Do You Ever Admit Migraine Patients?
In which Scalpel again pokes the anthill.
(and borrows Panda Bear's A.A. Milne literary device)
After perusing the migraine forums and considering my recollection of previous discussions with former blogger and migraineur Carrie (NeoNurseChic), I have come across several reports that one of the currently-utilized treatments for migraine is to admit such a patient to the hospital for several days to administer various IV therapies.
Now I'm aware that some of the Major Headache Centers do this, probably with the assistance of some sort of government or pharmaceutical company funded research protocols. But looking back on my career, I can only recall ever admitting one migraineur to the hospital. And I remember that at the time, I was quite surprised that the Neurologist wanted to pursue that option. Furthermore, that case was about 8 years ago.
Now I'm going to exclude anyone with intractable vomiting or neurologic deficit, because those are indications for admission on their own merits. And I understand that the migraine literature states that "status migrainus" or unrelieved headache is an indication to admit.
I just have never failed to relieve the headache of such a patient in the ER. It might take two (or rarely three) rounds of medication, but they always leave satisfied and pain free. As long as they agreed to my terms, that is. Maybe I'll talk more about that later.
I suspect that at least some of the Headache Specialists (to whom altars are likely constructed in darkened bedrooms all over the world) typically practice in spa-like facilities with plush bathrobes, soothing background music, and scent-free candles. And I also suspect that some of them are only too happy to swipe the credit cards of desperate migraineurs but decline insurance reimbursement.
I wonder if insurance would even pay for a 7-30 day migraine hospitalization, as I have read often occurs at these sorts of specialized facilities. Heck, most hospitals discharge patients the day after giving birth and a few days after a heart bypass nowadays. I can't even imagine keeping a patient with a headache in the hospital for a month. Even if it was the sort of REALLY BAD headache that MIGRAINE SUFFERERS get.
Now, judging by my recent experience, I'm certain that the angry mob of hand-wringing migraineurs will wave these comments around like a burning effigy of George W. Bush at a Code Pink rally as evidence of my incompetence and obvious need to "educate myself about migraines." Well, I'm trying. Give me credit for that.
So I humbly ask my fellow physicians and nurses....how often do you admit patients with migraines who can tolerate water by mouth and have no neurologic deficits? To a regular hospital, that is.
Speaking for myself, my N=1.
(and borrows Panda Bear's A.A. Milne literary device)
After perusing the migraine forums and considering my recollection of previous discussions with former blogger and migraineur Carrie (NeoNurseChic), I have come across several reports that one of the currently-utilized treatments for migraine is to admit such a patient to the hospital for several days to administer various IV therapies.
Now I'm aware that some of the Major Headache Centers do this, probably with the assistance of some sort of government or pharmaceutical company funded research protocols. But looking back on my career, I can only recall ever admitting one migraineur to the hospital. And I remember that at the time, I was quite surprised that the Neurologist wanted to pursue that option. Furthermore, that case was about 8 years ago.
Now I'm going to exclude anyone with intractable vomiting or neurologic deficit, because those are indications for admission on their own merits. And I understand that the migraine literature states that "status migrainus" or unrelieved headache is an indication to admit.
I just have never failed to relieve the headache of such a patient in the ER. It might take two (or rarely three) rounds of medication, but they always leave satisfied and pain free. As long as they agreed to my terms, that is. Maybe I'll talk more about that later.
I suspect that at least some of the Headache Specialists (to whom altars are likely constructed in darkened bedrooms all over the world) typically practice in spa-like facilities with plush bathrobes, soothing background music, and scent-free candles. And I also suspect that some of them are only too happy to swipe the credit cards of desperate migraineurs but decline insurance reimbursement.
I wonder if insurance would even pay for a 7-30 day migraine hospitalization, as I have read often occurs at these sorts of specialized facilities. Heck, most hospitals discharge patients the day after giving birth and a few days after a heart bypass nowadays. I can't even imagine keeping a patient with a headache in the hospital for a month. Even if it was the sort of REALLY BAD headache that MIGRAINE SUFFERERS get.
Now, judging by my recent experience, I'm certain that the angry mob of hand-wringing migraineurs will wave these comments around like a burning effigy of George W. Bush at a Code Pink rally as evidence of my incompetence and obvious need to "educate myself about migraines." Well, I'm trying. Give me credit for that.
So I humbly ask my fellow physicians and nurses....how often do you admit patients with migraines who can tolerate water by mouth and have no neurologic deficits? To a regular hospital, that is.
Speaking for myself, my N=1.
Labels: migraineurs, neurology, surveys
posted by scalpel at 9:31 AM
63 Comments:
never, never, never
A li'l inapsine goes a long way! Enough will give 'em such a dystonic reaction they'll never forget! BTW, Haldol works just as well. I give Haldol for HA's all the time. Hehehe!
And, my favorite.... A distracting injury will surely make them forget that headache they came in with!
Look who is back from the tropics! I thought that you might have gotten sucked up in the bermuda triangle, welcome back. i have never seen a migraine admitted, most of the migraines i see would not want to be admitted anyway, once they have their demerol, they are good to go
Most of my migraine patients get significantly better with IV benadryl, reglan, and decadron.
I don't admit "migraine" patients.
I can't believe that people even want to be admitted for an uncomplicated migraine (ie: no intractable vomiting, neuro deficits etc). Why not get managed by your regular doctor and save the ER for the headaches that you truly can't handle?
