Should my friend go to the ER?
September 6, 2017 9:33 PM   Subscribe

I'm writing on behalf of a friend, who has had a bad headache since Thursday. She's in a foreign country and is trying to decide whether she should go to the ER. She is not sure whether the headache is serious or treatable in the ER (and is of course worried about the cost). In her words:

It is the back upper left of my head - a very localised spot. It is a searing stabby pain, not a dull ache.

My headache was much better this morning and throughout the day, but now I have woken up in the middle of the night in extreme (9/10) pain at he same part of my head that has been hurting me all along (back upper left). It is so bad that I am clutching my head and crying.... I don't see how it could be stress related if I am waking up in the middle of the night after not having tensed my head and neck muscles for hours since I fell asleep. I am also a little bit nauseous.

I took migraine meds (sumitriptan) on Monday. They didn't seem to help. 2x 50mg tabs, taken a few hours after each other as directed. My friend suffers from migraines and she said that would have helped in 20 minutes if it were a migraine so she doesn't think it is.

Don't remember how it started. It was probably a 5/10 for 2-3 days. Then it was bad, like 8/10. But it comes in waves of varying intensity. It is always present but cycles between 5-10 to 9/10 without ibuprofen. When I take ibuprofen it goes down to 1-2/10 to 5-6/10 usually. But sometimes ibuprofen doesn't help much for some reason.

There wasn't any incident that started it. I probably just woke up with it. I usually have a headache when I wake up.

Thoughts? Thanks.
posted by ClaireBear to Health & Fitness (30 answers total) 5 users marked this as a favorite
Better to go and have it turn out to be nothing, than not go and die from something that could of been treatable. Please urge her to go.
posted by littlesq at 9:36 PM on September 6, 2017 [2 favorites]

Should my friend go to the ER?

posted by Kwadeng at 9:43 PM on September 6, 2017 [7 favorites]

Yes, go to the ER. Normal headaches don't last that long.
posted by kapers at 9:44 PM on September 6, 2017 [2 favorites]

Also. Clutching your head and crying level pain is an emergency.
posted by kapers at 9:46 PM on September 6, 2017 [14 favorites]

Yes. As a migraine suffered, it could still be an intractable migraine that the ER should be able to treat.
posted by bookworm4125 at 9:46 PM on September 6, 2017

Yes. Pronto.
posted by praemunire at 10:05 PM on September 6, 2017

Maybe if you tell us which foreign country she is in, somebody local might have some relevant advice. For example, I'm in Italy, and ER tretment here is free for foreign visitors.
Apart form that, yes, yes.
posted by aqsakal at 10:27 PM on September 6, 2017 [2 favorites]

Yes this could be very serious but just check first that she hasn't suddenly stopped having coffee (caffeine withdrawal hurts!) or drinking way less fluid than usual.
posted by hazyjane at 10:34 PM on September 6, 2017

Thanks for the input so far, guys - really appreciate it!

She's in the UK (Scotland, currently) on the automatic 90-day tourist visa. She's extremely stressed right now (because she's en route to another European country to begin a tough graduate program), and she's out of her usual routine, so it is possible that it's a tension headache or triggered by a lack of caffeine/fluids.
posted by ClaireBear at 10:41 PM on September 6, 2017

Please have your friend go to the hospital. Emergency medical treatment is free for everyone in Scotland, including foreign visitors. The ER is called A&E (Accident & Emergency) here.
posted by CompanionCube at 10:51 PM on September 6, 2017 [8 favorites]

Please urge her to go. It might be nothing, but better safe than sorry!
posted by dancing_angel at 10:52 PM on September 6, 2017

She should go. Let us know how it goes.
posted by limeonaire at 11:02 PM on September 6, 2017 [1 favorite]

Yes definitely go. I get migraines and that doesn't sound like one to me.
posted by fshgrl at 11:20 PM on September 6, 2017

always go to the ED for "the worst headache you've ever had."
posted by j_curiouser at 11:24 PM on September 6, 2017 [4 favorites]

If it hurts so bad you can't sleep, go to the ER. (My husband didn't, and it turned out the next day that he had a pulmonary embolism. It turned out ok, but it would've been better to go in earlier.)
posted by leahwrenn at 11:31 PM on September 6, 2017

Yes. ER now.
posted by SLC Mom at 11:38 PM on September 6, 2017

Well, if being in extreme prolonged pain doesn't seem serious enough, and being in an area where healthcare is free at point of use doesn't seem cheap enough, I'm not sure what you could say to convince your friend to go to A&E.

