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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

Please also see Migraine and the ER – a Follow-up Interview

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Macbeck
    3 years ago

    I am currently working to set up a Migraine Treatment Protocol book for myself. Thank you for the suggestion!!

  • MIScramlin
    5 years ago

    I’ve taken my Grandmother to the ER for her migraines many times.
    Steps 1-3 don’t matter, as following them will still get the patient treated just the opposite.
    Step 4 is somewhat helpful because it’s very hard to have a conversation with anyone when you’re in that much pain.
    Step 5 is a complete joke that isn’t funny. I’ve NEVER seen an ER doctor follow my Grandmother’s treatment plan.
    Step 6 is a great thing but unless they’re on duty at the ER, it’s pointless to bring it up to the ER staff.
    Step 7 is allowed but you have to wait and let them inject you with medications that don’t work well for you or do not work at all.

    Her experiences terrify me because I am on the same path. For both she and I, preventatives cause adverse reactions that are just as bad as the migraines. OTC medications do nothing for my Grandmother and I have to take at least 2x more than the recommended dose for it to even barely touch my pain. The ER nurses are generally compassionate but not the ER doctors are not as compassionate.

    Just once, I would like these doctors to feel the pain that we sufferers feel, so that maybe we can get the effective treatments we need, want, and deserve.

  • MNW
    6 years ago

    Recently I found out what helps me at the ER, it does include an opiate tho. I get DHE, Zofran and Morphine. Sometimes other things are added too. I have an allergy to antihistamines so they can’t use some of the medicines that they normally would. I remember going to an ER 4 years ago and they tried a lot of things. I know they were trying to help, but in the end I felt strange and was having muscle spasms for 24 hours. My body would tense up and I was so uncomfortable. I don’t like being a test subject in the ER.

  • TinaJason Dotson-Alery
    6 years ago

    I am realizing that there were many errors in my message as far as grammar and spelling go but my point still remains the same and I am deeply saddend to see that it says here that you do ur best to respond and you can’t seem to answer my very long yet simple question, which is How would you treat me if I was a patient at your er? Would I have to try everything, every single time and would you base your decision making off blogs on the Internet? Or will you just to save face say ” Well each person is different and I would have to see you?” To make a Statement claiming that a doctor in the ER is doing me a favor by not giving narcotics for a migraine is a very bold statement. I truly and wholeheartedly believe that if you felt my pain for even two minutes you would be begging for any kind of relief from your pain. Maybe I am better off the next time I have one of these severe migraines, where I’m throwing up crying and screaming, and I go in the ER I need to tell them I have a backache instead. Because it seems based on what you were telling me that you have a backache or toothache (is that what u said) I would be better treated then I would if I have a migraine. I currently have 4 Herniated discs in my neck, and last yr I had An abscess tooth which they had to do a root canal and put crown on and the pain from both never has yet to compar with one migraine. I want to say I in no way am trying to be cruel or unkind I feel very Passionate about this subject, as it is a huge topic of controversy. I am very very discouraged to see that there are blogs out there telling other ER doctors not to treat their patients correctly. What blogs like this do, is they cause other ER doctors to make instant judgment calls not based on the person in their individual situation but on this general Word.. migraine… it happens now before that person has even walked into the door, the er doc sees that someone in the waiting room is labeled “migraine” and they have already decided I am going to be difficult, They’ve already decided I will not let them try anything except narcotics, they’ve already decided that nothing will work that is not a narcotic. When that is not the truth because as for me personally I let them do everything I have begged them to find something other than a narcotic to get rid of these migraines but nothing else asked from this trio of med works, help me, help me, figure something out tell me what would you do? I have a family member who currently has Kaiser and she is treated like total crap now, they usto take care of her but now they do not, now she doesn’t get them as frequently nor as bad as I do but maybe once a yr she does get this exact horrible migraine I get every single month, I just remembered they r called status migraines, I can’t ever remember that word I don’t know why, but here’s the frustrating thing, she is not a narcotic Junkie and its maybe once a yr that she gets the same one I do but now Kaiser will no longer issue any narcotic injections or meds (& btw they were the first ones to ever give her this kind if meds) now here’s what she went through (& thankfully she has not had one this bad for almost 3 yrs this time where as its been about once a yr before) but what happened is they let her suffer, she was throwing up so much. She ended up 2 weeks later in a non kaiser hospital (Where by the way it will cost or $800 for going to a non-Kaiser Hospital) and she was in Severe dehydration and still having this horrible status migraine, Finally after about six hours in the ER and then giving her everything but a narcotic they broke down and gave her 2 mg of die lauded and something for nausea and she ended up going home going to sleep and the next day woke up without a headache, because she had, eventually, proper treatment. Kaiser wanted to give her steroid which bothe my sister and myself happen to be very allergic to and a headache is a side effect steroids. So I guess I am telling you all this because im so botherd that anyone, Especially someone who is never suffered a migraine, Could possibly make a generalized statement saying if you go to the ER with a migraine and they do not give you a narcotic your doctor is doing you a favor. What kind of a favor is it to make someone suffer. And isn’t every situation different? Ive said it all I feel, I just hope someone hears this because drs r not perfect but neither are patents. So cutting people slack goes both ways. I truly would like to know your thoughts on this. I hate with a passion getting migraines, I am praying to God when I hit Menopause that they actually go away. But who knows if that will happen to me I don’t all I know is I deal with what is ahead of me today and right now I get one horrible migraine every single month and is always when I have my. I don’t know what to do they tried every birth-control they tried so much stuff it’s ridiculous and nothing has worked I do everything the doctor has ever told I don’t fight them I don’t complain I do everything they say and yet I’m in the immediately labeled when I walk in er. And just as much as I feel the ER doctors don’t want to be treating me I don’t want to be there. I hope that you can hear the passion in my heart and what I’m saying and maybe you can see that I’m not someone who’s wanting to go just get a narcotic I just don’t want to have migraines not ever

  • Kristaina
    6 years ago

    I agree with you 100% Tina and have unfortunately experienced many of the same situations as you have in trying to get anything to relieve the migraines. Today is day 4 of a level 9(10 by night time)migraine. I ran out of relpax but thank God I have an rx that I can pick up tomorrow.
    I find it very frustrating being treated by someone who has likely never experienced a migraine themselves. They have NO IDEA how terribly we suffer!! I have suffered from knock down migraines for as long as I can remember. It was early elementary school when they got real bad. I spent many days in the nurses office laying in what actually was the perfect room for a migraine. It had a cot, pillow and a light to turn off. I spent many days in that nurses office.
    I’m lucky enough to still have my best friend that I met in preschool in my life, still best friends. She’s told me how she remembers me crying in the corner holding my head because of the pain. She says it made her so sad.