If you've got a real migraine, would you really want to be hanging around an smelly/bright/noisy hospital anyway?
This is why people roll their eyes when you mention that you get migraines. Brings a bad name on those of us who can handle it and are not malingering/drug seeking/looking for a day off work.
I am both a Migraineur and a physician, and I can say that I cannot think of a time I would admit someone to the hospital for a migraine. Yes, the pain is intense and the symptoms overwhelming at times. We do reach the end of our rope in the office at times, but can always send them to the ER for IV meds. True migraineurs will get better if you treat them right.
hey charity doc when ya coming back to the blogosphere? We all miss ya
Never
Once in six years, at the neurologists' request.
He was so tired of getting telephone calls from the patient and family he figured admitting them would allow him to get some sleep.
GruntDoc
I used to work on a neurology floor and we'd get the occasional "migraine" admit, admitted usually because of numerous unsatisfactory ER visits in a relatively short period of time. Most or maybe all of these patients turned out to just be your run-of-the-mill "I need 2 mg of dilaudid IV chased by benadryl for MY headache" patients whose pain never fell below an 8/10 and would throw a temper tantrum if you told them 'no'.
I told one patient that a treatment for migraine was to sit quietly in a dark room and that I would not give her any meds unless she did that. [She'd follow me around the nurse's station, demanding narcotics, yelling, etc].
Never have! IV compazine works like a charm.
You know, Scalpel, I once made an offhand, somewhat disparaging remark about that insipid musician Kenny G, and rather than a chuckle or two discovered that I had stumbled upon a secret cell of Kenny G fans who proceeded to work themselves into a lathter of indignation.
You seem to have done the same thing.
I have admitted one patient for migraine, which had been going on for WEEKS despite all of my and my local neurologist's best efforts. It's was more of a duration rather than intensity thing. She ended up being transferred to Hopkins where she sat around for a few days before she got discharged to home with the headache unchanged.
All in all, not a great experience for her. The migraine resolved with time.
Never. If they let you give them things that actually work and actually WANT their headache to go away with those things (as opposed to just wanting to get as much demerol/dilaudid/etc. as possible), they get better.
During my short stint at one hospital we had one neurologist who would regularly admit migraine patients and give them the "DHE protocol" which if I remember correctly consisted of IV Benadryl and Xanax 30 minutes prior to giving IV Dihydroergotamine and IV Phenergan 30 minutes after.
Never seen one admitted.
I'm a medicine/neurology resident at a pretty large hospital in a pretty good size city. I admitted a headache from my neuro clinic this past week. Granted she was in her 60s with new onset headache, so hers was a little more concerning than average. There's usually at least 1 migraine patient on our team, admitted for DHE treatment (no narcotics. Period.) and IV fluids. We also give IV magnesium as that can also break a headache.
I'll admit it, headache clinic is one of my least favorites. Sometimes, there are times where I feel like I'm making a difference, such as the patient that I helped relieve daily headaches by doing trigger point injections. Then there's the others where nothing I do touches them and they demand relief NOW when nothing has helped them for months or years.
I get migraines myself, luckily OTCs still do the job of treating them.
OK, so non-hypothetical question:
30-something vascular headache sufferer - they used to feel more like cluster, of late they're more like classical migraine with aura. Not enough frequency (3X/year) to justify prophylaxis, unpleasant reactions to triptans the last three times he's tried them, would sooner die than take opiates due to unpleasant side f/x (bad experiences with codeine, demerol and fentanyl post-surgery).
Eighty percent of the time I can abort one with 5mg olanzapine ODT, a couple of metoprolol and a very long, very cold, shower/bath taken in a pitch-black room.
My worry is that 20% of the time when I don't catch it in time or it just gets out of control. I'm in exquisite pain, and neither Tylenol (1000 mg), Aleve (660 mg) or Celebrex (400 mg) can touch it. I've usually got one shot at getting the pills in before I start vomiting.
So, I'm now in what, no lie, is easily 8 or 9 out of 10 pain (I can't imagine it being much worse without passing out). I want to be in a very dark room, and I just want to take it down to a five or six, and be able to sleep it off.
I'm scared shitless to go to the ED, despite being an insured, white, clean-cut guy in a rural/suburban area with two nice ERs within 25 minutes. I don't want to be labeled by some triage nurse as an opiate-seeking #*$*bag when in reality I want to *avoid* opiates. I don't *want* to be parked out in fluorescent-lit purgatory for a couple of hours because the last guy who looked like me was there for a fix.
I'm not an expert in vascular headache treatment. I don't know if I'm wasting $600+ bucks to try to save the day (or two) afterwards - these things really take it out of me.
So tell me what to do.
Tell me what to tell the triage nurse such that I will rapidly be back in a dark environment with a door that will close. Tell me what to say so that you know I'm there not to get high but that I'm really bloody miserable and am at the end of my rope.
I've got no idea, but this entire discussion over the last few days totally explains how I got treated the last time I went to the ED five years ago. It's nice to see that I'm Just Another Fucking Drug Seeker to y'all, before anyone's taken enough of a history to know that I would refuse opiates.
E
Ever think that these "migraineurs" already know the kind of wait and lack of attention they're in for when they visit the ER? And yet they are still there. Maybe that might give you a clue? Fuck you assholes. The only way you'll ever see me in one of your emergency rooms is unconcious.
