Migraine Headaches

Symptoms

• Throbbing or pulsing pain: Often on one side of the head, moderate to severe, and worsened by movement, coughing, or physical activity.
• Nausea and vomiting: Many people feel sick to their stomach during an attack and may be unable to keep food or fluids down.
• Light and sound sensitivity: Bright light and noise become painful, so people often seek a dark, quiet room.
• Aura: Temporary visual changes such as flashing lights, zigzag lines, or blind spots, sometimes with tingling, that usually build up over minutes and precede or accompany the headache.
• Warning (prodrome) signs: Mood changes, food cravings, neck stiffness, or fatigue in the hours before the pain begins.
• Duration: Untreated attacks typically last from 4 hours to 3 days and can be disabling.

When it's an emergency

Go to the nearest emergency room immediately for a sudden, severe headache that reaches its worst intensity within seconds to a minute (a thunderclap headache), or for the worst headache of your life. These can signal bleeding in or around the brain and need urgent evaluation.

Call 911 immediately if a headache comes with any neurological warning signs: weakness or numbness on one side, drooping of the face, trouble speaking or understanding, sudden vision loss or double vision, confusion, loss of balance, or a seizure. Use the FAST test (Face, Arms, Speech, Time) and call 911 for possible stroke.

Seek emergency care for a headache with fever and a stiff neck, a rash, or sensitivity to light, which can point to meningitis. Also come in for a severe headache after a head injury, a headache that wakes you from sleep or steadily worsens over days, or a new or unusually severe headache if you are pregnant, over 50, immunocompromised, or have cancer.

The key question is whether the headache is different from your typical migraine pattern. A headache that is new, sudden, or comes with any of the signs above should be evaluated in the ER even if you have a history of migraines. Bellaire ER is open 24/7 with on-site CT to rule out dangerous causes and treat severe headaches in the same visit.

When it's not an emergency

A typical migraine that follows your usual pattern, responds to your normal medication, and comes without new neurological symptoms can usually be managed at home with rest in a dark, quiet room, hydration, and your prescribed or over-the-counter treatment.

If you need a diagnosis, a prescription refill, or advice on managing recurring migraines, Bellaire ER's virtual urgent care is a reasonable first step. A virtual visit can help you start or adjust a treatment plan without leaving home.

Your primary care physician or a neurologist is the right place for ongoing migraine management, identifying triggers, and preventive medication. A migraine that is bothersome but stable, with no red-flag symptoms, does not need emergency imaging, though Bellaire ER can treat one that will not break with IV medication rather than leaving you to wait it out. When a headache feels different from your usual migraines or you are unsure, choose emergency care.

What else could be causing this

Migraine

A neurological event, not an ordinary headache. Throbbing pain, often one-sided, worse with movement, with nausea and sensitivity to light and sound, sometimes preceded by visual aura that builds over minutes. The pattern repeats and is recognizable to the person who gets them.

Tension-type headache

A pressing or tightening band across both sides of the head, mild to moderate, without the nausea and light sensitivity of migraine and not made worse by activity. The most common headache there is, and the one least likely to need an emergency visit.

Cluster headache

Severe, strictly one-sided pain around the eye or temple, lasting minutes to a couple of hours, with a watering or red eye, a drooping lid or a blocked nostril on the same side. People pace rather than lie still, the opposite of migraine behavior.

Subarachnoid hemorrhage

Bleeding around the brain, usually from a ruptured aneurysm. A thunderclap headache that reaches maximum intensity within a minute, often described as the worst headache of a life, sometimes with neck stiffness, vomiting or loss of consciousness. Uncommon, and the single reason a sudden severe headache is imaged without delay.

Stroke or bleeding within the brain

A headache accompanied by one-sided weakness or numbness, a drooping face, slurred or confused speech, sudden vision loss, or loss of balance. The headache is not the main event; the neurological deficit is. This is a emergency care call, not a drive.