    Anyway, I’ve suffered at least 40 of my 45 years with chronic migraines. It’s depressing because not many people understand and you feel as though they feel you are faking it, especially when you’ve had plans and get that pain in the ass migraine and have to cancel at the last minute.

    I been offended many times by doctors making me feel like I am a drug addict! I just want to punch them in the face, or maybe on the side of their head to where it starts throbbing as badly as mine is… a migraine to where they throw up all night. Just have one of these migraines and then talk to me about not giving me something that’s known to work in my case. When I get my migraines, the bad ones make it to where my arms and legs actually begin to feel numb, weak and heavy and my entire body is so tight it hurts to even move – especially my neck. In the few times where I might be able to get a hold of the migraine I then deal with the extreme tense muscles where my neck meets my skull. That can last for days and most times brings the migraine back.
    I believe it is MY BODY and I should be able to decide what I want to treat it with. For crap sake, stop added to my stress and just give me something that will work for ME. Next time I go to the ER I think I’ll take a copy of my entire file from my neurologist.
    I hope things get better for you TinaJason Dotson-Alery.

  • TinaJason Dotson-Alery
    6 years ago

    I am a long Tim’s sufferer of migraines, I started getting them at the age 12 and after my 4th child they went crazy, it took about 5 yrs and very excellent migraine specialists (Neurologists who delt with migraines exclusively) to get me to where I was having not so bad migraines every other day and the really bad never go away I would b literally throwing up and in bed for weeks u til I went to the er, to finally now I get one each month on about the 2nd day of my period and idk why but they r bad…anyone who comes near me can clearly see they r really really bad, now they have done everything to me and I mean everything, being allergic to Benadryl (which is a little ironic as Benadryl is an allergy med) I can’t get the regelan Benadryl fluid Iv, they have however done this and it didn’t work. When I get this one kind of migraine the DHE I think it’s called and regelan and everything they possibly can do doors not work and I would spend hours and hours in the er, now one day my nurohad them give me 4mg of diloted 50 mg of phinnergin and 60 mg of toridal (sorry if my spelling is wrong) neways it worked this migraine that lasted well the longest for me was 47 days, it never even goes below a 9 it steadily stays so bad I can’t be a mom, or even a person, so after they gave me this crazy dose of meds (& at the time I had no experience w pain meds) I felt like I was saved, this was about 15yrs ago, ever since I go to same er, see same nuro but I have moved 3 times cuz if my husbands work, so in each state they start all over and they spend forever trying everything else and NOTHING has ever worked, (fyi I take frovaor acert w ne of the little ones it gets rid of them worst case on second dose) but these bad ones I get w my period nothing works so I go to er and I am labeled a drug seeker, but only ever by the women drs, idk why maybe they don’t like other women, I will do whatever they want I almost always say I don’t care what they do just don’t give me an iv (I usto let them but every single time I got an iv the pillow is covered in blood or some messed up thing happens and it takes ten tries to do it and they all say I have perfect veins but my veins collapse and I think they r scared) but now knowing the whole iv fluids w regelan does not work I say no iv unless I’m dying…my nuro right now has written letters and stated that they have actually tried everything and all it results in is me suffering a lot, so she tells the er to give me the same 4mg diloted and 50mg phinnergin and 60 of toridal, now here’s the other thing if they change that in any way like only give me 25mg of phinnergin or don’t give me the toridal it doesn’t work so nw I’m stuck every month trying so hard to get rid of these horrible things that r not a rebound headache cuz they would not rebound a month later, but I will try and suffer for days and weeks just so I don’t have to go to the er but I always end up having to go and I am always treated like I am just a crack head, I don’t get the studies, I have people I k ow that say they get migraines but I dot believe they do and I think to many people r Diagnosed wrong, that’s why a simple little thing gets rid of there so called migraine and pain meds don’t cure anything cuz I’ve heard that, I was actually told by a dr that the New England Journal of medication said that narcotic pain meds do not cure migraine…no kidding narcotics don’t cure anything, so I have started to research myself and check this out,now PLZ pay attention! I found out for about 10$ anyone could find drugs on the street and they would be exactly the same as what is given in the er, but who would do that I’m not willing to go to poision cuz I have a real migraine and I’m sick and it sux and I’m screaming cuz mine r so bad I scream and it makes them worse, but if I was a drug seeker I would never go to the er cuz I have no insurance so it’s best case costing me 300-500 a month to get rid of a headache so again I say if I was a seeker I would not pay to go to the er and be treated like dirt when I’m nice, well I’m usually crying so hard my husband does all the talking, but I’m not mean I do whatever they want but it always ends up they finally give me what my nuro said to, but why do I have to be Literarily tortured because someone like you post a blog stating that the doctor is doing them a benefit by not giving them narcotic pain meds in the ER. What kind of a sick twisted favor is that, I go through this every month it is hell, I have literally prayed to die when I have these headaches they are so bad and to see a blog like this makes me cry I can’t even believe that doctors are convinced there’s only one way of treatment. Ok I said that wrong, I can’t believe that drs r convinced that every treatment is correct but pain meds, I was told by a fantastic Neurologist who was a headache specialist up in Seattle Washington he was I believe in the top 10 in the entire United States for headache and migraine specialists and he said this 50% of all meds work for 50% of the people, figure that math out. The problem is this, like I said I have met people who fake headaches or do get real headaches but they r rebound and its cuz they take to much pain meds at home, but what about the one person who is not a drug addict who actually is suffering and u do everything u can but it doesn’t work and because this particular dr just read something like is days no narcotics than I’m sent home to cry and not sleep even more and I end up straight back in the er…I swear to God I wish that there were on site staff trained to do a lie detector, it would suck but I know many wouldnt go to the er just cuz they knew that so that now weeds out a lot of drug seekers and then for migraines they could ask me and know I’m not lying, it sux cuz I have low blood pressure my BP is usually about 80 over 59 so when I have a migraine it is about 128 over 80 and I think that’s freakin normal so they have to go by how I look thankfully I never look to good, I can’t say I actually know how I look but when people in the waiting room tell me oh dear I’m so sorry u look like ur in so much pain..if non drs can c this why can’t drs? But I’m truly upset as you r the reason when I go to the er now I spend 4+ hours being out through hell only to end up getting the exact thing my dr ordered, and the last time I went my husband actually called my nuro cuz the girl dr was so so so mean to me and this dr called my nuro as well and got caught flat in a lie, so drs in the er I guess are allowed to lie straight to our face which I would never ever have believed had it not just happened to me. Thankfully when she was lying to my husband about what my nuro said he was on the phone w her and my nuro told my husband, cuz she could hear the er doc, that what was being said was not what she told her, my nuro told her I have gone through hell and this is the only thing that works, that I was not a drug seeker, they have an MRI if my head from when I had a migraine and that MRI shows 4 blood vessels swollen, so I’m not faking but because of article like this and the people who do fake I get the privilege of going to the er, which sux in and if its self the lights and beeping and crying, it’s hell. I now get to be poked and prodded only to after hours of torture be treated. The last er doc said she had been reading online that the best protical is to not treat with narcotic pain meds, I wonder did she read ur site? Did I spend 7 hours at the er because of u? People will always lie and fake and yes there r to many drug addicts but what about people like me who truly r suffering and not there just for narcotics if anything worked more power to the doc that finds that I hate it I the that its a freakin narcotic cuz if it wasn’t I would b treated quickly. I hate this, so like I said what about me and those like me? Are there never exceptions to the “general plan!” I’m sorry do ne spelling errors I have massive sinus infection which I had the last time I went to er and was never treated for cuz the dr got caught in a lie, so she just wanted me out, I’m nice, one day when I have a migraine so bad I spend a month s reaming and throwing up and finally snap and drive off a cliff maybe then drs won’t judge everyone so badly, idk. This breaks me. I hope u never ever suffer the way I have. If u did u would not have wrote this blog

