Migraine red flags

Most migraine attacks are not emergencies, but some headache symptoms need urgent assessment because serious conditions can mimic migraine.

Get urgent help

Seek urgent or emergency care for sudden extremely severe headache, headache after head injury, fever with stiff neck, confusion, seizure, fainting, new double vision, new vision loss, new weakness or numbness, new trouble speaking, new drowsiness, or a headache that is clearly different from the usual pattern.

Also seek prompt care for new headache after age 50, headache that worsens with coughing or exertion, migraine lasting longer than 72 hours, aura symptoms lasting longer than one hour, or headache during pregnancy or soon after birth.

Do not self-triage stroke-like symptoms

Migraine aura can include neurologic symptoms, but new stroke-like symptoms should not be handled as routine migraine. When in doubt, use local emergency services.

If you are unsure whether a symptom is new, compare it with your written baseline: usual aura type, usual duration, usual side of symptoms, usual headache build-up, and usual recovery. A clear baseline helps, but it should not delay urgent care when symptoms are sudden, severe, or different.

Sources

• Mayo Clinic: Migraine symptoms and causes
• NHS: Migraine
• Mayo Clinic: Headache causes