Meningitis or encephalitis

Infection of the lining or the substance of the brain. Headache with fever and a stiff neck, light sensitivity, a rash, drowsiness or confusion. Progresses over hours, which is why fever plus a stiff neck is treated as an emergency rather than observed.

Post-traumatic headache

Headache after a blow to the head. Usually from concussion, but a headache that worsens over hours after a head injury, or comes with vomiting, drowsiness or confusion, raises the possibility of bleeding inside the skull, particularly in older adults and anyone on a blood thinner.

Raised or lowered pressure inside the skull

Headache that is worse on waking or when lying flat, worse with coughing or straining, or that wakes a person from sleep, sometimes with visual changes or vomiting. A mass, hydrocephalus or idiopathic intracranial hypertension can produce it. The pattern, position and timing, is the clue.

Sinus, dental and eye causes

Sinusitis gives facial pressure with congestion and is often worse bending forward. Dental infection and acute angle-closure glaucoma, a painful red eye with blurred vision and haloes, both present as headache and both need their own treatment rather than migraine treatment.

Medication-overuse and withdrawal headache

A daily or near-daily headache in someone using pain relief or triptans frequently, or the headache that follows stopping caffeine. It is the common explanation for a headache that has changed from episodic to constant, and it does not improve until the pattern of use changes.

What happens when you arrive

When you arrive at Bellaire ER with a severe or unusual headache, a board-certified emergency physician reviews your symptoms and headache history to distinguish a migraine from a dangerous cause.

Your evaluation includes a focused neurological exam. When a red flag is present, we use on-site CT imaging to look for bleeding or other serious problems, along with lab work and, when appropriate, other tests, all under one roof.

For an acute migraine, treatment often includes IV fluids and medications that target migraine pain, nausea, and inflammation, so you can get relief faster than with oral pills alone.

We diagnose and treat in a single visit, and most patients do not need a hospital transfer. Before you leave, your physician explains your results and gives you a clear follow-up plan.

Tests we can run on site

Neurological examination

A structured bedside assessment of strength, sensation, coordination, speech, eye movements, pupils, the back of the eye and the neck. It is not a formality, a normal examination in a typical migraine pattern is what makes imaging unnecessary, and an abnormal one is what makes it urgent.

CT scan of the head

Cross-sectional imaging, available on site. It is good at what matters most acutely: blood inside or around the brain, a large mass, swelling, hydrocephalus, and skull fracture after injury. It is the test for a thunderclap headache, a headache with neurological signs, and a significant head injury.

Blood work

A blood count, metabolic panel and inflammatory markers. These look for infection, anemia, electrolyte and kidney problems, and, in adults over 50 with a new headache and scalp tenderness or jaw pain, the raised inflammatory markers of giant cell arteritis.

Blood pressure and vital signs

Severely elevated blood pressure can cause headache and needs treating in its own right. Fever points toward infection. A low oxygen level or an abnormal heart rate redirects the evaluation entirely.

Pulse oximetry and carbon monoxide consideration

Headache with nausea affecting several people in one household, or appearing in winter with heating use, raises carbon monoxide poisoning. It is easy to miss because it mimics a viral illness, and worth naming because the treatment is nothing like migraine treatment.

Pregnancy test

Done for anyone who could be pregnant. New or severe headache in pregnancy, particularly after 20 weeks or with visual changes or swelling, raises pre-eclampsia, which changes the evaluation and the urgency.

Treated here, or transferred

Bellaire ER is a licensed freestanding emergency room: board-certified emergency physicians and nurse practitioners, on-site CT, X-ray, ultrasound and laboratory, medication administered on site, open 24 hours a day, 365 days a year for adults and children. It is equipped for emergency evaluation, stabilization and treatment, and it is not a hospital.