It's folks like Anon. 12:23 that Haldol works great for!
I'm telling y'all. Based on my experience, Haldol's a great drug for migraine headaches. No narcotics needed.
A li'l vitamin H. and off they go to la la land. If they get too much of a dystonic reaction or extrapyramidal side effects, give Benadryl, another plus!
Sure, it may sound sarcastic, but I really find Haldol to be quite effective. The true migrainers will appreciate the rest/sleep. And the fake migrainers/drug seekers...well their yaps are shut, too. A double bonus!
I've admitted a several over the years with no neuro deficits, but obviously in pain and typical measures either didn't work or they reacted badly to. (In our ER, not previous experience recounted by pt.) Some fluids along with IV DHE in some cases or mag sulfate, both repeated two or three times over the course of 24 usually takes care of them.
beachdoc commented - "Never have! IV compazine works like a charm."
Ahhhhhhhh. A kindred spirit. I appreciate the pts who look at you and comment along the lines of, "I don't care if you give me dirt if you'll please just stop this migraine." Even if they comment that they've never heard of Compazine as an abortive, these people are willing to try it.
A patient I'd seen about six months earlier came in one night when I was off and asked for IV Compazine. Was given an Imitrex injection, and when that didn't touch it, IV Toradol and Benadryl. A couple of hours later, Demerol and Benadryl. After several hours, the woman asked to just go home since nobody would give her the Compazine. Came in the next day, still with migraine. I gave her IV Compazine and monitored bp, which was high by then.
The Compazine generally works well. Don't know why it's not given more commonly.
In reply to anon 11:19,
If you only come to the ER a couple of times a year for headaches, aren't abusive to the staff, and don't demand (or accept) narcotics then why would anyone be suspicious of you? I always scan the old charts of every migraine patient before I go in to see them.
You aren't the problem.
Oh, Lord.
I'd love to see how Keystone HealthBastards -- the same ones bitching that my newborn was using up precious company financial resources, despite being a preemie, by being in the NICU -- would deal with an admit for migraines. My guess is they'd dump the bill back on me as frivolous.
I also can't even remotely imagine going to the ED when I had a migraine, unless I was unable to keep water down for eight hours or so.
Oy.
Charity Doc, you needn't worry about using your Haldol on me. If I were a drug abuser I'd have more sense than spend $2000 and eight hours in an uncomfortable chair. Keep your Thorazine in the bottle as well. As I said, I won't be willingly crossing your threshold. The ailments you seem mainly concerned with are malingering and obstreperousness and you've found the "cure". Good for you. Hippocrates would be proud.
The ailments you seem mainly concerned with are malingering and obstreperousness and you've found the "cure."
Actually, those are the ailments we are LEAST concerned with. That's why patients like that are last in line.
E -
you can tell them just what you told us, that you DO NOT want narcotics. reasonable patients who accept offered treatments are not the problem. It the unreasonable one, demanding specific medications (demanding, not asking for....refusing one, demanding another), screaming, being verbally abusive, that is the problem
Benadryl, Compazine, Naprosen, and Intranasal Lidocaine....if that doesn't work, break out the feathers and rattles.
Anonymous 12:33,
I can absolutely answer your question: no way would I want to be dealing with the usual sensory overload of a hospital while experiencing a migraine. Been there, done that, and they were all having a practical coronary because of my history of shunted hydrocephalus. I discovered only much later on why they all freaked out a bit; turns out shunt problems can present just that way. Fortunately it was realized that my tendency for migraines is just a really bad coincidence, so now I just take to the nearest dark, quiet room. No noisy insanity for me, thanks!
Personally I've never had a migraine that an Imitrex and a nap in a blacked out room won't kill. I did go to a doc-in-a-box joint (Not an ER) when I had my first one because I couldn't understand the light sensitivity, but they diagnosed me very easily. They make me non-functional, but I don't feel in any way that they represent an emergency.
Cmon, Scalpel-"if you only come to the Er a couple of times a year for headaches, aren't abusive to the staff, and don't demand (or accept) narcotics then why would anyone be suspicious of you?"- Every time I went to the ER, they saw ESLD secondary to ETOH, and there was NO pain meds headed my way, and I got a lecture about how liver disease doesn't hurt. Recently I had pneumatosis coli, and went to the ED for increasing pain, but with my own pain meds, refusing theirs, I got the "You have liver disease, It's gonna hurt" lecture.
I'm learning so much following this discussion, both from the docs and the patients. I can't remember if I posted this here, but I think I'm working with a migraine sufferer cum addict and this conversation seems to confirm my impression.
Up until reading all this, I thought it was normal to need narcotics by the bucket because Imitrex "doesn't work" and to never come to work.
M
Um docs, have you read the druggie forums and newsgroups?, Their not asking for drugs by name or demanding opiods. They've perfected their subtleties (actually have many postings on how to fool the lot of you in the ED into giving them drugs) - and made those of us with Chronic Pain conditions look like drug seekers unless we learn the ways of the junkies - after all G-d forbid we ask for a drug that we know does the trick, instead of leaving it up to an ER Dr. we've never seen before (granted I've never had to go (thank G-d) to the ER for my condition, but G-d forbid I did - what then?