  • Tracy Gable Worth
    8 years ago

    not everyone responds the same way, maybe u shouldn’t be an ER doc.

  • A Matthew Deal
    8 years ago

    Worst advice ever. I’ve literally been on the verge of killing myself when medications for aborting cluster headaches have failed and the number one piece of advice is to remain calm? No perspective on the severity of headaches for some patients.

  • Migraine.com
    8 years ago

    Although it may seem next to impossible, remaining as calm as possible is likely to improve the quality of care you receive in the ER – precisely what Dr. Kingsley is suggesting. ER staff is looking to understand your condition, and patients who are unable to communicate clearly are more challenging to treat.

  • Cheryl Hatfield Hibberts
    8 years ago

    I am treated with daily prophylactics. I take 300mgs of topiramate and increase to 400mgs next week. Also take Imitrex nasal spray, Axert, antidepressants, and also am a Warfarin lifer. I see a neuro every 6 mos., but my migraines are no better. I am unfortunately at the ER more often than I would like…I am treated for the acute pain. because I am on Warfarin, I am limited to what I can tolerate too. Botox may be in my future

  • Pat Blamer
    8 years ago

    What a nice, polite, utterly unrealistic article.
    A list of demands about how patients should behave, and “respect the rights of the ER staff”. The ER staff have all the power and the patient none, yet the patient is expected to assume responsibility for ensuring proper treatment.

    A care plan! Great! Assuming that you can afford a neurologist. Good luck with that if you’re poor. Other migraineurs have said that their care plans have often been ignored by ER docs, in contradiction to what this article claims.

    “Opiates are terrible drugs for migraines!” Not at all. They’re actually quite good at what they do. They’ve worked well for me and I’ve never developed an addiction. More info here: http://doctordeluca.com/indexold.htm.

    Political pressure is on to ration opiates just like the rest of healthcare is being rationed – reserved for the wealthy. Hence the anti-opiate scare campaign, and the “assume migraineurs are drug seekers unless they can somehow answer all my questions right AND don’t dare to ask for an opiate.”

    However politely worded, this article is just more victim-blaming of migraineurs and perpetuation of false information about treatment options. You’re not doing us any favors at all, Dr. Kingsley.

  • Elliegal
    3 years ago

    I’m with you, Pat. Went to doctors care thrice for severe migraine (which is now chronic). First 2 times they injected me with nubain & phenergan. Knocked it right out. Third time a couple years later, the doc actually looked at my arms for needle tracks before insisting on Toradol which did not work at all and ensured that I would suffer in agony for another 2 days before the migraine cycle subsided! I find it interesting that this dr neglected to mention “all those other treatments for aborting migraine’

  • Diana Downing
    8 years ago

    I have had chronic migraines for over 40 years and have had 7 different neurologists try all of their pharmaceutical “bests” on me. Once, ONCE, I had my hubby take me to ER as I was desparate and meds were not working to abort the severe pain. ER gave me benedryl and sent me home. $150 copay, no help for the excrutiaing pain, and treated like a druggie. I am not a fan of ERs for anything to do with pain. PS, I also worked in one and know how they talk about patients coming in for pain. Sadly, chronic pain sufferers are poorly cared for.

  • Jawing into
    7 years ago

    Thank you friend, I couldn’t have said it better myself…. What a poor excuse for an ED doc.

  • Laraine Bradford Morrison
    8 years ago

    I have suffered from migraines for 30 + years and am on disability, Jessica. I believe you would qualify, BUT I have found that qualifying and actually getting it depends almost primarily on what your Dr. says on your forms. Don’t give up because you need it and it is there for people like us. I have been to practically every neurologist in Alabama and a few in Georgia. Like you most treatments make me sicker. I have learned what helps and what doesn’t. It is so frustrating to hear the “whining” and excuses about poor ER treatment and that opiates don’t work. OMG! So, so sad Dr. Kyle Kingsley. You’ve obviously never had a severe migraine that has lasted for days. I just lost a whole lot of respect for Migraine.com. So basically….very well stated Jessica Madore. You dropped the ball on this one migraine.com and Dr. Kyle Kingsley. You have no clue….But like so many others who treat those of us who are not helped by “alternative treatments for migraines”, we can’t help that and need some relief. You need to re-think your position. I almost, yes just almost, wish a 3 or 4 day migraine on you, that would not respond to your “alternative migraine treatments” but make you sicker! Just one of those, might change your mind. I feel sick now! SO SORRY, Jessica. Feel free to message me if you need to talk or if I can offer any suggestions/help for you getting disability. Thank you for speaking for so many of us!

  • Migraine.com
    8 years ago

    Laraine – Please see Dr. Kingsley’s follow-up post which specifically identifies other medications that can be used to treat migraine in the ER (other than opiates). Although opiates are used for extreme pain, headache specialists and migraine advocates do not recommend these medications due to the risk of medication overuse headache and long-term treatment challenges they can create: http://migraine.com/blog/expert-featured-article/migraine-the-er-%E2%80%93-a-follow-up-interview/

  • Newdancerco
    2 years ago

    For many migraine sufferers, other options work.
    For those where nothing else works, the decision to blanket deny an entire class of drugs (yes, it is a CHOICE to refuse to consider a medication) is poor doctoring. I respond to almost NOTHING, but don’t bother with ERs because of attitudes like this. This Doctor would cost me a significant chunk of my pay and not treat my problem. AND treat me like a junkie to boot!

