Frustrations in the ER
I don’t know if it’s a good thing or a bad thing when the doctors and nurses in the ER start to recognize you. On one hand it can make it easier to get care you need but on the other hand, it means you probably go to the ER more often than you would like to admit. When my migraines turned chronic, I began to average one ER visit every 2 months.
I was lucky that my insurance company offered a small emergency department for its members that was a step above going to Urgent Care, but didn’t have all the bells and whistles of a full ER, like the ones connected to major hospitals. This allowed for more personalized care and I didn’t have to compete with patients with life-threatening issues (clearly they take priority over my migraine!).
Trial and error at the ER
The first few times in the ER were trial and error to figure out what worked best to calm my week-long migraines. With each visit, we unlocked the secrets to making each trip more productive. I learned to cap my pain level at an 8 or 9 on a scale of 10, so that I would be taken more seriously. A 10 should be reserved for those in labor, in severe accidents, or on the verge of death. I figured out the right combination of drugs, I knew what time of day was best to go to the ER, and I knew that if I called my neurologist first he would put in orders for me when I got there, making the whole process pretty smooth.
The doctor who refused to prescribe me painkiller
After a year of successful ER outings, I ran into a new doctor I’d never seen before. She made it very clear that she did not approve of my regimen of an anti-inflammatory, steroids and a painkiller. Stunned that she would vary from my secret recipe, I tried to plea my case. If she would just look into my records, she would see that this is what has helped me in the past. In fact, she could ask her colleague who I saw roaming the halls earlier- that doctor had treated me many times successfully. Surely she would vouch for me. This particular time, my neurologist hadn’t returned my calls about sending orders to the ER, so maybe paging him would help the situation. But no, this doctor was determined to treat me her way, meaning no painkillers.
Understandng the opioid predicament
I absolutely understand the fine line doctors have to walk with painkillers. More people overdose on opioids than all other narcotics combined. It is a serious problem in our country. But I was not a drug seeker. In fact, the drugs the doctor ordered, I had already given to myself at home in hopes of avoiding this trip. I needed relief that sadly comes from a good shot of Demerol. I know that painkillers don’t target the root cause of the migraine, but coupled with the other drugs it gives my brain a chance to rest after days of constant pain.
I had to endure a long speech from the ER doctor on the dangers of opioid use and rebound headaches. She mentioned that she saw in my chart that I had completed a 12-week pain management program, so she should know that I was educated about the issue. With a raging migraine, it was difficult to fight back and advocate for myself. I felt like a little kid being scolded by my mother.
Getting support from my neurologist
After 8 hours in the ER with no relief, I gave up. Clearly I was not going to get what I needed to break this migraine cycle. I called my neurologist the next day to discuss how to avoid this problem in the future. He put in a standing order for the meds I need when I go to the ER and so far it has worked. But I had to return 2 days later because the migraine still had a hold on me. My go-to concoction was used and I was on my way to recovery.
Need to remove the drug seeker label
I know that not everyone has the luxury of a small emergency department that works closely with your doctor. Trust me, I don’t love the fact that I have doctors and nurses there who know me by name. I try very hard not to abuse the system, only going after trying DHE and Toradol for days at home. Each year, about 3 million people visit the ER for head pain and I bet the majority of them are not satisfied with the care they receive. Doctors have to prioritize life-threatening patients over migraineurs. There are no tests to prove you are having a migraine, so they have to assess each situation and treat to the best of their ability. Sadly, it seems that the first label they put on us is drug seeker. There has to be a better way.
A pain scale study
A study was presented at the American Society of Health-System Pharmacists convention in 2013, suggesting that the typical pain scale of 1-10 is outdated for migraine patients. Everyone has a different pain scale, making it difficult to treat the pain appropriately. Asking a patient if they need more pain medication is more productive than asking their pain level. Some patients report a high pain score hoping the doctor will dole out pain meds. In this study, one group of patients was given pain medication as determined by the physician based on the patient’s pain level. The other group was given pain meds with a standing order to repeat after 15 minutes if the patient felt more was needed.
The patient driven method saw significantly more improvement in pain relief within 60 minutes than the physician driven method. Pain meds don’t always work immediately and having an order to repeat the dose allows for a quicker response and relief than having to wait until the doctor has time to come back and check on a patient before administering more medication. To read the full study, go here.
Hopefully, this practice will become more routine for migraine patients in the ER. Until then, the ER continues to be a place where stigma runs deep. Here are some other nuggets of info when preparing for an ER visit. What are ways you try to make your ER visit quicker and more effective?