A migraine admit is not for a patient with episodic migraine (unless there's complications like dehydration, neurological symptoms), it's for someone with intractable migraine who's not responding to multiple treatments. The admit is intended to break the cycle and give preventative medications a chance to work. Typically a patient's regular migraine doctor handles these admits, not an ER doc.
My son developed excruciating headaches about four years ago that would take him from standing around talking to writhing, puking agony within the span of seconds. He would beg me not to take me to the ER since he had heard me complain about drug seekers and didn't want to be labeled as one. Besides the fact that just standing upright would bring on more n/v and pain.
After following up with his pcp and a referral to a neurologist. (nothing covered by insurance since he had graduated and was no longer covered by my insurance-he had mommy insurance) He was diagnosed with cluster headaches and placed on verapamil and amitryptiline. His headaches are so much better now and gratefully he has a job that provides insurance now. He had also gotten a Rx for high flow 02 for during headaches.
I don't know how we discovered it, but he found at one point that eating canned pineapple (not fresh) would help with his headaches sometimes. Strange but true. For a while I had a cupboard full of canned pineapple.
I have a lot of sympathy for people with migraine or cluster headaches. But when they sign in with their dunkin' donuts coffee and looking like they are waiting for a manicure appointment with 10/10 pain, I admit...my sympathy drops to 2/10.
I wish we could be less concerned with ferreting out the drug-seekers and more concerned about those who suffer chronic and life-changing pain. I've witnessed enough suffering that could have been relieved if only our medical workers didn't have to serve as lieutenants in the War On Drugs. Temporarily delaying a drug addict (or ten) does not make up for prolonging agony for someone in legitimate pain. The addicts will eventually get their fix somehow. The pain sufferer will often give up, and just suffer.
Having read all these comments, I now have a question about when to seek medical attention. I get migraines that have gotten worse over the past year (increased frequency, increased pain). I was prescribed Maxalt (the kind that dissolves) before I traveled to Bolivia. It worked for a while - it no longer works as well.
I now generally take the Maxalt and then 2-3 vicodin. Sometimes it seems to work and I sleep. On other occasions, I've had to go to the doctor for treatment. Even when the Maxalt/Vicodin work, my pulse is generally around 40-42 beats per minute and my left hand begins tingling/going numb. When the meds don't work, people ask me questions such as what day it is or what my name is or what my phone number is and I think I'm telling them the correct answer but apparently I am not. If I try to repeat something, once again I think I'm repeating correctly but apparently I'm not.
My question is when should I go to the ER. I've recently moved and don't have a doctor yet. Also, after this last migraine, I've had periodic tingling/numbness in my left hand and slight headaches. Should I be concerned about this?
Any time anyone is worried that they might have an emergency medical condition, they should seek prompt medical assistance.
To the person who left the anonymous comment about their H/A's and maxalt/vicodin. As Scaple said always seek emergency medical care if you feel you need it. Also, if the treatment doesn't seem to be helping after a period of time (sometimes it really does take time for treatments to really work), ask for a neuro consult, or a consultation with a pain clinic. NOBODY should suffer with chronic, debilitating pain.
Please, don't take comments we may make in frustration about people who are not experiencing real pain abusing the system personally. Nobody wants to see someone suffer, and most of the time we can tell when someone is experiencing real pain.
I'm a nurse and I have chronic daily migraines. I've been admitted three times for my headaches--twice to a regular hospital and once to the infusion program at the Cleveland Clinic. CC was the only time it worked--rather than just give me DHE and an antiemetic, they gave DHE, reglan, toradol, solumedrol, mag sulfate, vistaril, and a ton of fluid.
I should note that the first time I was admitted, it was because the migraine had been there for about 3 months, resisting everything, the second time was six weeks later after I had a TIA, and the third was after another several-months-long headache.
ER doc in the south here. Our headache neurologist admits a few occasionally. Otherwise it's this:
Toradol 10 IV
Benadryl 25 IV
Compazine 10 or Reglan 10 IV
MgS04 1g in 1000 cc over 1 hour.
Inapsine if I'm feeling ballsy or Haldol if they are the panallergic type.
Our nurses are conditioned to give demerol/phenergan by other docs.
I can understand both sides-- As a migraineur, I know how excruciating the pain can be. I only get bad ones a few times a year, but they are absolute agony, and I would literally take anything just to make it go away.
On the other hand, my father is a nurse in a Chem. Dep./detox unit. In college I would help out and translate for patients if need be, and the last thing I would want would be to become an addict, or to be perceived as one.
I've never been to the ER for one of my headaches. I have seriously thought about it when I've had a puker that lasted a couple of days, but who would actually want to go to the ER? It's loud, bright, and often the wait is for hours in that environment... UGH, that would make the headache even worse... pure misery!
I have ended up at a prompt care (i.e. doc in a box) place a couple of times after not being able to take the pain and vomiting any more. Usually by that point I'm on day 2 of not being able to keep down water. So far, I've gotten reglan, toradol, benedryl, IV fluids, phenergan and tramadol. I've only once needed tramadol, usually the toradol works well, and the phenergan helps my stomach, and knocks me out (which by that point is a total blessing). I'm still trying to find something that will help to either treat or prevent them. Fioricet doesn't work for me, the triptans and my asthma don't agree, and so far I haven't had luck with preventatives. (so far I've tried amitryptaline, nortryptaline and verapamil)
I would love to find something that reduces the frequency/severity. (other than 40mg prednisone/day, which works very well, but is -not- something I am willing to take long term)
I wouldn't wish migraines on anyone-- they are truly miserable, but even so, I can't imagine running to the ER constantly, or constantly calling out of work. I've had to miss some time, but only a couple of days in the past 4 years. (one of which I went to work but spent the day with my head in the toilet. Blech. I just hate missing work, it puts me so far behind!)
