An ER Doctor’s Perspective: Strategies for Migraine Relief

Continued from Part 1 - Migraines From an ER Doctor’s Perspective

  1. Stay calm. This is very difficult when in pain, but it is very helpful to ER staff and you will be treated much more quickly. Any delays in history taking and physical on account of drama (even if completely justified), will result slower treatment for you.
  2. Be honest. This includes the honest appraisal of pain. Yes, please tell us you took some of your sister’s pain medications. We appreciate honesty, even if you think it makes you look bad.
  3. Treat staff with respect. Even if you are not treated appropriately, it is vital that you stay respectful. I have heard horror stories of how patients are treated by ER doctors and nurses. If you get a surly doctor or nurse, don’t fight or argue with them. They can just leave the room. You are the one stuck in the cramped room with pain and fighting will only hinder your treatment.
  4. Bring family—I like that. A few posts have mentioned bringing a family member or advocate. I think this is great, as long as your family will also remain calm and advocate for you (not fight for you). This is helpful on many levels. They can often provide additional history and background. I love it when patients have reasonable, calm family members present.
  5. Have a care plan, follow it, and bring it with you. It is very helpful if you have a care plan that outlines your headache treatment protocol. ER doctors will almost certainly follow this—especially if it is from a headache specialist.
  6. Get a headache specialist. This is a huge help and they are often willing to write up a care plan for both daily treatment and abortive care when you have to come to the ER.
  7. Don’t ask for opiates. Opiates (morphine, Dilaudid, Demerol, Fentanyl, Vicodin, Perocet etc.) are terrible treatments for migraines. If a doctor is not giving you opiates for your migraine—it is because she or he cares about you! In the past, the philosophy in the ER was to treat patients ASAP and get the patients out the door, even if it was just a temporary fix (such as giving Demerol to migraine patients). Many headache clinics and specialists will refuse to see patients or give them appointments if they are taking these medications. Taking these opiates results in profound changes in your brain, increasing your sensitivity to pain and worsening future attacks. This can be shown on the cellular level. Pain receptors are altered with the use of these medications. This is very real and I have seen this many times in the ER. The use of these medications will also make you less responsive to more specific migraine therapies. Fortunately there are so many alternative treatments for migraines.

In summary, we are a flawed crew in the ER. We are impatient, hurried and often forget what it is like to be a patient. In spite of these things, the wise patient will try to empathize with ER staff. Even though this isn’t your job, it may helpful for you to get fast, effective relief. We get sick (often), we get divorced, our wives have miscarriages, we get sued and yet we have to keep working when life hits us. We definitely want you to feel better, and we are truly sorry when we come up short on the compassion end.

I hope this has been helpful to some. My apologies as I know much of my advice doesn’t apply to many on this forum. These are the observations of a single, simple ER doctor. I would very much welcome comments and thoughts. I will do my best to respond. @kylekingsleyMD

Dr. Kyle Kingsley is board certified with the American Board of Emergency Medicine and a member of the American Headache Society. He currently practices emergency medicine in multiple hospitals in the Midwest. His interests include his two young children, health/fitness, triathlons, and Eastern medicine, particularly when it is applied to chronic health issues including chronic headache conditions. Dr. Kingsley studied acupuncture and alternative medicine in Cuba in 2003. He also presented his unpublished study “Acupressure in the Treatment of Benign Headache” at the Society for Academic Emergency Medicine annual meeting in 2005.

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