When Should You Go to the Doctor or Emergency Room for Migraines?

Migraine is a chronic neurologic disease that causes intense, recurrent headaches and related symptoms. If you suffer from migraines, you’ve probably done a lot of searching online to learn about them. But it might be difficult to know when and where to get help for them. We’re here to help you get answers to those questions.

What causes migraines?

In the past, people believed migraines were caused by dilation of blood vessels. But this theory no longer holds. Recent research has helped experts understand migraines a little better, but there are still some questions. 

There is a genetic component to why people get migraines. Individual vulnerabilities and triggers also play a role. As it stands now, researchers believe these lead to neuronal dysfunction. This means that neurons, or nerve cells, in the brain are not behaving like they should. 

Imaging and electrical studies of the brain suggest that disruptions in brain connectivity and changes in brain activity are at least partly to blame for migraines. Studies also suggest that a substance in the body — calcitonin gene-related peptide (CGRP) — may also play a part in neuronal dysfunction. Research is ongoing.

When should you see a doctor or neurologist for migraines?

It’s important to seek help for your migraines because there is a wide variety of treatment options available. You don’t have to suffer in silence. 

This isn’t an all-inclusive list, but it provides a starting point if you’ve been thinking about getting help for your migraines. If any of these are true for you, it might be time to speak to a healthcare professional:

• You get more than four headache days per month.

• You need medication more than 2 days per week.

• Medication doesn’t help your symptoms or causes side effects.

• You get additional symptoms, such as fever, bowel changes, and the like.

• There’s been a change in the pattern or location of your usual headaches.

• You also have neurologic symptoms, like weakness or slurred speech.

• You recently started a new medication.

• You are pregnant. 

• You have cancer or have had it before.

What your doctor will want to know

When you do speak with your provider about your migraines, they are likely to ask several questions. Try to provide as much information as you can, so you can work with them to identify potential triggers and decide what the next step in treatment should be. Here are some talking points with a few example questions:

• Timing of migraines: 

  • Do they happen at the same time each day or month? 

  • Do they happen when you’re working, eating, exercising, etc.?

• Migraine characteristics: 

  • Are your migraines always in the same area?

  • What do they feel like?

• Relieving or exacerbating factors:

  • What makes them better or worse?

• Medications (including supplements) and medical history:

  • Did you start any new medications recently?

  • Do you have a history of headaches/migraines?

• Environment:

  • Do you smoke, vape, or drink?

• Activity level and occupation:

  • Are you exposed to anything new at work? 

• Sleeping habits:

  • Do your migraines affect your sleep patterns?

When should you see a headache specialist?

Most people who experience migraines will eventually find patterns in their migraine pain. If that’s you, and you notice that things seem different or more severe than your usual migraine, it’s probably worth getting checked out. 

The medical community understands more these days about migraines. But research is ongoing, which means things like treatment recommendations and guidelines can change quickly. Headache specialists (often neurologists) are well versed in all of the new research because it’s their sole focus. 

It might be time to see a specialist if:

• You’ve tried medications but nothing is working.

• Your migraines are getting worse or happening more often.

• You find yourself relying on opioids (narcotics) to treat your migraine pain.

• You’re interested in newer medications that your current healthcare provider might not be familiar with. 

Remember that you may need a referral to see a specialist, and seeing an in-network versus out-of-network provider can greatly affect your cost. So it’s a good idea to do your homework first. 

Having migraines is tough and can be life changing, but there are ways to manage them. Ask your primary care provider if you need help, or use online tools such as this headache specialist finder. 

When should you go to the hospital or emergency room for a migraine?

Headaches and migraines — especially when severe — can be scary. It helps to pay attention to your migraine patterns and recognize signs that indicate something more serious is going on. 

Some characteristics that suggest you should seek help immediately include:

• Sudden onset (worsening within a few minutes) 

• Sudden neck pain or stiffness

• Severe or unrelenting nausea and vomiting

• Confusion or feeling disoriented

• Neurologic symptoms (such as weakness or imbalance) that are not normal for your migraines

Why trust our experts?

Written by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Reviewed by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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