Two years ago I was doing some last-minute shopping the night before Thanksgiving day. I started experiencing a prolonged aura that could have been the early signs of a stroke. After an hour of progressively worsening symptoms, my husband took me to the local ER for evaluation. All the tests were clear, so I was sent home with instructions to return if the symptoms recurred. Fortunately they never did. Even though it was a “false alarm”, that’s one ER trip I will never regret. Knowing the signs of a true migraine emergency is essential for every migraineur and caregiver.

People who say “Migraines don’t kill” have obviously never heard of these life-threatening complications, any one of which can be deadly if not diagnosed early and treated aggressively. We get so accustomed to tolerating the pain that it’s easy to forget how dangerous migraine can be sometimes. We take for granted that “…at least it’s not fatal” when we should be much more vigilant.

Migraines can kill.

There are four potentially life-threatening complications of migraine. Even though they are rare, learning to recognize the symptoms is essential for every migraineur. Knowing what to look for helps determine when it is appropriate to seek emergency help.

If you do end up in the ER with these symptoms, it is critical that you (or your caregiver) be able to clearly explain the symptoms that you are experiencing so that you get fast response to either rule out problems or get emergency treatment right away.

Status migrainosus
Migrainous infarction
Persistent aura without infarction
Migraine aura-triggered infarction
Status migrainosus

Any migraine attack that lasts longer than 72 hours should be evaluated by a doctor. Even if you are able to sleep through the attack or get temporary relief from taking medication, you still need to get it checked out. Doctors will want to rule out stroke and administer treatments to break the cycle. Sometimes long-lasting migraine attacks are caused by other problems such as medication overuse headache. However, status migrainosus must be ruled out first.

Persistent aura without infarction

Anytime we have an aura that lasts for 1 week, we should get it checked out. Again, your doctor should rule out stroke before giving this diagnosis. On rare occasions, persistent aura without infarction can last for years.

Migrainous infarction

This is what doctors are trying to rule out in order to make a diagnosis of persistent aura without infarcition. It appears like a typical migraine with aura except that the aura lasts for longer than 60 minutes. When tested, an MRI or CT scan will show evidence of a stroke. This is distinct from the increased risk of stroke in younger patients (under 30) with migraine with aura.

Migraine aura-triggered seizure

The name is pretty self-explanatory. It is a seizure that is triggered by a migraine attack and typically occurs within the first hour during or after a migraine attack. Patients with epilepsy often experience migraine-like headaches just as the seizure is ending. When a seizure follows a migraine attack, is it commonly referred to as “migralepsy”, although the more accurate diagnosis is migraine aura-triggered seizure.

Of the four complications of migraine, only status migrainosus is seen in patients with migraine without aura. The other three are only seen in migraine with aura. Since none can be accurately diagnosed without at CT scan or MRI and time may be critical, the ER is best equipped to determine the level of your emergency, rule out life-threatening issues, and provide the right interventions should you experience one or more of these migraine complications.

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In addition to the situations listed above, please ensure that you discuss any symptoms that are new or different with your physician or a healthcare professional. While migraine symptoms can change over time, it is essential to rule out any other underlying causes for your symptoms.