    Why should we trust doctors, when they ignore us?

  • Marquita Fuchs
    8 years ago

    I appreciate you trying to treat migraine pts , with the care they need and deserve. As a migraine sufferer for 40 years, I never ever go to the er, if I told my husband to take me to the er, it is a Emergency. I have been treated poorly by er and family practice drs. I now ask, my docs if they have migraines or anyone in their family has migraines. I find these are mostly in my experience the only medical providers whom do not think , we are drug seeking. As you explained narcotics are not the treatment of choice. Rehydrating can help us and adding a drug for nausea. I agree with Jessica, there are times that we do need a narcotic to break the cycle. Please do not offer me a NSAID for pain.

  • Dona Stevens
    8 years ago

    I haven’t been to an ER in 15 years because I was always treated like I was some kind of drug addict or looked at “suspiciously”… which really hurt me when I was in terrible pain and just needed help! I will say that I eventually became dependent on Fiorcet w/Codeine. About 3 yrs my headache specialist helped me get into a rehab. I spent 5 days at rehab and about 6 months in a fog, but got off the drug. I still suffer from Migraines but now I mainly use Imitrex tabs and/or Tylenol to get rid of migraines. I can hardly believe it. I’ve had migraines for 40 years.

  • Nicole Bolisay
    8 years ago

    You’ve never had a migraine in your life. #7 is a joke. I’d like to know what you suggest as an alternative treatment. Thank god I live in a city where I have some of the absolute best ER doctors who actually want to stop the pain and suffering instantaneously. Migraine sufferers know the long term game plans and recommendations. When we come into the ER, it is for instantaneous halting of our pain. That’s it. We don’t want/need to discuss #1 – 6. Just give us the pain meds. You’re an ER doctor and it is an emergency. Just do your job. Help the EMERGENCY, which is the pain we’re feeling at that moment we enter the ER.

  • Migraine.com
    8 years ago

    Nicole – It is important to remember that treating the pain (and ONLY pain) can put you at risk for missing other diagnoses people with migraine are at risk for, including stroke.

  • Janice Eads
    8 years ago

    There will be a discussion today on the television show, “The Doctors”, looks to be specific to general migraines, just in case anyone is interested.

  • Stacey Bruhn-Robinson
    8 years ago

    I am a registered nurse and I work full time at two jobs. In October of 2007 I was at work and obtained the worst headache of my life. After being treated in the ER and being flown to a city hospital for treatment, I was told I had a subdural hematoma. This is usually caused by trauma but with no recent trauma, the docs were at a loss for cause. Anyway, I had 2 burrholes and then full surgery and since that night, I have had chronic head pain and severe migraines. I have a migraine 3-4 times a week with nausea and vomiting and photosensitivity. The pain is so bad that I can not physically move and often lay in vomit until it subsides. It is the most awful thing that could ever happen to someone. I have been to at least 10 neurologists and a headache specialist and I have no relief. They have tried so many medications and nothing is working. Actually I think most of the medications make things worse as they do not stop or relieve the migraine and they add many side effects to that pain. I miss many days from work, am at risk for losing my job and my home. I am a single mother of five and I cannot live off of Social Security. I have done exactly what the docs have said. Followed instructions precisely and no relief. I have an MSN so I am very educated and understand about the use of narcotics and migraines but let me tell you from personal experience that in the middle of a migraine I wish for death as the pain is so bad. I do not feel that way normally but laying in vomit, not being able to move with the worst pain imaginable in the left side of my head, death is a more humane option! I am telling you all this as if I feel a migraine coming on, often but not always though, 2-4 percocets will stop the migraine. It will also put me asleep for a while but after waking up a few hours later, there is no migraine. My migraines last sometimes up to 8 hours and to get any relief is a blessing. Having said all this, I have to disagree that narcotics are not an option as for me, any day there is no migraine no matter how it is accomplished is a wonderful day for me!

  • Lynn Migraine
    8 years ago

    Wow. I realize that from a doctor’s professional experiences, a pain scale includes a wide range of experiences, but I am very surprised to read how apparently a patient’s answer to this basic question could have a major impact on the quality of care he or she receives. Why offer a pain scale at all if there is a wrong answer? Why ask the question in the first place if you are going to disallow the information based on your own perceptions?

  • Charlene Whitcroft
    8 years ago

    go back to the er and I when do worek to at er satff.

  • Chey Ewertz Cobb
    8 years ago

    Really? Are you serious? I have had ER staff take my medical papers and toss them in the trash can while stating, “We don’t have time for that crap. Show it to your GP.” (Who did they thing GAVE me the paperwork?)

    WTF? No opiates? Really? And WHAT are these amazing, fantastic “alternative” treatments? Are they secret or only available to the elite?

    Please tell me how many migraine patients you’ve SUCCESSFULLY treated!

  • Migraine.com
    8 years ago

    Chey – Please see Dr. Kingsley’s follow up interview which includes treatment suggestions (other than opiates): http://migraine.com/blog/expert-featured-article/migraine-the-er-%E2%80%93-a-follow-up-interview/

  • Migraine.com
    8 years ago

    Jamie Sohn – Great thoughts, thanks for sharing!

  • Jamie Sohn
    8 years ago

    Magnesium SUlfate, Lidocaine IV, Benedryl/Reglan shots, Other treatments out there. I’ve been there- when they wanted to give me opiates. Refused it.

    If ER staff do that with your papers, you have a right to file a complaint with the hospital Risk Management. Document, if you have someone with you.

  • Parin Stormlaughter
    8 years ago

    Cannot recall ever seeing advice from a doctor as unhelpful as this advice. When I cannot speak, have no feeling on the right side of my body, weep and vomit from pain and sensitivity, I have absolutely no interest in your knowledge of alternative treatments. You don’t list them in your article and I have never seen any administered by an ER, so to tell me that I am making my own situation worse due to whatever my doctor has prescribed for breakthrough pain – blaming me, the victim – accomplishes nothing for me but would accomplish everything that you seem to want which is to get me away from you as fast as possible whether you treat me or not.

    I am about as involved in CAM as a person can be. It most assuredly IS possible to integrate the two and I do it with all my doctors’ full approval but CAM will never and should never be scolded into a patient in an ER instead of administering pain treatment.

    Energy medicine can only be performed by patients for themselves as long as they can keep up their concentration. Diminished ability to concentrate is a hallmark of migraine. Crystal therapy helps as long as you can stay underneath the rocks. Plant infusions and extracts are wonderful to round out pharmaceutical treatments if one is trained and experienced but do you really want pain patients to go back to the days of, well, no modern pain treatment? Ever tried to explain the benefits of Bach Flower Remedies to a migraineur in the midst of a full-blown attack?

