself out. The check-in person who takes vitals before they bring you back made me turn around in the wheelchair so she could get my vitals. I told them I couldn't, and I was just screaming no no no. She told me she couldn't help me if I couldn't sit straight. So I turned around, and two seconds later I passed out, cracked my head open on the floor, and was unconscious for I don't know how long." —Skipper D.

Your ER Doctor May, or May Not, Be Very Familiar With Migraine or Migraine Treatment.

Watch a few episodes of Grey's Anatomy, and it will become clear. You're not going to get a board-certified headache specialist, or even a neurologist, in your local ER. After all, they're trained to set a broken arm, remove a bullet, and shock your heart. Stat!

"I was taken to the ER in an ambulance with migraine aura, thinking I was having a stroke because half of my tongue was numb and I was slurring my speech (typical migraine aura). Of course, the doctor who saw me was pissed that I wasted his time and talked to me like I was an idiot."—Monica S.

"That was my very last visit and I will NEVER go back for a migraine. It was very traumatic for me and made matters worse. I also think that ER docs are trained to treat emergencies and having a migraine is low on their list and not an emergency to them … so you are handled in a very, very slow manner and a lot of times without compassion." —Cherry S.

"When I went the ER doctor was SUPER nice about it. They turned off the lights and made me do a CT scan. Since I had not had one that was like that, he was afraid I was having a stroke. Two days before I had gone in [to the same hospital] with the same migraine, but they treated it like a tension headache and acted like I was wasting their time." —Megan P.

"After being stuck in constant migraine for 10 days and a very thorough assessment by my GP and A&E, for some reason I got put onto a cardiology ward because there isn't a neurology ward. The ward sister was really rude openly about me taking up a bed when there is nothing wrong with my heart. I was seen by a rude cardiologist who shouted at me saying Amytryptiline is for depression not migraine, "Why are you taking this? Are you depressed?" —Lisey D.

You're Not Exactly 'Fine' When You Leave.

In the absence of a cure for migraine, you're going to get medication. And lots of it. Enough to knock out a horse. Better not make plans for tomorrow — that's time for your migraine hangover, aka postdrome.

"They give you 'abortive meds.' Knock you out, send you home. Then you're in a medicated induced coma for the rest of the day. Then you wake up the next day still having the same migraine." —Jaselle H.

"Shot me up with meds so strong I couldn't even move." —Victoria S.

Not All Hospitals and Emergency Rooms Are Alike. Some Are Lifesavers.

Although it's a fairly common complaint among ER patients, the space and process are designed to prioritize and treat life-threatening conditions, not migraine. And to be fair, sometimes they do everything right.

"I have been to our local hospital here several times for a migraine. Couldn't have been better cared for. The nurses turned the lights off and gave me a cool cloth to put over my eyes while I waited for the Dr. He gave me a shot of Imitrex and I have been taking the pills ever since. Changed my life. I was told that I would never have to wait out in the waiting room, there was always a cool dark room to wait in. Also, when I get the chills as I often do with migraines, they bring me heated blankets." —Roberta C.

"They know me, and someone way back must've educated the ER staff– I've only had 1 bad experience in the 16 years I've been having these. It happened to be a just awful nurse that was showing her need to retire… " —Hollyanna C.

"Luckily I get treated pretty well at the ER for migraines. Give me some meds and a drip and 5 mins later I feel great. With all the other 'patients' that go to the ER they know I'm for real. Around here it's a lot of people who think they are pregnant, or have a toothache that go to the ER. Mainly because they don't have insurance." —Meg W.

"My last visit to the ER for migraine was very straightforward and helpful. Checked out, IV fluids, Toradol, Compazine — actually was a good experience… (for a change)." – June B.

6 Alternatives to Going to the ER

To avoid the misery of the ER, try to:

Change Your Approach

Is there another migraine treatment you can try? Talk to your doctor about your options.

Talk to a Doctor Online

You may be able to skip the wait to see a headache specialist by using telehealth.

Ice Up and Wait

Ice provides pain relief for many people with migraine, including me. If you're really struggling with pain, see if you can calm it (or wait it out) with the help of ice.

Go to Urgent Care

In some places, urgent care will be a lot like the emergency room, but that's not always the case.

Request Rescue Meds

Rescue medications are those that you reach for when your regular migraine treatment isn't working. Talk to your healthcare provider about your options.

Get a Referral to a Specialist

This is definitely not a quick fix; many headache specialists have months-long waits for new patients. If you have frequent migraine attacks or find yourself in the ER again and again, a headache specialist is going to be able to offer the best help long term.

Final Thoughts

There's a lot of pain and a lot of wisdom in these personal stories of ER for migraine care — thanks to all who took the time to share. That's one of the best things about the Migraine Again community: We learn from each other's disasters and victories.

Interested in discovering how to make the best of a tough situation? See more on migraine emergencies:

How My Migraine Treatment Protocol Makes ER Visits Easier

When Should You Go to the ER with a Migraine

Just remember: You know yourself. If your symptoms are different from usual, always seek medical care from the ER, urgent care, or a physician. Ignoring a life-threatening medical emergency isn't worth it.