I have had a chronic migraine lasting 5 days associated with nausea and light headedness. the pain is debilitating and also noticed when it reaches its peak my left pupil dilates (unequal pupils). could this just be a migraine or is imaging necessary?

See a Dr: Dilated pupil with severe headache/nausea can be a sign of increase intracranial pressure and should be thoroughly worked up by your Dr. The workup will include an exam, lab tests and imaging to determine the cause and treatment. It is possible that this could get worse if left untreated, so don't delay.

Headache : Hi. Although this could be migraine as pupil changes can occur as an autonomic feature it is not typical or common so I wound suggest getting eval ASAP and imaging to make sure.