I keep ending up in the ER for migraines

Start at the first familiar sign, not at the worst point — that single change is what keeps more of the attack out of the emergency department, and it is also what gives your doctor something to work with next time.

I am not a clinician and this is not a diagnosis, and nothing here changes a medicine or a dose. What follows is a home routine, a decision tree, and a short list of questions so the next appointment produces a written plan instead of advice you have to remember.

1. Waiting until it is severe, compared with acting at the first sign

2. Tonight, in about twenty minutes, no cooking

You are running a school week with someone else in the house, so this is built in short blocks, not as a project.

• Five minutes — the attack corner: the bed or chair in the darkest, quietest room, water, one snack they already eat comfortably, the phone and a charger within reach, a notebook and pen, and their own labelled medicine box holding only what a doctor has already advised for them.
• Five minutes — one card on the fridge: "First sign = ______ → start the routine. Call your local emergency number now if any red flag appears."
• Five minutes — the diary, started tonight: one row per attack.
• Five minutes — the caregiver card below, sent to whoever covers the school pickup.
• Five minutes — write the six questions from section 6 down, so the next visit produces a plan on paper.

If the person with the migraine is also the one doing the school run: on an attack day the sibling or the elder takes the pickup, and the migraine person does not drive.

3. The decision tree

1. Any red flag? → Call your local emergency number now. Note the exact time it started. Do not drive them yourself.
2. Not their usual attack — new pattern, different shape, first ever, or headache on most days? → Arrange a clinician review this week instead of managing it at home.
3. Their usual attack and they are otherwise well? → Dark quiet room, water, a snack, their own prescribed medicine exactly as the doctor has written it, phone face down, note the start time. Then fill the diary row the same day.
4. Their usual attack, but no relief within the window the doctor has written ("if not clearly better by ______ then ______")? → Call the clinic line or the urgent care service. Worse than usual, or the written plan did not work? → emergency department.
5. After every attack, the same day: fill the diary row. Bring the diary to every visit.

4. If an attack is on tonight

• At the first sign: dim room, quiet, water, a snack they already eat, their own prescribed medicine exactly as on their own label, phone face down, write the start time, and let them sleep if they can.
• Do not add another tablet, do not use someone else's migraine tablet, do not use anything bought online, and do not use alcohol to get them to sleep.
• If it does not follow the plan, go back to step 1 of the tree and use the door. Using the door is the plan working, not the plan failing.

5. Caregiver card — screenshot this to whoever is home

• What it looks like: one-sided throbbing, nausea, light and sound hurt, they want to lie still and not talk.
• What to do: quiet dark room, water, a snack they already eat, their own medicine exactly as on the box, write the time.
• What to write down: start time, what was taken, when it eased, how many hours they slept the night before.
• Call your local emergency number now if: it is the worst headache of their life and peaks in seconds, there is new weakness on one side or slurred speech, there is fever with drowsiness or a stiff neck, there is a seizure, vision flickers or goes, or one eye is red with rainbow rings around lights.
• Do not give any medicine that is not theirs. Do not dose the child, the elder or the pet out of your own bag. Do not let a drowsy person drive. Do not put a feverish drowsy person to bed to see how they are in the morning.
• School line to send: "[Name] has a migraine and is resting at home. I can pick up by ______. If it becomes a worst-ever headache, weakness, or fever, I will call emergency services."

6. Six questions to get a written plan (take the diary with you)

1. Our written plan for an attack: which medicine, at what point do we start it, and what is the time limit after which we leave for the door?
2. What specifically should bring us back to the emergency department?
3. Which pain relief already in this house is safe alongside the blood-pressure tablet, and how many days a month is safe for them? The limit is theirs to set, so I will not guess it — I will bring the count of days they used.
4. Could the morning headaches with snoring and daytime sleepiness be part of the sleep picture? They are already being followed for sleep apnoea and sleeping badly, so please connect these.
5. Could this be the daily headache that comes from using pain relief so often? I will bring the days-per-month count.
6. What should the diary show, and when do we review it?

7. Please do not

• Do not wait until it is severe, and do not wait out a first-ever one-sided weakness.
• Do not add tablets, do not borrow someone else's, do not use opioids, and do not start any new migraine medicine without a doctor.
• Do not buy powders or supplements online for this. Unknown contents, no proof, and real interaction risk with the blood-pressure tablet.
• Do not stop, double or change any prescribed medicine, including the blood-pressure tablet and the thyroid tablet. Keep taking them as prescribed.
• Do not turn a home blood-pressure reading into a dose change. Record it, bring it, and let the doctor decide.
• Do not set your own days-per-month limit for pain relief. Count and record; the doctor sets the limit.
• Do not dose the child, the elder or the pet from your own bag. Their dosing is theirs, or their doctor's.
• Do not let a drowsy person drive, and do not put a feverish drowsy person to bed to see how they are in the morning.

8. Red flags: stop the home routine and get help

Go now — call your local emergency number:

• Thunderclap: the worst headache of their life, peaking in seconds. Someone who gets migraines can still have this one.
• New weakness or numbness on one side, slurred or confused speech, changed vision, a first seizure.
• Fever with a bad headache, drowsiness, or a stiff neck. Not every person gets the stiff neck, so do not wait for it.
• Flashing or briefly lost vision in one eye, or a red eye with rainbow rings around lights.
• A severe headache in pregnancy or after birth with visual change.
• A headache after a head knock with increasing sleepiness.
• Several people in the house with headache and nausea — get everyone into fresh air first, then call.

Same day or this week, and not a home problem:

• The pattern changing, attacks becoming more frequent, or headache on most days.
• Pain relief that used to work no longer working, or a headache there on most mornings.
• A headache that wakes them from sleep, that is worse on coughing or bending, or that comes with vomiting on waking.
• A new headache after the age of fifty with jaw pain on chewing, or a tender temple.
• Every emergency visit is itself a reason to review the plan, not a reason to try harder at home.

9. What the next twenty-four hours can honestly deliver

• One written plan on paper from the doctor: when to start, what to use as already prescribed, when to leave, and what to bring.
• One diary row per attack, starting tonight.
• One attack handled at home instead of an emergency night, if the pattern holds. If it does not hold, going to the door is the plan working.
• Not a cure. I cannot promise fewer attacks or no more emergency visits. What can change is how much of each attack happens at home, and how much your doctor has to work with.

10. What I did not check this turn

I did not verify your local emergency number, your nearest emergency department, or the clinic's out-of-hours line, so no phone number is printed here and none should be copied from this message. Tell me the country and city or region you are in and I will check the official door and the number worth saving on the fridge card.

The one-page version of this plan is here: migraine-home-plan-efe794fa.pdf

Source: merck-pro https://www.merckmanuals.com/professional/neurologic-disorders/headache/approach-to-the-patient-with-headache
Source: merck-pro https://www.merckmanuals.com/professional/neurologic-disorders/headache/migraine
Source: merck-pro https://www.merckmanuals.com/professional/neurologic-disorders/headache/medication-overuse-headache
Source: rch-cpg https://www.rch.org.au/clinicalguide/guideline_index/Headache/
Source: who-core https://www.who.int/news-room/fact-sheets/detail/headache-disorders
Source: who-core https://www.who.int/news-room/fact-sheets/detail/hypertension
Source: merck-pro https://www.merckmanuals.com/professional/cardiovascular-disorders/hypertension/hypertension