I am a medical professional who suffers from migranes almost daily. The only difference is I normally can work through them and I have a high tolerance for pain. 4 or 5 years ago I devoloped my worst migrane ever. After 3 ER visits and multilple refusals of narcotics I was finally admitted. Turns out I has been on Viox for my shoulder and had stoped it the previous month. Evidently I developed increase inflamation of the head(brain). The treatment that finally cured me was IV steroids, not narcotics. I have never have been back to an ER for migranes and hope I never do. But I must add, for all of you ER nurses and physicians who think all migraners are drug seeking stop offering narcotics, you are probably the ones who got them hooked in the first place.
I am permanently disabled due to completely debilitating migraine headaches. For the first time in five years I tried to travel home to Indiana to be with my family for Thanksgiving. Well, due to the neglect and discriminatory treatment at the local hospital, I never got a chance to see Thanksgiving. I travel with a prescription from my PCP for demerol injections when I reach crisis mode. The hospital informed me that they NEVER give demerol for headaches. I told them to give me what they felt was best as my blood pressure was 167/106 (simply due to the pain). I was given multiple injections of dilaudid and nubain. I was sent home, only to return about six hours later with my pressure still elevated and still vomiting bile. The next ER physician told me again that they did not give demerol. I begged each of these doctors to please contact my PCP as maybe she could suggest something that would save my life. I was told that this would not be necessary and was given more dilaudid and nubain. After three more hours of this treatment and no relief, the ER doctor decided to admit me to the Neuro ICU. He informed me that they could dispense the demerol on the floor. I again begged them to contact my PCP, as I was sure I was have a stroke. When I got to the floor, the nurse called the admitting physician who again refused to give me demerol and ordered more dilaudid and nubain with zophran. This was 12 hours after my first visit to the ER. I refused the medication at this point and begged the nurse to call the Neurologist on-call as the admitting physician had given her instructions, which they placed in my chart to "Do Not Call Me Regarding This Patients Pain Medication." The neurologist on-call NEVER came to see me, however did have the nurse fax my prescription to him. He then ordered demerol injections every three hours until my crisis had passed. My blood pressure went to 120/70 15 minutes after receiving the demerol. I believe that I was discriminated against because I am disabled and was too weak to even fight or demand that they call my PCP (which by the way this hospital says is my RIGHT, per the Hospital's Bill of Rights). I am not a drug seeker, I am an American with a Disability and should be treated as such. Denying me treatment is equivalent to elder abuse and any healthcare professional who does not evaluate each patient based on their history is doing a disservice by not maintaining continuity of care and not upholding their oath to "FIRST, DO NO HARM."
I am permanently disabled due to completely debilitating migraine headaches. For the first time in five years I tried to travel home to Indiana to be with my family for Thanksgiving. Well, due to the neglect and discriminatory treatment at the local hospital, I never got a chance to see Thanksgiving. I travel with a prescription from my PCP for demerol injections when I reach crisis mode. The hospital informed me that they NEVER give demerol for headaches. I told them to give me what they felt was best as my blood pressure was 167/106 (simply due to the pain). I was given multiple injections of dilaudid and nubain. I was sent home, only to return about six hours later with my pressure still elevated and still vomiting bile. The next ER physician told me again that they did not give demerol. I begged each of these doctors to please contact my PCP as maybe she could suggest something that would save my life. I was told that this would not be necessary and was given more dilaudid and nubain. After three more hours of this treatment and no relief, the ER doctor decided to admit me to the Neuro ICU. He informed me that they could dispense the demerol on the floor. I again begged them to contact my PCP, as I was sure I was have a stroke. When I got to the floor, the nurse called the admitting physician who again refused to give me demerol and ordered more dilaudid and nubain with zophran. This was 12 hours after my first visit to the ER. I refused the medication at this point and begged the nurse to call the Neurologist on-call as the admitting physician had given her instructions, which they placed in my chart to "Do Not Call Me Regarding This Patients Pain Medication." The neurologist on-call NEVER came to see me, however did have the nurse fax my prescription to him. He then ordered demerol injections every three hours until my crisis had passed. My blood pressure went to 120/70 15 minutes after receiving the demerol. I believe that I was discriminated against because I am disabled and was too weak to even fight or demand that they call my PCP (which by the way this hospital says is my RIGHT, per the Hospital's Bill of Rights). I am not a drug seeker, I am an American with a Disability and should be treated as such. Denying me treatment is equivalent to elder abuse and any healthcare professional who does not evaluate each patient based on their history is doing a disservice by not maintaining continuity of care and not upholding their oath to "FIRST, DO NO HARM."
Demerol isn't a standard (or recommended) treatment for migraines. And it's surprising that any state would actually consider migraine to qualify anyone for disability.
god will judge you for what you have done. there are real people suffering . sometimes nothing works . i really have no words for such a low life dr as yourself . i will just pray for you and hope that noene close to you ever suffers these terrible demons called migranes.
What exactly is it that you think I've done that would justify (your implied) harsh judgment from god, or your verbal abuse for that matter?
