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Migraine Treatment in the ER

Migraine Treatment in the ER

Going to an emergency room with migraine is a nightmare. It’s loud, bright, smelly and chaotic. Health care providers may suspect that you’re not really in pain, but are looking for opioids (narcotics). The treatments aren’t any better than what could be given in any doctor’s office (as long as your doctor offers them and can see you in a timely manner). Yet, migraine accounts for more than 800,000 emergency room visits in the U.S. each year. A study published late last year examined why.

Are you thinking, “They didn’t have to do a study for that; I go to the ER because I’m in pain and I have no other way to stop it”? That’s pretty much what the researchers found: patients consider such severe pain to be an emergency and can’t get the necessary treatment elsewhere, but there were some other interesting findings and points of discussion.

Researchers asked 100 questions of 186 patients who met the diagnostic criteria for migraine. These questions assessed demographics, economic status, migraine/headache history, and the severity of the attack that took them to the hospital. The most common reason for going to the emergency room was that patients perceived the migraine/headache to be an emergency or were referred by their doctor. That accounted for 33% of the patients’ ER visits. Other reasons included that the patient’s doctor’s office was closed (20%), they were unable to get an appointment with their regular doctor soon enough (11%), and they had no doctor and didn’t know where else to get help (9%).

Patients who had an attack of similar severity in the past and/or had previously been diagnosed with migraine were just as likely to go to the ER because they thought it was an emergency or their doctors had told them to go as those who hadn’t been diagnosed prior to the visit. This was of particular interest to researchers because, presumably, patients who had been diagnosed with migraine know that it is not a life-threatening emergency.

Patients go to the ER for many reasons: severe pain that doesn’t relent with any treatments you have at home, vomiting so frequent that dehydration becomes a risk, not being able to get on their doctor’s schedule, a lack of insurance or an established relationship with a doctor, a frightening change in their migraine frequency or severity. This study identified many of the reasons other than fear that people go to the emergency room for migraine. It does not say that patients should never go to the ER for migraine, but that many in this study did because they thought it was an emergency. Because of this, one major point of discussion was the disconnect between doctors telling patients that migraine wasn’t an emergency and people still going to the ER because it seemed like it had to be. That last part is what caught my eye because I think it highlights and interesting disconnect between patients and doctors.

Even if we have a diagnosis and our doctors have told an attack is not an emergency, both those things can be hard to believe. Attacks feel so violent that it seems impossible that they could be caused by something most of us are told is just a headache. How could something so painful and disabling not be life-threatening or at least very, very serious? Since there’s no way to see migraine, no test to prove a person has it, we have to go on our doctor’s word that, based on our symptoms and family history, our lives aren’t in danger. We have to believe this even though the symptoms of an attack feel just like the body is screaming, “Danger! Danger! Get help now!” If a doctor doesn’t recommend an MRI or CT scan, many patients remain convinced that their doctors are missing a brain tumor or aneurysm. Even with brain imaging, we still worry our doctors are missing something.

Society tells us that either headaches are not big deal and can be relieved with OTC painkillers or that they are a sign that we’re about to die from brain tumor or aneurysm. Common beliefs about headache don’t allow for severe, recurrent pain that isn’t life-threatening. And because headaches aren’t thought to be a big deal, many of us don’t mention them to a doctor until we’re scared they’re a sign of something serious. Most of us don’t get a migraine diagnosis until we’re already freaked out—and it’s hard to be reassured by words from a doctor when what’s happening in our bodies feels so wrong and frightening.

On the surface, the problem seems like one of patient education—that if doctors educated their patients about migraine, then patients would understand they don’t need to go to the ER for an attack. That is probably true for some of us, but I think the problems are deeper than that. Public perception plays a large role. If there were widespread knowledge about what migraine is like, not everyone would automatically assume an excruciating headache equals a brain tumor or aneurysm. It’s also a problem of meager funding for migraine research. If scientists understood exactly what was happening in the body with migraine or why, there’s a chance a test could be developed to identity those things in the body. And, of course, there’s fear. Even with education and public knowledge and tests, it will probably take most patients a while to believe that something that feels as awful and abnormal as a migraine attack is not an emergency.

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.

Minen, M. T., Loder, E., & Friedman, B. (2014). Factors Associated With Emergency Department Visits for Migraine: An Observational Study. Headache: The Journal of Head and Face Pain, 54 (10), 1611-1618.

