When should I go to the ER for migraine headaches?

Making the Call: ER, Virtual Visit, or Home

The right level of care depends less on how much a migraine hurts and more on whether it is behaving like your usual migraines. A familiar attack that responds to your treatment is a home-care situation. A headache that is new, worsening, or paired with warning signs belongs in the ER. Here is how to sort it out.

Go to the ER for a Migraine When

• It is the worst headache of your life or comes on suddenly and explosively (peaks within a minute).
• Any neurological sign appears: weakness, numbness, facial drooping, trouble speaking, vision loss, confusion, loss of balance, or a seizure. Call 911 and use the FAST check for possible stroke.
• The attack will not break after 72 hours despite your usual medication (status migrainosus), or the pain is uncontrolled.
• You have repeated vomiting and cannot keep fluids down, leaving you dehydrated. IV fluids and IV medication often work when oral pills no longer can.
• The headache comes with fever and a stiff neck, follows a head injury, or is a first-ever severe headache, especially if you are over 50, pregnant, or immunocompromised.

At the ER, a board-certified physician can run a neurological exam and, when a red flag is present, an on-site CT scan to rule out bleeding, plus lab work, all in a single visit. For a confirmed acute migraine, ER treatment often means IV fluids and medications targeting the pain, nausea, and inflammation directly.

When Telemedicine or Urgent Care Is Reasonable Instead

You do not need the ER for a routine migraine. Consider a lower level of care when the headache fits your usual pattern and has no warning signs:

• Telemedicine / online urgent care is a good first step for a typical migraine when you need advice, a diagnosis, or a prescription or refill without leaving home.
• Urgent care or a walk-in clinic works for a migraine that is bothersome but stable, especially if you cannot reach your own doctor.
• Your primary care physician or a neurologist is the right place for ongoing management, trigger identification, and preventive medication if you get frequent or disabling migraines.

The Bottom Line on Timing

Do not wait if a headache is sudden, severe, or different from your normal pattern, or if any neurological sign appears. When you are genuinely unsure whether this is your migraine or something more serious, err toward emergency care.

For a complete guide, see our migraine headaches page. Bellaire ER is open 24 hours a day, 365 days a year at 5302 Bellaire Blvd, Bellaire, TX 77401. Walk in any time or call (713) 660-0001.