Idiot.
I am a migraneur and a nursing student. I have had migraines for 11 years with almost every preventative meds from antipsychotics, TCAs, Neuontin, Petadolex, etc. I have had an outpatient 3 day tx of infusion DHE, Benadryl, Mag SUlfate, and compazine. No narcs.
I am tired of everyone in the healthcare field and DEA who do not have chronic (turning into acute) pain that thinks anyone who needs an Rx pain med is a drug seeker. Try and have a true full blown migraine, take care of a family, study, etc. in that state. NO dark room then!
I do not 'seek' drugs. Narcotics rarely touch the headache compared to triptans. So get off your judgmental/jump to 'addict' conclusions and get the facts so you can help your patients.
Having a judgmental attitude gives poor patient care. Most docs don't even know wtf to do for a migraine. I went to the ER and they wanted to give me Flexeril! ANyway, I understand there are tons of drug seekers but you need to do better assessments and quick judging until the day you have a migraine 10/10 and you wanna bang your head and stick needles in your temples!!
But I would never be hospitalized for a migraine...too many ppl in and out, noises, and chances of getting crap.
I would be happy to inject vasodilators (alcohol, morphine) and give you a migraine to know what it is really like!! anyone up for it since it is just a headache and overexagerration?
I'm a longtime sufferer of migraines. Fortunately my migraines peaked at around 17 and have tapered off to 1 or two a year. After years of little help from the various Drs and ER, I found 2 percocet, 1 Relpax, and an anti nausea would do me OK, I can sleep off most of the experience.
In the past 10 years I've had 2 horrendous migraines. To the point that I thought I may be having a stroke. Paralysis of face and one side of body. Unable to remember my wife's name or the ability to spell my own.
Question, at what point should I go into the ER when experiences symptoms like that? Am I at risk of stroke? Will the ER be sympathetic to my condition?
I guess we had one of you as a doctor last weekend. They kept shoving pain meds that did not work down my wife's throat...calling her symptoms migraine.
Guess what...it was a CSF leak. But thanks for the GREAT service for treating us like drug addicts.
Now because of all the crap they've given her for migraines "the dhe protocol" including reglan (sans benadryl) I guess you could say she's having extrapyrimidal symptoms a week later.
Zero years of school, and an internet connection and I can figure out patients better than most doctors...just by LISTENING to their symptoms without prejudice or pre-judgement.
OMG! Are you doctors actually retaliating against patient who come in with migraines by giving them other meds to make the violently ill so they can see what real pain is b/c you don't believe their migraine pain? That's just sick!
Docs are taught "when you hear the sound of hoof beats think horses, not zebras ... " I showed up at my local ER with a massive headache and had never had a migraine in my life. They ran an MRI & CAT scan of my head and saw nothing wrong and sent me home. Days later now screaming in pain I have a 2nd MRI - this time head & lower spine - bingo - 2 litters of CSF had leaked into my behind from L-4/5 and I was a very sick person - CSF leak requrinf surgery and many weeks in hospital
Docs are taught "when you hear the sound of hoof beats think horses, not zebras ... " I showed up at my local ER with a massive headache and had never had a migraine in my life. They ran an MRI & CAT scan of my head and saw nothing wrong and sent me home. Days later now screaming in pain I have a 2nd MRI - this time head & lower spine - bingo - 2 litters of CSF had leaked into my behind from L-4/5 and I was a very sick person - CSF leak requrinf surgery and many weeks in hospital
"And it's surprising that any state would actually consider migraine to qualify anyone for disability."
Seriously? Are you KIDDING me?
Do you understand that chronic pain disorders that don't respond well to treatment suffer from a decreased quality of life, especially when the disorder interferes with their ability to get anything done because they cannot get out of bed, and they are stigmatized by the "migraine" sufferer who has the "ability" to work through their pain maybe twice a year? Not to mention the depression and burden it puts on self and on caretakers?
God lord, you must lead such a great life to not have to worry about anything like that.
I really kind of feel sorry for you with an attitude like that.
I understand there are fakers and there are drug seekers, but your incessant "migraine patients are all the same and should be treated as such" is really getting old.
You can't really see the forest for the trees, can you?
I wouldn't expect an ER doc to cover every single illness in the world expertly, but extending courtesy to the patient is not really much to ask for. People like you are what makes hospitals horrible.
I hope you do not treat other chronic pain sufferers the same way nor stigmatize them with the same cookie-cutter mentality.
I work in a nursing home where we treat a common headache with Vicodin. If that doesn't work, our Med.Dir. will order a more powerful narcotic (dependent upon the patient... of course).
I'd absolutely hate to see what we'd do for a Migraine... if we didn't admit them -- we'd probably drug them beyond function.
Personally... I'm fond of the Haldol idea.
also by the way er docs are stupid that is what specialists are for. they know a hell of a lot more than you scalpel. and why would your nick be scalpel you aren't qualified to be a surgeon.
I've read this entire thread - all 50 posts, or whatever - and it's been quite enlightening.