Comments

  • tlocker
    3 years ago

    Nightmare doc. didn’t introduce himself, first sentence, “I don’t give narcotics for headaches”. I got up to leave. Dear Husband waving neurologists lettter for protocol STILL didn’t get quality service. This was Day 4 of a 6 day level 7-9 migraine. Really? I am calming down, almost ready to call their Patient Advocate number…but can’t find it!

  • RobertCan
    4 years ago

    I understand that for some, a migraine does not fit the definition of an emergency. I only head to the ER when pain levels reach a 9 or 10, and I’ve exhausted all my prescribed pain management techniques. Am I a drug seeker? Absolutely, and I make no apology for it. I’m experiencing incredibly high levels of pain. I’m puking my guts out. I’m dizzy and not sure I can last another minute without blowing my brains out. ER’s provide the relief I need to regain control of the pain.

    The last time I went to major chain Urgent Care, they told me that ER was the best place for me to receive the treatment I needed to regain control. That Urgent Care isn’t equipped to treat major migraine. ER is the only source for the ‘migraine cocktail’ of medications I need to regain control.

    My insurance company is discouraging ER visits by limiting total visits to three in twelve months. Anything more than three is not covered by insurance. Talk about stressful. My neuro recently provided me with my own migraine cocktail that I can deploy when my migraine reaches ER levels. Granted, I can’t run IV’s in the home but I can use Dilauded tablets along with other medications to simulate what I receive in the ER. The challenge will be to keep from throwing up the drugs long enough for them to be effective.

    My closest ER has an automated registration system. It scans your drivers license and then asks one question: What is your reason for this ER visit? There are only four answers you can select and “Headache” is one of those four. This tells me that ER’s must see a ton of folks seeking treatment for migraine.

    We all understand that ER is the most expensive form of treatment, but we are left with no alternatives. Give patients an effective, less costly alternative and we’ll use it. Simple as that.

  • Chronic migraineur
    5 years ago

    I found this article offensive as well. It sounds as though the author is saying that there is never a reason to go to the ER with a migraine. I cannot count the times that I have been to the ER with a migraine. Generally, I only go when my pain level is at a 9 or 10….completely unbearable. I have been lucky enough (for the most part) to have found caring doctors who do not assume that I am drug seeking, and will provide as many doses of Dilauded that are needed to strike out the pain. I can’t believe that someone would actually say that there is never a reason to go to the ER with a migraine. Perhaps she’s never had one before???

  • JaredCE
    5 years ago

    I was in two different ER’s in the safe week for migraine. Neither shrugged me off about it. The first ER had given me an Imatrex injection and held me for an hour. This happen at 3a.m. While I was out of town. That following weekend I found myself in my hometown ER with migraine again. This time they put me on IV fluids and gave me IV nausea meds. This seemed less affective but I guess kinda helped.

  • Jkr
    5 years ago

    I know this one all too well. I have a note from my neuro and I find that it really depends on the dr. It’s a crapshoot which just sucks. I have letters from pain mgmt Drs that are addiction specialists that state I have migraines and I’m not an addict and still depending on the dr they insist “there is a problem”. The problem is my migraine and all I want is for it to go away. At home I take imitrex injections but when they get really bad I have to go to urgent care or the Er. It’s very frustrating and an on going issue.

  • Diane
    5 years ago

    Many ERs will now refuse to treat anyone suffering from chronic pain of any kind. If it’s chronic it’s not an emergency by their standards. I have gone to the ER with a 10+ migraine a couple of times in the last few years and have been refused treatment and sent home both times.

  • mmjardel
    5 years ago

    I’m not going to rehash what everyone else is saying. It’s true a person can die from status migraines- which I’ve had for 3.5 years. When I had my first hemeplegic you better believe I was in the back of a helicopter on my way to the nearest hospital (2 hours away by car) I was blind which is my usual aura and couldn’t move the right side of my body and couldn’t speak without a severe slurred stutter. My husband was FREAKED. Looked just like a stroke. I believed then and still believe now I belonged in that helo. Same story when I had my first cluster.

