First I quote an answer given on this forum, then some about me, comments, and my experience/suggestions:
"A: Yes! You can go to the hospital if you are in severe pain and it will not stop and you can't manage the pain. It is especially important to go to the hospital if you feel like you are going to be at risk to yourself or others because of the pain. Hospitals in different countries and different areas of different countries all have different protocols for treating severe migraines, so I can't answer what types of treatment you will get for sure. Although, for the most part, emergency departments will treat severe migraines with at least one of the following medications or a combination of the following:
- If you have not already used two doses of triptans in the last 24 hours, they may give you an injection of sumatriptan.
- They may give you an antiemetic medication by IV that is called metoclopramide.
- They may give you IV fluids, such as normal saline
- They may give you an ergot alkaloid.
- They may give you oral pain killers or pain killers by IV. The pain killers could be tylenol/acetaminophen, morphine or dilaudid/hydromorphone.
- They may leave you to rest in a dark room.
- They may run tests such as a CT scan, an MRI, an EEG, and/or blood tests."
First, let me tell you that I suffered my first migraine at age 11, they went up to 5 to 6 times a year when I got my menses, and became chronic, near daily in 1996. Post-hysterectomy now for over 3 years, I get them about 5 times a month. I have been on drugs in every class of preventative, taken a number of abortive agents and spent more time in the ER than I would have cared to, as well as went for stints of acupuncture, including blowing thousands of dollars on a trip to the Ontario Migraine Clinic out of desperation because of recommendation and what they touted.
Okay, let me say tylenol on its own would never have touched a 10 migraine for me in the ER, so if they suggest that's all they do, please don't waste your kidneys on it. And not mentioned in the answer above, but if they offer you toradol, you might try it once, but I don't know anybody that toradol has helped with a bad migraine, me included. If it doesn't work, I'd forget it in the future (my opinion). If your like me, most anti-nausea meds given IV make me highly nervous, so you might try for one in an IM shot form, like I did with much better success with that problem. And while you are waiting for hours (if you are in a crowded ER like I frequently was) to be called back, be sure and have on hand an emesis basin and ask frequently for ice paks from the front desk to help freeze the pain (if that helps you as it often has me). I learned long ago in nursing school that the sensation of cold trumps the pain sensation. But occasionally, it actually makes my migraines worse, so if that happens, by all means quit fast!
I used to see Dr. Richard Shubin, associated with Fortnasce in CA and he told me morphine was a bad drug for heads and ineffective for migraine pain and my experience with that drug for migraine bore him out- ineffective. I tried sumatriptan shots at home and the second one gave me such horrible abdominal cramps, my migraine paled in comparison (not everybody's experience, I'm sure). They are optimally given when the migraine is first starting, and would I believe far less likely to be effective if they were given when your migraine reached a level 10. You can also get rebound headache potentially from imitrex pills, at least I used to, as well as chest pains (not supposed to be used if you have certain heart problems, which I'm not sure I had, but got chest pain anyway, though what stopped me from taking them was the rebound headache when they stopped being effective.
I was never offered an EEG at an ER or by the neurologist who followed me the longest, who diagnosed me with common, intractible migraines. Nobody ever thought it was warranted for my migraines, so there must be some kind of criteria (like other neurological symptoms that I didn't fit). If it is your first migraine, or it has been five years, they should offer you a cat-scan or MRI when you have a 10 migraine in the ER.
Lastly for now, may I suggest, try to get to where you have an emergency plan where trips to the ER become rare, because your body can get addicted to narcotic medication, as mine did. The one thing that went right about Canada is that I got off the demerol shots (which I was so scared because they were losing their effectiveness with the pain) and a lot of the pain medication to go there. I was sick as a dog and in pain for the 7 weeks I was there and Brendan Cleary could not count me in his claimed 94 percent success rate, or even in his typical failure, which he claimed was where the person got migraines five or six times a year, but I was so desperate and I did get off a lot of medication that may have been driving the headaches on even more. Once I was off most the drugs, I came home with plenty of migraines, got some help for awhile with acupuncture and prescribed "coptis purgefire" by "HealthConcerns", and got to the point where drugs that wouldn't have helped anymore before started to be more effective.
I now take either 2 extra strength tylenol (sometimes with 4 low dose aspirins) or 600 mg ibuprofen and 25 mg phenergan in the evening (or occasionally valium 5 mg at times when TMJ is involved) for migraines, augmented by ice paks. I have demerol, 100 mg tablets, which I take very rarely, as my emergency pain medication. Thanks be to God, Who has kept me out of the ER for migraines for a long while now.
I'm sorry this is so long!