I have had migraine headaches for 17 years. They started out every few months, then every few weeks, and two years ago, I was diagnosed with chronic daily headache. I have been through more medications and neurologists than I can count to try to get rid of the pain, and I do plenty of my own research as well. I am not a whiner or a drug-seeker: I am a community college instructor and sometimes have to take Aleve, Advil, a triptan, AND a Vicodin to DULL the pain enough to make it in to work, yet I have never missed a day because of my migraines. However, I find it shocking that someone with a medical degree could have so little understanding of the day-today suffering of a chronic pain patient as to claim that it isn't a disability: when was the last time you needed to take 4 different painkillers to get out of bed in the morning? Do you know how it feels to wonder what it must be like to be a "normal" person who can go through a day without pain? To be unable to bear children because you can't go more than 24 hours without painkillers? Until you have, you really can't say you understand what your chronic pain patients are experiencing: it is NOTHING like what happens to you when you have a bad day at the office and your head hurts, so you take some Advil and it's gone.
Regarding migraine patients visiting the ER, I can tell you that none of us EVER want to go there, not the least because of the treatment we know we can expect from the doctors there. I always try every drug in my arsenal in DOUBLE-DOSES before I would EVER consider going to the ER. However, even then, and even though I won't go unless my pain is over a 9, I end up in the ER about every other month: I have migraines every day, and while they're usually manageable (and I've developed a healthy tolerance for pain over the years), my menstrual migraines have become just brutal since I entered my mid-30s. I have several doctors in my family, so I fully understand the frustration of patients who come in demanding this thing or that thing or behaving rudely (I'd like to think I'm too exhausted to be rude when I'm in that much pain, but I guess you'd have to ask my husband - he's always there with me); however, I'd like to ask that you take into consideration that a patient, like myself, with a 17-year history of migraine has probably been around the block more than once and knows what has worked and what hasn't FOR HER. There is no "one patient fits all" solution: many of the regimens I saw discussed on this website involved drugs that I have had terrible adverse reactions to (Dilaudid, Compazine, Reglan, Phenergan, and Imitrex), so while I'm sure they work wonderfully for some people, every time I have given in to an ER doctor who "didn't prescribe Demerol" because I was in pain and tired of arguing and allowed him or her to give me one of these meds, I have left the ER feeling worse than when I got there. I'm sure many migraine patients know the feeling - we leave not because we feel better, but because, as you doctors accurately noted, the bright lights and the noise are horrible, they make the pain worse, and we realize that whoever is working that day isn't really going to help us, so we say "Yeah, I'm better", sign the sheet, and go home to take 2 more Vicodin and cry a little and wait another day or two for the pain to go away.
I'm getting a little emotional now, possibly because I've got a headache that's lasted for 1 1/2 weeks with no relief and we've been debating another ER trip for the last 24 hours, so I should go. I guess I just want to ask everyone working in an ER to give your next migraine patient the benefit of the doubt: assume that he/she doesn't want to be there, is in pain, and isn't a moron, and please try to LISTEN to what he/she is saying. It makes a huge difference to us at a time when we feel really vulnerable and miserable.
I am reading this because I really don't know where to go anymore, and I am appalled at the complete lack of compassion from some of the practitioners here. Why on earth would you do what you do if your only goal is to treat symptoms. Read through this. Look at all the cases that turned out to be more than met the eye. I understand that the ER is not necessarily a place for diagnosis, but it is an opportunity to be more than just a narcotic-pushing, Haldol-wielding, pompous ass.
I have lupus and trigeminal neuralgia. I am 29. I have had meningitis, vasculitis, and a headache continously for the past 3 years. I have 3 children - ages 2, 4, and 6. I am a medical transcriptionist. I work full-time and maintain a working household. I have been to 3 rheumatologists, 2 neurologists, and several ERs when it got severe enough. I have been hospitalized. I have been treated with narcotics and antidepressants and anxiolytics and muscle relaxants. I don't want any of them. I know the reaction I'm going to get when I come in. I certainly don't want to deal with ER physicians anymore than they want to deal with me. But at some point, maybe a step back for some perspective is in order.
Maybe there are 30 headaches in a day, and maybe 25 of them are drug seekers. Maybe 2 are infectious, serious issues needing an LP or CT or MRI. A couple are migraines. And maybe one is something outside the box. And if you blow that one off like it's nothing and treat someone like a lunatic that needs to be put down, then you should be ashamed. You should be ashamed to call yourself a doctor, a healer. How dare you joke about giving a distracting injury. What a sad life...You could change a life, put an end to someone's misery, or at least point them in the right direction. Try walking in my shoes before you assume I want something I'm dreading. You people are disgusting, and I pray I never see any of you in clinic.
Since I do have migraine headaches and they can be terrible pain (I broke my femur once and had a 18", yes 18" metal rod and pins inserted in that femur for recovery and that hurt less than most of my migraines.
So, to make sure that if I had to go to an ER in my location and that they would have some data on me, I contacted or had my doctor contact local ERs or the doc in a box to let them have my history so they could see the medications I am on (if any I try to not take anything). I also have a note with the physicians letterhead about my condition.
I take my diary of migraines to the ER with me to prove that I do have this condition. I also will listen to the ER doctor and nurse and will do exactly as they ask. If they want me to take non opiates first I will.
But the main thing is I come prepared as a patient to prove my condition. A complete list of what I have eaten, taken are in my diary. I have all of the numbers of my neurologist and MD.
Basically, my wife is a nurse. I have seen her have to deal with patients who are unruly and who are abusers of the system.