    I have had migraine since I was 5 years old. I am now 51 years old.

    There are laws that require pain to be treated. I insist that my doctors follow the law or I fire them. They won’t care one way or the other but I care.

  • Migraine.com
    8 years ago

    Parin – Please see Dr. Kingsley’s follow up interview which addresses some of your questions, including treatments options other than narcotics: http://migraine.com/blog/expert-featured-article/migraine-the-er-%E2%80%93-a-follow-up-interview/ Also please keep in mind ONLY treating the pain can put you at risk for missing other serious diagnoses, including stroke.

  • Pat Blamer
    8 years ago

    Me, either! And so slick and smooth, I’ll give him credit for that. It’s easy to be smooth when you aren’t the one in pain.

  • Jaime Clark
    8 years ago

    I have to agree with Jessica. I have had migraines for 20 years now. I just wish there was just one ER doc out there that would admit that a migraine can and does probably know what is best. We may not have an MD by our name, but we are the ones suffering and after so long, we do know what works for us and what doesn’t. I actually had one doc tell me I will no longer be treated at his hospital. That he would not give me any opiates for my pain. I looked at him and told him, I don’t care what you give me, just make the pain stop. He gave me zofran and sent me home. There needs to be more ER docs that are educated in migraine treatment and please stop treating us like our pain is nothing, like we are drug seekers. We are people to, we are people with real pain. And I’m sorry but when I’m in the ER and a nurse or a doc does not show me respect or treats me like I’m crap, you bet your ass, I will not be treating you with respect. Why would I show you respect when you are not showing it to me?

    Oh and just for the record, I to would like to know what you would suggest for migraine treatment other than opiates. Because for me, I have tried everything out there. And the only thing that works for me now is morphine. So what would you suggest? And please don’t give me that crap about Toradol or anything else like it. It does nothing for me.

  • Migraine.com
    8 years ago

    Jaime – Please see Dr. Kingsley’s follow-up interview with Ellen, which includes treatment suggestions (other than opiates): http://migraine.com/blog/expert-featured-article/migraine-the-er-%E2%80%93-a-follow-up-interview/ It is important to remember that everyone needs to discuss treatment options with their physician to determine what is best for them.

  • Lisa Murrey Brown
    8 years ago

    This ER doctor really has no clue…by the time I go to the ER to treat my migraine it is because I cannot take it any longer. The pain is so bad and has lasted so long that I need the pain to stop. I have a headache specialist…there isn’t a headache medication that helps my headaches therefore I live with the pain, however when my specialist has tried medication that didn’t work and sent me on my way and my migraine lasts for 15 DAYS STRAIGHT and I go to the ER its b/c I cannot take it any longer! This is exactly what happen… A horrible migraine started 4 days into I went to my Neurologist who wasn’t available but the NP was they gave me shots and said I will feel relief in a few minutes and sent me on my way…3 days later the pain is still going on and now worse. I called the NP and was told there is nothing else we can do…so I suffered in extreme pain taking Benedryl to get any sleep but as soon as I wake up the pain is so intense I can’t stand it…

    I continue to suffer for 8 more days with no medication, no pain medication NOTHING…I finally feel like I am going to lose my mind if this horrible pain doesn’t stop. My mom a retired nurse comes with me to the ER….they give me the same meds the NP did at my neurologist’s office but this time thru an IV….I ask about 30 minutes later when will it start to work…and get well if it was going to work it would have already. They make me suffer there another 30 minutes without anyone coming to see me and I finally buzz and say if this is all you are going to try let me go home so I can try to sleep and get away from this pain. This nurse comes in and says “let’s try this” and gives me compuzine (sp) now even I know this is for nausea and not to help get rid of the migraine…She doesn’t know my mother is a nurse at that point my mom had had enough went to the doctor as a nurse and to explain my situation, the pain I am in and how nothing is working the Dr then decided I have been thru enough pain and gave me 1mg of Dilaudid…. That finally broke my migraine and it finally went away after 15 days!

    That was all it took, I never had this medication before it was obvious nothing else was working this doctor finally listened…but I seem to think it was b/c my mom was a nurse that the doctor really listened. This happened 2 yrs ago and I haven’t had to go back since but this shows you DR. KINGSLEY you cannot group everyone together! Your thinking is wrong…I have MRI’s and yes there is a growth on my Pineal gland but it has nothing to do with my migraines…I don’t go to the ER unless I cannot tolerate it any longer….and again I get treated like a pain med seeker and I take NOTHING for my pain b/c NOTHING WORKS.

  • Lisa Murrey Brown
    8 years ago

    Joe Meisch very interesting…2 comments 1) I get botox injections at these trigger points the problem with botox is it wears off and I have to get it every 3 months. My 2nd comment…I suffer from tinnitus too…and I have inner ear nerve damage so my hearing is getting bad and with the tinnitus it gets even harder to hear. I will check out your sites. Thank you.

  • Angie Bowman
    8 years ago

    been having migraines since I was 16, now 59, there is no way ill be asking for botox, has to many side effects, i have been on painmeds, but now the doctors refuse to give it to me, to me that is not a good doctor, i have these headaches allmost all week long, with no relieve, now what I do.

  • Pamela Klekar Burns
    8 years ago

    I took a friend with a horrible Migraine to a ER while we were at a conference. She does not get frequent migraines but when she does, he doctor gives her phenergan (sp?). We both told the doctor and he refused stating that was not protocol. I even offered to call her doctor at 2 am and he said he would still refuse to give her that treatment. I suffer from Migraine too and was appalled!

  • Lynne Heller Smith
    8 years ago

    I agree with much of what you have written, except your interpretation of the pain scale. Migraine patients often come in either with a sudden intense new type of headpain they’ve not experience before to rule out stroke, etc., or they have been suffering for days with a high level of chronic discomfort and array of symptoms because their treatment plan has failed them. You do not mention Status Migrainous.