An acute migraine is a condition the emergency room treats. Treatment for a severe attack usually combines IV fluids with intravenous medication aimed at migraine pain, nausea and inflammation, given in a darkened room, which reaches people whose oral medication has already failed or who cannot keep tablets down. Tension headache, sinus and dental causes, medication-overuse headache and severely raised blood pressure are also identified and managed here, with treatment given during your visit and any continuing medication prescribed for you to fill at your pharmacy.

Some causes need a hospital. Bleeding around or inside the brain, a stroke, meningitis, a brain mass, or a headache in someone who needs a neurologist, neurosurgeon or admission will be stabilized here and transferred. A lumbar puncture and specialist neurological care are hospital services. The CT that identifies the problem is done here, treatment and monitoring start here, and both continue during transfer. Transfer is a normal outcome of a headache evaluation, not a failure of it.

If imaging and examination are reassuring, your physician explains what was excluded, treats the attack, and sets out a follow-up plan, which for frequent migraine means ongoing care with a primary physician or neurologist, where preventive treatment belongs.

Children

Migraine is common in children and often looks different from the adult version. Attacks are frequently shorter, more often felt on both sides of the head, and dominated by abdominal pain, nausea and vomiting rather than by the headache itself, a child who goes pale, stops playing and wants to lie down in the dark may be having a migraine without saying their head hurts. A family history of migraine is common and is part of the picture.

The red flags in children are the ones worth acting on. Call 911 immediately for a seizure or sudden stroke signs such as a drooping face or sudden vision change. Seek prompt emergency evaluation for a headache with weakness, numbness, unsteadiness, a drooping face, confusion, a seizure, sudden vision change, or persistent vomiting. A headache that is worse on waking or that wakes a child from sleep, a headache that is steadily getting worse over weeks, or a headache in a child with a new squint or head tilt needs evaluation rather than a wait-and-see approach.

Fever with a stiff neck, light sensitivity or drowsiness in a child is an emergency, as is any headache following a significant blow to the head. In an infant, a bulging soft spot, a high-pitched cry or unusual drowsiness carries the same weight.

Bellaire ER treats adults and children, and the same on-site CT and laboratory are used to work out which cause is present. In children the threshold for imaging is weighed carefully, a typical migraine pattern with a normal neurological examination usually does not need a scan, and avoiding unnecessary radiation in a child is part of the decision. Ongoing migraine management, trigger identification and preventive treatment belong with a pediatrician or pediatric neurologist, not with repeat emergency visits.

After you leave

After treatment for an acute migraine, expect to feel washed out for a day or so even once the pain has gone; that postdrome is part of the attack rather than a sign something was missed. Rest in a dark, quiet room, drink fluids, eat when you can, and avoid driving until the medication you were given has fully worn off.

A normal CT is meaningful but it describes that scan, at that moment, answering the questions a CT can answer. It does not make the next headache safe to wait out. Call 911 immediately for a headache that peaks within seconds to a minute, for weakness or numbness on one side, a drooping face, trouble speaking or understanding, sudden vision loss or double vision, confusion, a seizure, or loss of balance.

Return too if a fever and a stiff neck develop, if the headache steadily worsens over hours or days rather than easing, if it starts waking you from sleep, if vomiting means you cannot keep fluids down, or if the pain comes back as severely as before once the emergency treatment wears off.

Take what you were prescribed as directed, and keep track of how often you are using pain relief, using acute medication on most days of the week is itself a cause of daily headache. Book the follow-up you were advised to book. A headache diary recording timing, triggers, sleep, meals and medication use is the most useful thing you can bring to that appointment, and it is what makes preventive treatment possible.

Lowering your risk

You can reduce migraine frequency by identifying and avoiding personal triggers, which commonly include skipped meals, dehydration, poor or irregular sleep, stress, alcohol, and certain foods.

Keeping a headache diary, staying hydrated, eating and sleeping on a regular schedule, and managing stress can help. If you have frequent or disabling migraines, talk with your doctor about preventive medications and treatments.