I think in the case of migraine visits to the ER...first...no patient should visit the ER multiple times. It should happen once or twice in a year. But I haven't gone to the ER in a couple of years since I have worked closely with my doctor on how to avoid this uncomfortable position. Also, I think a patient should come in prepared, even with excruciating pain, to discuss calmly the situation. Third...listen to the physician. Fourth...bring supporting material (I have this in a migraine emergency bag I carry)...my medication list, diary etc.
In my opinion and judging from the comments here from SOME on both sides...we need to put each other in the other person's shoes for a minute.
The ER doctor has multiple emergencies occurring RIGHT NOW! Some are severe, some are moderate and some are fabrications to get drugs. The ER staff have to prioritize constantly due to changing variables of patients and staff. They have also been burned by druggies. So, I can understand your hesitation in dealing with a phantom pain like a headache which is not as easy to detect as a broken bone.
The migraine sufferer is in immense pain to come to an ER facility if they truly have a migraine. This should not be their 10th visit as if they have them that often they should be working more closely with their doctor to avoid it. They may not be thinking coherently due to the pain. They are scared, depressed and pissed that their life continues to be interrupted with pain that is indescribable.
So please, both sides show some compassion for the other.
Patients, even in emergencies be prepared and bring as much supporting data of your condition as you can.
Doctors, please be aware of our pain and that though these headaches occur frequently for some...this does not mean that we are used to it. I have literally wished to die when these headaches have happened in the past.
Both sides can do better to make sure the right patients are getting the right treatment and that the doctors can be confident that they are providing the care and compassion that got them into the field in the first place.
Dealicious...I feel you! I am also on disability for my headaches. I have chronic refractory hemiplegic migraines with permanent right side weakness and radial nerve neuropathy. I have all of the effects of a TIA or stroke but it is not. I have been hospitalized 3 times now over a 15 year battle with the same headache. Not one day break. These headaches are by far the worst. I find myself praying for my time to be up at times. That in no way means I would hurt myself. Just explaining how bad it really is. Due to the posiblity of causing a stroke I cannot take triptans like Imitrex or Ergots like DHE. I have had 3 occipital blocks, lidocaine injections in neck and head, steroid injections, acupunture, chiropractic treatment, physical therapy, massage treatment, preventative meds (beta blocks, epileptic meds, anti depressants), 2 treatment of Botox, Caffeine and MSG free diet, nasal lidocaine, Right ovary removed (teratoma thought to might have thyroid tissue), Deviated septum surgery to try to help oxygen flow to help h/a, biofeedback, psychologist therapy, hypnotherapy, i'm sure I'm leaving others out, but you get the point. I now am on opiate therapy because nothing helps. I have been on Duragesic 100mcg and msir 15mg for breakthrough for 3 years and just recently asked for it to be changed. Thing stop working after a while. Now trying Roxicodone and Methadone. As for the person that said Demoral helped them. That medicine gives me a rebound. Some doctors think all opiates give rebounds for the same people. In fact, we are all different. What they gave you Dilaudad. Works best for me. When it wears off you don't feel like you have a hang over or something or been hit by a truck. Because of use of pure opiates I can't have Nubain, it would throw me into withdrawls. Here, this will throw you for a loop. I AM ONLY 27 YEARS OLD. I never went searching for specific drugs or anything of that matter. Just over so many years and so many treaments I know what works for me. I get the "drug seeker" thing just as every other migrainuer does, so its hard to communicate to doctors when they have a predisposition of you. I would eat cow crap if it would make my pain go away. I often black/pass out, slurred speech, temporary paralysis, extreme pain worse than any classic migraine (yes I have regular ones too, they are much more tolerable, much, much) Just wanted to open some of your eyes that people do suffer and there are many things that we dont know. I was finally diagnosed with FHM Familial Hemiplegic Migraines 2 years ago. Which they are learning more and more about. My sister and mother both have them, but nothing to the degree that I do. Supposedly there is a genetic deficiency that causes this. Any thoughts....anyone??? I still need help and will take any advice. I'm in the NW Arkansas area. So there just aren't a lot of doc familiar with this. It is said that 0.01% of people have this. So I'm in the lucky few.
palmhillharm@yahoo.com
Migraine patients. Stop eating tyramine containing foods such as aged wine, cheese, processed meat (hot dogs, sausage, bacon, lunch meat). Tyramine releases norepinephrine, dopamine, and serotonin which triggers a migraine. That is why drugs like Imitrex and Compazine/Reglan work to stop migraines because they block serotonin and dopamine.
My son has had intractable headache pain for 3 1/2 years. The doctors refuse to treat him because a pill makes you and addict. We have had many ER visits and he is treated like an addict. No one has to suffer so bad for so long. Stop judging and relieve the pain. It's ethical. I am now going to file for disability for him. Learn pain management so you cam do your job! See subsection 16 of the AMA practice code.
I was admitted when I was a teenager with a migraine (long before the triptans existed) because I had lost my vision, hearing, and language - I couldn't speak or understand English for a few hours! It was the most horrifying day of my life. They thought something horrible was happening to me and did CAT scans and all kinds of tests until I sort of woke up! I have my drugs now and I never had anything nearly as freaky as that one ever since. Last thing I would ever want to do is be in a hospital. I even have my own 02 tank at home and a basket of drugs. Sometimes I guess these "rogue migraines" can happen though because it really did happen to me. I really could have used something for that pain but they gave me nothing but shining lights in my eyes every 2 hours for 3 days.
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