  • Migraine.com
    8 years ago

    HI Lynne – Dr. Kingsley has addressed your comment in the follow-up interview. Although most patients who are in the ER are not experiencing atypical migraine symptoms, he notes that those who are should explain that specifically to ER staff (new or different symptoms, worst migraine ever, etc): http://migraine.com/blog/expert-featured-article/migraine-the-er-%E2%80%93-a-follow-up-interview/

  • Kathleen Sanchez Deen
    8 years ago

    I’m going to agree with the masses **comment edited by moderator due to violation of forum rules**, Mr Doctor person. You take just ONE of my cluster headaches and see if you’re not reduced to tears and begging for something, ANYTHING (opiates, oxygen, imitrex, a gun to the head, stabbing a screw driver in your head, death…etc) to take the pain away. **comment edited by moderator due to violation of forum rules**

  • Pat Blamer
    8 years ago

    Migraine.com The power, and therefore responsibility, is with the doctor to provide effective care. Not on the patient to jump through all the correct hoops before being rewarded with treatment.
    Anti-opiate paranoia and rationing of opiate drugs ensures that migraineurs wil continue to suffer. Not the fault of the patients, therefore it is not their responsibility to please their doctors by behaving submissively and not asking for anything which might actually be useful to them.
    We need to be questioning the stigmas surrounding opiates, migraineurs and “drug seekers”. And we need to be listening to the people who actually are suffering here, not self-appointed experts who have never had a migraine in their lives, or they would be ashamed of themselves for spouting such rubbish.

  • Mike Widing
    8 years ago

    Kathleen Sanchez Deen i agree with you how is a patient suppose to know what drug to ask for and what pain rate to give they do not have the degree it seems Dr always have a excuse for not doing there job right

  • Michelle Springston Pingel
    8 years ago

    Hi Chey! I now live in southern, MO and the regional hospital here is absolutely wonderful. the staff in the ER is amazing and they know all about cluster headaches. I’ve lived in this town for a year and a half now and had to go to the ER twice, once when the cluster eye was swollen shut, a first for me. I’ve never had such good care! They know me now and all of the wonderful care I received here more than makes up for the terrible suffering at the other ERs. I think the article by Dr. Kingsley is very nicely written, though. It’s just that there will always be some arrogant or ill-informed doctor out there who has no care to understand our pain. Soooo many doctors have no clue what a cluster headache is, but chiropractors and dentists and dental students are very familiar with them!

  • Chey Ewertz Cobb
    8 years ago

    Migraine.com you said: “ER staff who aren’t familiar with your health history”… are you kidding??? I hope I never have to go to an ER so much that they actually KNOW ME!

  • Penney Hardcastle Redman
    8 years ago

    While watching NATGEO last night we watched how some people handle them. I’m so sorry for your pain & hope they can relieve your pain. Your in our prayers.

  • Kathleen Sanchez Deen
    8 years ago

    …But thanks

  • Kathleen Sanchez Deen
    8 years ago

    Migraine.com By the time I get to the ER dept, I just wish somebody would knock me the f out or give me a swift dose of arsenic…

  • Migraine.com
    8 years ago

    Kathleen – You will find that the ER recommendation post written by one of our patient advocates provides similar recommendations. Asking ONLY for opiates can be taken the wrong way by ER staff who aren’t familiar with your health history and don’t know you personally. Explaining that you are interested in any medications (which can include abortive medications and pain medications) that can help ease your pain will increase chances that you’ll have a better experience in the ER. http://migraine.com/blog/living-with-migraine/tips-and-tricks-for-a-successful-emergency-department-visit/

  • Alicia Weber Williams
    8 years ago

    I am a very fortunate migraine patient. After multiple, almost daily issues with migraines and trips to the ER I was sent to a neurologist. The neurologist did an MRI in the midst of one of my migraines and also treated it there in his office. He also took me off of almost all of my medicatons. When I walked into his office I was on 15 different medications and when I walked out I was on 5. My headached improved dramatically. That was over three years ago. I then started having more frequent and worsening migraines again and so was switched to a difference preventative medication and have them back under very good control. I live a very small community and the doctors and ER staff around here, save a few not so great experiences) are consistent and helpful. I have to say that I find this article pretty much right on the money aside from the statement about the pain scale – when asked about pain scale I ALWAYS give a range of two numbers because I don’t feel that a straight flat one number is accurate usually followed with description like stabbing, searing, etc. Insurance coverage should not come into play, but from experience I can say that it has for me depending on who the treating physician is on what treatment I receive and how promptly it is done.

  • Alicia Weber Williams
    8 years ago

    I am also I medical transcriptionist. I have to say that when I go to the ER or to the doctor office, the staff where I go are very good about putting me into a roomand shutting off lights and shutting the door until the doctor can get to me. A lot of the time they will also get me an ice pack for the back of my neck which helps to ease the pain slightly. All too often the horror stories posted are true and I do realize this. I do have to say that I have had to have Toradol and other medications to break a migraine, but have found that IV saline bolus along with speeds recovery as well. I am very fortunate to have found a preventative that is working for me. I had to go GLUTEN FREE as well as cut back on salt and I now drink an abundance of hot tea (decaf). These changes have been a life saver for me and I am truly thanking God and my doctors.

  • Migraine.com
    8 years ago

    Thanks for sharing your experience with us, Alicia!

  • Rosette Alcantara Doyle
    8 years ago

    Having worked in the ER as a nurse case manager, I can understand some of the points you have made. The situation can be made worse when ER is short staffed, and unexpected trauma’s, heart attacks, stroke patient and other unforeseen events happen during the course of a shift.

    I do know that where I worked there were patient advocates that worked in the ER, but they had no clinical knowledge. A patient advocate with clinical background specifically to relay a patient’s needs and to inform the patient on what the plan of care is, I believe, is essential. I do not mean nurses that are already doing nursing care, but nurses that are employed specifically to be a patient advocate. They would be integral to the team approach to caring for patients in the ER, especially when they are alone. Many times this responsibility fell to case managers or social services, and while their role is invaluable, they are also spread thin with many other responsibilities.

    Many times a patient just wants to be heard. They just want to know how their needs will be met and what the plan of care will be. This is essential, especially when a patient is alone and in pain. I speak from experience as I have also been an ER patient with my Hemiplegic Migraines, before it was even diagnosed. If you can imagine how fearful I was when I was not able to walk, speak properly, and also suffering from head and neck pain. The one thing I did wish for from my ER experience was empathy, and sadly it was lacking.

    So I write this, not so much to be critical, but mostly to voice what an ER patient needs. A clinical patient advocate whose primary role is to advocate for the patient, and not to appease the staff.

  • Mary Regina
    8 years ago

    its tuff being respectful when treated by somneone who has no clue what the hell they are doing for what your disease even is. if you want respect LEARN TO GIVE IT.

  • Barbara Gilmartin
    8 years ago

    WOW…either he is green or has no clue of what it is like to have a migraine. Stay calm, take abuse and still stay calm and the person who is sick should be the respectful and caring one. Think he has it backwards. Drs. have tough lives…that is what you chose to do. Don’t like your job get another.

