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

Call 911 or go to the nearest ER 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.

Go to the ER right away 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, telemedicine or an online urgent care visit 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. Consider urgent care or a clinic for a migraine that is bothersome but stable and not accompanied by any red-flag symptoms. When a headache feels different from your usual migraines or you are unsure, choose emergency care.

What Happens at Bellaire ER

When you arrive at Bellaire ER with a severe or unusual headache, a board-certified emergency physician sees you promptly and 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.

Prevention

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.