What should you know about intractable migraine?

Migraine can cause headache with nausea, vomiting, light sensitivity, dizziness or visual symptoms. An intractable attack is unusually persistent or difficult to control, and may prevent sleep, drinking, work or normal movement. A long-lasting attack can also cause dehydration and medication-related problems if pain medicines are taken repeatedly. Symptoms such as headache or nausea can occur with many conditions, so a clinician considers the overall pattern, examination and any change from your usual migraine.

Contact a healthcare professional if your usual treatment is not working, you cannot keep fluids down, or the attack is lasting longer than expected for you. Record the onset, medicines taken, food and fluids, sleep, possible triggers and associated symptoms. Rest in a quiet, dim room if that helps, take small sips of fluid and use prescribed medicines only as directed. Avoid adding repeated doses or combining products without checking, since this can worsen headaches or cause side effects. A clinician may review acute treatment, prevention and other causes.

Seek emergency help for a sudden severe headache, new weakness or numbness, trouble speaking, confusion, fainting, seizure, stiff neck with fever, new vision loss or headache after a head injury. Urgent assessment is also needed for persistent vomiting with inability to drink, or a new headache during pregnancy or after childbirth. Do not assume a new or markedly different headache is migraine.

Does this attack fit my usual migraine pattern? What should I take at the first sign, and when should I stop self-treatment? Could another condition or medicine be contributing? Would preventive treatment help, and how will we judge whether it is working?