  • Mary Regina
    8 years ago

    just a hint. you love it when patients bring calm family memebers. if you LISTENED to your patientS. you would not need family members.

  • Tricia Lee Bond
    8 years ago

    Migraine.com and it is only going to get worse…..

  • Migraine.com
    8 years ago

    Hi Tricia Bond – As we all know, there are too many people in your situation, and it is difficult (if not impossible) to receive proper care without health insurance. Unfortunately this is a much larger structural problem, and one that cannot be solved by individual ER physicians who aren’t trained to act as specialists in every field of medicine. While we always hope the recommendations provided by our contributors may be helpful, we never expect them to apply to every member of the community.

  • Tricia Lee Bond
    8 years ago

    Migraine.com what happens if that person has no insurance. Believe me I lived in hell for almost 10 months because I had lost my job, my home, my car, and my life. Not a doctor in this town or any closer towns would even evaluate me, and the local ER scoffed at me. It was not till I showed up at a clinic that a doctor took pity on me and sent me to Stanford Medical. Stanford gave me my life back and they did the treatments and the evaluation for free. Recommendations are always a good thing, but when people get lost in the system because of lack of insurance the recommendations are useless.

  • Mary Regina
    8 years ago

    do you really think we need to read your articles. we have read for years. maybe you should have a teaching class for your doctors

  • Migraine.com
    8 years ago

    Hi Tricia Bond – It is always recommended that anyone with severe migraine find a specialist to work with them. In fact, we’ve had several articles on this topic in the past (http://migraine.com/blog/how-are-migraine-specialists-different/). Visiting the ER is unfortunately necessary in some situations, but the ER is not the place to expect the same level of care as you would receive from a specialist in any specific area… including migraine.

  • Tricia Lee Bond
    8 years ago

    Migraine.com Mary suffers the same Hemiplegic Migraines I suffer we do not have Classic Migraines we has Hemiplegic Migraines. Which are 80% more dangerous than a Classic or Sporadic Migraine. I have permanent sensory loss on the right side of my body, because of doctors not knowing what kind of migraines I suffered.Education is key; our ER doctors need to be updated on the different types of Migraines there are, because there are not just a few simple kinds.

    Abdominal Migraine
    Basilar Migraine
    Complicated Migraine
    Cyclic Migraine Syndrome
    Nocturnal Migraine
    Ophthalmoplegic Migraine
    Pregnancy Migraines

    Hemiplegic Migraine, FHM 1, FHM 2, FHM 3, and SHM.
    FHM and SHM share the same symptoms, which will vary among different Migraineurs. The difference between the two is that FHM can be traced back in the family history and has been linked to mutations of specific genes on chromosomes 1 and 19. SHM is FHM without the familial connection and that particular genetic mutation.

    Familial Hemiplegic Migraine 1 (FHM1): About 7% of patients with FHM seem to have FHM1. FHM is related to the gene locus CACNA1A. This gene is related to other conditions, such as nystagmus (involuntary movement of the eyeballs) and ataxia (unsteadiness, loss of muscle coordination), as well as same cases of more common types of migraine. Ataxia is a very common symptom of hemiplegic migraine. About 40-50% of families with FHM1 experience nystagmus and ataxia (chronic and progressive, though usually mild). Fever, confusion, and loss of consciousness may be more common in this type of migraine, sometimes even including coma.

    Familial Hemiplegic Migraine 2 (FHM2): Another 7% of FHM patients have FHM2, characterized by a gene mutation in ATP1A2. This gene has been connected to seizures, fever, and other mental illness, as well as at least two other types of migraine. This type of FHM often occurs with epilepsy.

    Familial Hemiplegic Migraine 3 (FHM3): Characterized by mutations in the gene SCN1A, this type of migraine is believed to be extremely rare. Seizure disorders have also been connected to this gene mutation.

    I went 10 months with treatment that was not working and ER doctors that had no clue how to deal with Hemiplegic Migraines. It took a Stanford Neurologist to give me the proper treatment and now I am able to life a somewhat normal life. I had a migraine that lasted 10 months with stroke like symptoms. Come to find out I am a genetic mess….. FHM Type 1 is my diagnosis and a simple blood test proved that.I also have other genetic blood disorders that run in the same Chromosomes that my FHM Type 1 runs in. SO why could a simple ER doctor figure that out?

  • Mary Regina
    8 years ago

    Migraine.com i am one of those who difficulty speaking and writting when i am in hm mode. but when i would arrive with paper you dont look at them assume i am having a stroke and when i tell you i am not okay they have seen enough she is irate. please listen

  • Migraine.com
    8 years ago

    Mary – Many people experiencing severe migraine attacks find it difficult to communicate with others, especially in a hectic environment such as an Emergency Room. Others experience aphasia, a symptom which makes using language (speaking, understanding others, writing) difficult. Bringing a family member or advocate is a common recommendation, as cited by Ellen in her post on ER tips (http://migraine.com/blog/living-with-migraine/tips-and-tricks-for-a-successful-emergency-department-visit/). Although this may not be an appropriate recommendation for you, it is a helpful tip that can benefit many others with migraine.

  • Janice Eads
    8 years ago

    Having spent time in the ED, and time as the patient, I can see both sides pretty clearly. As a person with Hemicrania, I do get stigmatized as drug seeking, by ER physicians. Most recently a stay in an ED led to a hemiplegic stroke due to an obtuse attitude and poor diagnostic care. Maybe your ED is superior to those everywhere else because suffice it to say, we are treated just a bit differently in the rest of the world…

  • Pat Blamer
    8 years ago

    His ER isn’t superior. He just claims it is. He won’t give opiates to treat migraines, which is not a superior treatment strategy at all. Just covering his own butt legally and letting his patients suffer while he consoles them with his warm friendly fatherly voice.

  • Jessica Madore
    8 years ago

    I’d like to know what you suggest…..I’ve had migraines for more than 30 years and in that time have tried every treatment out there and have found that opiates are the one thing that will stop a full blown migraine for me…by stating that those are the worst thing is ridiculous! My mother and my father both had migraines for most of their lives and found that opiates were life savers for them as well! I have been admitted to the hospital for a migraine that would not break because they refused to give me what I know works! I spent 4 days once in agony, unable to eat, sleep or get any kind of pain relief because they kept trying meds that have not ever worked for me and made me sicker than I already was. Finally the Doc gave me dilaudid and within 6 hours I was home with full relief. Each patient is different and while I know there are those out there who misuse opiates, I firmly believe after 30+ years I know what works for me and what doesn’t and to rule out opiates is crazy. I would have committed suicide by now if my own docs weren’t prescribing me the medication that works! As far as the pain scale goes…If I want to take a gun and blow my brains out or am seriously thinking death would be better than dealing with another migraine then it’s a 10 most definitely and I am not exaggerating! Just because some people out there take advantage or lie to get “high” doesn’t mean I am! I have both a pain management Dr & A headache specialist and I still get treated like crap when I have to go to the ER when my home treatments don’t work. I even get refused treatment at one local ER now. It’s ridiculous for another person especially a DR to dismiss my pain, if I’m vomiting all over your ER and can barely talk or open my eyes…I would hope you would be a bit more compassionate and listen to me or my family member who knows what works and what doesn’t and give me the medication needed to get the pain under control! I live each day in fear that I will get a migraine that my home meds won’t help and I will be forced to go to an ER. I wish that the same Dr’s who dismiss my pain would get a migraine like me and have someone dismiss their pain so easily!

