Yes, urgent care can treat a migraine, and ours treats it by IV. Express Urgent Care gives migraine medicine through an IV in the infusion chair inside our clinic on Woodson Road, a physician directs every infusion, and most patients are on their way home within one to two hours. Call (314) 886-5290 on your way so the chair and the medicine are ready when you walk in.
Why the pills stopped working
By the time a migraine is bad enough to send you looking for urgent care, the tablets in your bag have usually failed, and there is a mechanical reason. Migraine slows the stomach. In a scintigraphy study of people with migraine, food sat in the stomach far longer than in people without migraine, and the delay showed up between attacks as well as during them. A pill swallowed at hour two can still be sitting there at hour five, unabsorbed, while the nausea climbs. Add vomiting and the morning coffee you skipped, and by evening you are also dehydrated, which makes the headache worse. An IV skips the stomach entirely. The medicine reaches the bloodstream in minutes, at a dose we choose, while a nurse watches how you respond.
What goes in the IV, and why each part is there
An anti-nausea medicine that is also a migraine drug. Metoclopramide or prochlorperazine settles the vomiting, and it also treats the headache itself, because both act on the same dopamine pathway that drives migraine nausea. The American Headache Society review of injectable treatment rates these two among the best-supported options for an acute attack. We run it slowly, over about fifteen minutes, because a fast push can leave you restless and unable to sit still.
An anti-inflammatory. Ketorolac calms the inflamed blood vessels and nerve endings around the brain. We skip it for people with kidney disease, a bleeding ulcer or a blood thinner.
Magnesium. It quiets overexcited nerve cells and helps most when your migraines come with an aura.
A steroid, for tomorrow. Most people assume dexamethasone is the part that kills the pain. It is not; in the trials it did nothing extra for the headache in the room. What it does is keep the headache from coming back. Across seven randomized trials of adults treated for severe migraine, a single dose cut recurrence over the next 72 hours by about a quarter. You feel that on day two, not in the chair.
Fluids, if you have been vomiting or have not kept anything down.
We check on you at one hour. If the pain is still moderate or worse, the physician adds a second IV medicine or a nerve block in the same visit: numbing medicine at the back of the head for an occipital nerve block, or a thin applicator through the nose for a sphenopalatine ganglion block. You stay awake for both, and both take minutes.
Why there is no opioid in the bag
An opioid takes the edge off for a few hours and then hands the headache back, often worse. The same American Headache Society review advises against morphine and hydromorphone as first treatment for migraine because they show no real advantage and they bring problems after you leave. Repeated use also trains the brain toward more frequent attacks, the pattern called medication-overuse headache. The medicines above treat the migraine itself, so you go home without a rebound waiting for you.
Urgent care or the emergency room?
A migraine you recognize, the same pattern you have had before, only longer or worse, belongs here. These do not. Call 911 or go to an emergency department for:
- A sudden, explosive headache that peaks within a minute, or the worst headache of your life
- A first severe headache after age 50
- New weakness, numbness, trouble speaking or seeing, or confusion
- Fever with a stiff neck
- A headache after a head injury, especially on a blood thinner
- A new severe headache during pregnancy or after delivery
- A headache with a seizure or fainting
For everything else, the difference is time. The median emergency department stay in Missouri is about two and a half hours before you are on your way out, and a migraine sits in the waiting room with you. Our full comparison is in urgent care vs. the emergency room.
Before you come in
- Call ahead at (314) 886-5290. The IV chair is set up for you, so we want to know you are coming.
- Tell us what you have taken and when. A triptan such as sumatriptan, or an ergot, in the last 24 hours rules out some IV options.
- Tell us if you could be pregnant. It changes which medicines we use.
- Bring someone to drive you home. The anti-nausea medicine makes most people drowsy for the rest of the day.
- Bring your medicine list and your insurance card. We check your benefits before the infusion; an approval from your plan is not a promise of payment.
If this is your third bad one this month
An urgent care visit breaks an attack. It does nothing for the next one. If migraines are sending you here more than once or twice a month, the job changes from rescue to prevention, and the physician practice in our building handles that. People with 15 or more headache days a month have chronic migraine and qualify for Botox for chronic migraine. There is also a preventive infusion given every three months, in the same chair, that blocks CGRP, the protein that inflames the nerve during an attack. And there are the plain drivers no infusion fixes: skipped meals, short or uneven sleep, and daily painkillers, which keep the cycle turning. A headache diary that tracks all three tells the physician more than any scan.
The same chair handles our other IV treatments too; they are listed on the IV infusion page.
Visit us
Express Urgent Care
4479 Woodson Rd, Suite 290, St. Louis, MO 63134
Monday to Friday, 7:00 a.m. to 7:00 p.m.
Frequently asked questions
Can urgent care give you an IV for a migraine?
Ours can. Express Urgent Care has an infusion chair inside the clinic, so migraine medicine goes in by IV the same day, directed by a physician. Call (314) 886-5290 before you come so the chair is ready.
How long does migraine treatment at urgent care take?
Plan on one to two hours. The first round of IV medicine runs over about an hour, we reassess, and you rest about 30 minutes before you leave. A second treatment, if you need one, adds time.
Can I drive myself home after a migraine IV?
No. The anti-nausea medicine causes drowsiness for the rest of the day. Bring someone who can drive you.
What if my migraine has lasted more than three days?
A migraine that runs past 72 hours is called status migrainosus, and one visit may not break it. Come in; if the first infusion does not end it, the physician can set up infusions on several days in a row.
Do I need a referral or an appointment?
No referral is needed. For a migraine, call ahead rather than walking in unannounced, so the IV chair and the medicine are ready when you arrive.
What is in a migraine cocktail at urgent care?
Ours is an IV, not a shot: an anti-nausea medicine that also treats the migraine (metoclopramide or prochlorperazine), the anti-inflammatory ketorolac, magnesium, a dose of dexamethasone to keep the headache from coming back, and fluids if you have been vomiting. There is no opioid in it. A physician chooses the mix for you, and it runs in the chair described on our IV infusion page.
Is it dumb to go to the ER for a migraine?
No. A migraine that will not break is a real reason to get care. If it is your usual migraine, only longer or worse, urgent care treats it faster than a crowded emergency department. If it comes with any warning sign, such as sudden explosive pain, new weakness, fever with a stiff neck or a seizure, the ER is the right place. Our urgent care vs. ER guide walks through the difference.
Should I go to the ER for a migraine with vomiting?
Not for vomiting alone with your usual migraine. That is exactly what the IV is for: the anti-nausea medicine stops the vomiting and fluids replace what you lost, because the IV does not depend on a stomach that is throwing everything back. Go to the ER if the vomiting comes with a warning sign, such as confusion, a stiff neck or new weakness. For anything else, walk-in urgent care is the faster door; call ahead for a migraine so the chair is ready.
Sources
- Orr SL, Friedman BW, Christie S, et al. Management of adults with acute migraine in the emergency department: the American Headache Society evidence assessment of parenteral pharmacotherapies. Headache. 2016;56(6):911-940. doi:10.1111/head.12835
- Colman I, Friedman BW, Brown MD, et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ. 2008;336(7657):1359-1361. doi:10.1136/bmj.39566.806725.BE
- Aurora SK, Kori SH, Barrodale P, McDonald SA, Haseley D. Gastric stasis in migraine: more than just a paroxysmal abnormality during a migraine attack. Headache. 2006;46(1):57-63. doi:10.1111/j.1526-4610.2006.00311.x
- Centers for Medicare & Medicaid Services. Hospital Compare, measure OP-18b: median time from emergency department arrival to departure, Missouri.