The Good, The Bad, The Ugly- Emergency Room Visits with a Migraine-Part 2
In Part 1 of this 2-part article I looked at the Ugly Side of ER Visits for a Migraineur. Part 2 will look at The Good, and constructive ways we can get more Good visits!
The good- (and great!)
Sadly, the Good and Great ER visits for the Migraineur are often few and far between. However, a visit to the ER in June, is actually what prompted me to write this article. So, let’s talk about a GOOD and even GREAT visit to the ER for someone with a migraine. I will use my June experience as an example. I was wheeled in, sunglasses on, by my husband with a 5-day level 10 migraine. Everything at home has failed. The triage nurse checked me in and noticed quickly I had slurred speech, terrible pain, and was pretty miserable. Even with a crowded ER, I was pushed to the head of the line and within moments whisked back to an observation room. Not a make-shift room with a pull around drape with others within 2 feet of you, but an actual self-contained room! Within minutes I had an IV in, a nurse checking my vitals, and a PA talking to us. They have electronic records at the hospital where I go so they are able to see that I am have Status Migrainous and have been treated for it for years. They even bring in pads for the bed in case I should have a seizure. They begin with fluids, anti-nausea medication, morphine, and Benadryl. This sometimes works, but in the case of this cycle it does nothing. They immediately call for a neurology consult. The attending doctor was extremely attentive and asked all the right questions. The neurologist came in and had actually taken the time to review my medical records! After some discussion, and what had worked and what had not worked, he asked if we had heard of the recent studies involving Ketamine and Migraines. My husband and I were in fact, familiar with them. He asked if I would be prepared to try a Ketamine injection to the IV to see how it took. Of course, the attending would have to approve because either he or the PA would have to be present. This time Ketamine was not a drip but injected into IV line.
WHAT?!? A doctor that was thinking outside the box? A compassionate doctor? We immediately said yes! It was not long before the PA returned with the syringe of Ketamine. I do not recommend this without research and done in well knowledgeable environment. It is not a wonderful experience but the immediate relief was enough to have them allow me to be discharged and my husband poured me into the car and once home into bed.
As I woke up the next morning I slowly opened my eyes expecting more migraine pain. What I got was greater relief that I have in several years! IT was a GREAT ER visit.
So, with all of these examples… What can we do to prevent the UGLY and experience more Good visits to the ER as a Migraineur? Because the reality is that until hospitals begin to establish Migraine or infusion clinics, visits to the ER are going to happen for us!
- Electronic Records: IF you are in a system that has Electronic Records utilize that process. All my Dr’s are part of the same system and so all records are accessible.
- Get a letter from your Pain Management/Neurologist/Migraine Doctor: If you need to get a letter from your doctor stating that you have migraines and how best to treat a Migraine storm or cycle in the ER setting.
- Take an ADVOCATE with you: Friend, Family, loved one who is willing to stand up for you when talking is too much. Someone who knows you and your condition and is willing to get angry when things do not go right.
- Carry a list of your medications and a Migraine Journal
- DO NOT tell the ER docs your level is a 12 on a scale of 1-10… Although you want to, they will think you are over exaggerating the pain.
- Do NOT be afraid to ask for a neurology consult! They are better educated on migraines and latest treatments.
- I have even been told to pack a Migraine bag for the ER, with snacks, and earplugs, sunglasses, etc.
What works for one person with a migraine may not work for another, yet ER’s often use a standard procedure for treating all migraines. EVERYONE is different! You know your body and migraines better than anyone else! It is ok to question things and not give up and just live with the pain.
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