I do think she should go, though. Use mdonley's link.
posted by tel3path at 12:19 AM on September 7, 2017

To clarify: it's generally a bad idea to scare people into seeking emergency treatment, but given that her current situation isn't persuasive enough on its own, you'd have to start asking her to calculate things like funeral costs vs. her travel insurance, long-term disability care potential costs, whether or not she'd be on the hook for fees for her graduate program if disability prevented her from either starting or completing it, and so on. I don't think those are good lines of inquiry to pursue, though, so I think you should do everything in your power to convince your friend to get to an A&E without delay.

Given that it's her head that's the problem, be aware that her judgement may be compromised and that's what's causing her to doubt whether to go in or not.

But please do everything you can to convince her to go now, and not to wait. If you are in any doubt yourself and wish to be distressed, look for user University Nomad and read her last post.
posted by tel3path at 12:30 AM on September 7, 2017 [1 favorite]

Also, she should be in the best shape possible for the start of her graduate program. Any medical help/advice about her headaches could potentially have a large positive effect on her graduate program experience.
posted by amtho at 3:11 AM on September 7, 2017 [1 favorite]

Emergency care in the UK is free, so she won't be charged. Most headaches, even the really bad ones, are just headaches. But the minority which aren't just headaches are serious things like meningitis and brain haemorrhages. So she should get checked out.

She'll probably be in for 24hrs or so having tests (a CT and lumbar puncture). Better to go before the weekend or she'll be stuck there until Monday (most UK hospitals don't have enough staff to do non-urgent procedures like LPs over the weekend).
posted by tinkletown at 3:29 AM on September 7, 2017 [4 favorites]

She shouldn't be charged for emergency treatment, she might be charged if she's admitted. But she may not. Information about NHS Scotland charges for overseas visitors here.

Also, I believe from what I've read (mostly on here), NHS charges are much cheaper than bills from US healthcare. Don't let the cost be a factor.
posted by Helga-woo at 5:27 AM on September 7, 2017 [1 favorite]

NB, if she's travelling around, I would suggest it's better for her to get treatment in Scotland. NHS England is a different beast, and they're stricter about charging overseas visitors.
posted by Helga-woo at 5:30 AM on September 7, 2017

Go to the ER now. This does not sound like a migraine. Please let us know how she is doing.
posted by mermayd at 5:53 AM on September 7, 2017

Has she gone in yet?

Can you google car services in her area for her if transit is a barrier?

It's pointless for her or you or any of us to try to guess the cause; at this point the pain in and of itself is the emergency.

You don't go broke in Scotland over an ER trip, it's not the US.
posted by kapers at 6:06 AM on September 7, 2017 [1 favorite]

She should go to the ER. She should also mentally prepare herself to not be taken seriously there. (My female friends/family members and I have all found that ER providers are often more annoyed than anything when a female patient reports severe pain and few/no other symptoms.)
posted by schroedingersgirl at 6:09 AM on September 7, 2017 [1 favorite]

Yep, she should go. UK A&E departments are quick, easy and efficient. It has been 4 days since my last trip to A&E (vasovagal episode & migraine). I went to urgent care, but they referred me across to A&E. It took an hour.
posted by ambrosen at 6:12 AM on September 7, 2017

Also, my experience is that people are not kept in overnight waiting for a test. I've never been in that situation, but I've spent a lot of time in ambulatory care units and medical admissions units on weekday evenings, including Fridays.

In terms of charging, I used to have to do this as a (nasty) part of my job. 4 years ago, there were maybe 15 hospitals in England who had people who wanted to charge overseas visitors and had institutional support for doing so. I know it's been pushed a lot more since, as part of May's xenophobic agenda, but still I'd say that even an English hospital's unlikely to charge. When I've talked to hospitals in Scotland about money for patient treatment, there's also a very low appetite for linking costs to individual patients.

And if she was admitted, and they did charge, the cost of a hospital stay in England for Headache/Migraine/ CSF leak with low complications is £1300. So that would be the entirety of the bill, in the worst case.
posted by ambrosen at 7:14 AM on September 7, 2017 [1 favorite]

Hi all! I *really* appreciate all the advice and information. I sent on some of the links you provided, and I'm advising my friend to go to the ER now (I'm going to help her find the nearest one). Better safe than sorry in this case, I think.
posted by ClaireBear at 7:45 AM on September 7, 2017 [4 favorites]

If your friend needs some advice over the phone from a trained nurse, she can call NHS 24 and describe her symptoms. They will be able to advise her on her nearest A&E and will most likely tell her to go there immediately.
posted by Happy Dave at 11:58 AM on September 8, 2017

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