  • Pat Blamer
    8 years ago

    What they say about opiates just isn’t true. Scare stories about addiction and how they make migraines worse are just a smokescreen. The real agenda: to stigmatize opiate treatments, keep effective medications away from the suffering masses.
    Fob them off with kidney-busting NSAIDs, expensive, new, insufficiently tested miracle drugs or even homeopathic remedies (seriously, was suggested to me in a low-income clinic – bet they don’t tell the rich people to take placebos).

    Don’t fall for this hype. We deserve effective treatment and we have had enough of being labeled drug seekers by the puritanical and the paranoid.

  • Jessica Madore
    8 years ago

    Yes thank you for posting the article, problem is Dr. Kim my headache specialist won’t help me get disability. Right now I have no Dr that will say I am disabled….what am I supposed to do? I can’t travel further to see a new neuro that takes medicaid and I can’t work enough to afford to pay out of pocket for one in my area. I’m in a situation where I have no options for getting the help I need! Any other suggestions would be great!

  • Migraine.com
    8 years ago

    Hi Jessica Madore, That is very frustrating! While it sounds like Dr. Kingsley’s ER does take physician recommendations seriously, unfortunately the same cannot be said for every ER across the country. If you are experiencing 15 or more migraines per month, you likely have chronic migraine and should qualify for disability. Have you read Diana’s articles on this topic? http://migraine.com/migraine-basics/chronic-migraines-and-applying-for-social-security-disability/

  • Jessica Madore
    8 years ago

    yes I have actually, I have papers that say he wants me to be treated in the ER if my home meds fail and what he recommends, but the Dr’s don’t like to be told what to do and they tell me I should go see him when I have a bad one. However my headache specialist is 2 1/2 hours away from where I live because I have medicaid and there are no neuro/headache specs any closer to me who take medicaid. I can’t drive when my head is bad so finding someone to even get to an appointment is tough. My pain Dr will give me shots in his office if I need them but unfortunately my headaches don’t have set hours! So I am left to suffer or beg for help. Really pretty sad situation. I can’t afford out of pocket treatment because I can only manage to keep a part time job with so many migraines per month (15+). I have even had a lumbar shunt placed to see if it would help my PTC but it over-drained and then caused my belly to swell and had to be removed. It’s at a point now where my Headache Spec has said I have reached MMI but I can’t even work enough to support my family, yet don’t qualify for disability. Some days I wish I had a disease that’s more understood like cancer. I would get adequate pain management and understanding instead of treatment like I want to get high. Honestly it would be easier to get street drugs than it is to get proper treatment from a Dr. I take monthly urinalysis to show I am not using other drugs so I can keep a small supply of prescription opiates at home for the really bad headaches but when those fail I am left to suffer and even animals get mercy killings! Have we become so suspicious of drug seeking that we no longer have compassion for human suffering?! What am I supposed to do?

  • Migraine.com
    8 years ago

    Jessica – We’re curious to know if you’ve tried Tip #5 above (bringing a treatment plan from your specialist to the ER) and if so, has it helped?

  • Mary Regina
    8 years ago

    **Comment edited by moderator due to violation of forum rules** you are not thTesting me over and over again with useless catscan and mri’s for you to tell me nothing shows while I am suffering like an animal.

  • Simp Ly Gourdjus
    8 years ago

    you state in this article, “Fortunately there are so many alternative treatments for migraines. “”
    What are some of the “so many alt. treatments”? that are given at the E.R.

  • Migraine.com
    8 years ago

    Simp Ly Gourdjus – Please See Dr. Kingsley’s follow-up post which provides a list of treatment options used in the ER: http://migraine.com/blog/expert-featured-article/migraine-the-er-%E2%80%93-a-follow-up-interview/

  • Simp Ly Gourdjus
    8 years ago

    good to know. thank you!

  • Jenny Phillips
    8 years ago

    Hi guys
    I had chronic migraine for years and years and it is awful. I think the things that helped me and i would recommend anyone to try – magnesium 500 mg at night, also making sure i have some B2 (meant to help with prevention and also aborting) every day in the form of eggs, spinach, almonds. You have to be doing these things for a month to assess whether they are working. the magnesium definitely got the level of pain down for me. I do feel the site could have been kinder about your letters and your very understandable pain, anger and frustration! I think what that doc was trying to say about opiates was that they might help in the short term but in the long term they are making it all continue and be worse. his intentions good but i think he could do with a lesson in communication – starting his tips with everything the migraine sufferer does wrong. If he is like that in ER it might be creating some of the anger he sees. also talking about alternative treatments but not naming them. i hope he is reading this. even though he has had some bad experiences with some people perhaps, his approach could be improved to help himself, the very thing he is recommending.

  • Susan Long Hayden
    8 years ago

    I believe this is a great article and I appreciate the information in it. Thank you for taking the time to share with us your end of the situation. I have never really understood how to evaluate my pain on a scale of 1 to 10 but reading your article gave me a better understanding on how to analize it. When I am in the middle of a migraine attack my judgement suffers and being able to think about anything except the excruciating pain seems impossible.

    I see that you have studied alternative medicine in Cuba and wonder if you are familiar with Reiki and if you have any information on Reiki treatment being effective for migraines. I continue to search for non drugging types of preventives, or treatments. I have tried everything suggested to me for the last 20 years to help me cope with them. The best thing I have done that has cut down the frequency of my attacks is totally cutting out beef. I am not sure why this works for me, but I am grateful I discovered it.

    Again, thank you for the information you have shared.

  • Marquita Fuchs
    8 years ago

    Hi decrease carbohydrates, massage helps, I go to a chiropractor that
    was trained a technique called the blair . He has adjusted me three times in 4 years and my migraines have greatly improved from 4-6 a month at 9/10 pain scale to 1 month and a 3/10 pain scale. Co Q 10 is a proven preventative vitamin that decreases migraines.

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