  • Bev Todaro
    5 years ago

    Himmjardel. I also have he me pelagic migraines. As you see my phone will not spell that word.I’ve had them for over 20 years now. I get affected on my left side .We have been everywhere trying to find someone that could help us stop them.The frequency has changed to 1 or 2 a week, To us that’s a great improvement. We used run the ER all time. They had no idea what was wrong with me.They all just thought I was a nut looking for drugs. Well I hope you feel better. Mine is getting worse right now. It’s just nice knowing there are other people out there with same thing you That’s why I like Migraine. Com Hope to talk to you again.

  • Teresa
    5 years ago

    I too was offended when I read this article. But, I did see Kerrie’s post further down where she apologized for not making her meaning clear. (Thanks Kerrie. Apology accepted.) I have just been told by my neurologist that he is out of ideas to help me. I have tried so may different treatments, but none have been very successful. He has sent me to a pain mgmt.specialist to get a nerve block at the base of my skull for the pain in the back of my head, and gave me a prescription for the Cefaly device to treat the rest of the pain. I have not actually had either of these yet, but I am keeping my fingers crossed. So, back on topic, I have had to go the ER several times in my life, and have had to argue with doctors more than once about why I needed to be there. I had one doctor tell me it was just a sinus headache because my nose was stuffy. I just about got kicked out for screaming at him that my nose was stuffy because of the fact that I was crying from pain. The last time I went to the ER though, will probably be my last. I moved to a small town just over a year ago, and they have a privately owned hospital here. The doctors are independent contractors, and are pretty much allowed to do what they deem appropriate, and each doctor has their own ideas. I went in for a migraine that had lasted for 4 days, and I had used all of my Imitrex injections, along with several Imitrex tabs, and several pain pills. The ER wasn’t real busy, so I was put in a room pretty fast. The nurse was very thoughtful, and even turned off the light for me when she left. Then the doctor came in. He flipped on the light as soon as he opened the door without any warning, then proceeded to tell me that a headache was not an emergency, and that he could not even continue to talk to me until I paid the $300 fee. I got up and told him I was leaving. Then on the way home, I had to hang out of the window of the car because I could not stop throwing up long enough for the 15 minute trip home. I only wish that I could have thrown up sooner, so I could have done it on the doctors shoes.

  • HTR
    5 years ago

    This article is beyond offensive; it has the potential to influence people to not get the medical attention they need. Unrelenting pain and the desire for some quality of life are good reasons to seek emergency medical attention. Something doesn’t have to be life threatening to merit a trip to the ER. I cannot believe that a forum for migraine education would basically say that migraineurs only go to the ER because of a lack of understanding of their disease and poor communication between Drs and patients.

    As a migraineur who had 2 strokes, I can tell the difference between a life-threatening situation and a migraine. I go to the ER even in non-life-threatening situations to get relief from the debilitating pain, uncontrollable vommitting, photophobia, etc. And, I AM RIGHT to do so. You should be ashamed of making people feel wrong when they need help so they don’t suffer for 4-72hrs, curled up in the fetal position in a dark room, in excruciating pain.

  • Ruth Swain
    5 years ago

    I’ve gone to the ER with migraine several times over the years. Reasons? I ran out of money to buy my triptans, I’m out and simply cannot afford the refill or somehow I’ve managed to be out of refills and it’s a weekend. I’ve used 3 or 4 triptans in under 24 hours which can cause serotonin syndrome, and still am in horrible pain. The ER treats me well. They know I am not a narcotic seeker, I have a well documented history of migraine. I cannot tolerate noise or light when I am in there, and am usually crying and hanging on to my husband. They do not make me wait long..They start an IV. Give me anti nausea (usually zofran), some narcotic, and turn out the lights and speak softly around me. Not one nurse or doc has ever questioned the reason I sought ER care. I tell them the truth. I have been to both hospitals in the small city I live, with the same results. Severe unrelenting pain, when you are out of oral options at home, is certainly a reason to go to the ER. I am a RN. I wouldn’t even blink twice at a bad migraine coming thru the door. Now if she/he comes in every week, that might be different, She/he needs to find a neuologist for this condition, and I would expect a nurse to talk to me about finding appropriate care and have meds at home, but a couple of times a year, it’s never been a problem. I’ve run out of options, tell them that, and IV drugs and IV fluids are the only thing Ieft for me, except unrelenting agony and thoughts of suicide.

  • RailroadSpike
    5 years ago

    Dear Kerrie,
    I appreciate that you’re trying to give us perspective from a different source. It’s true there’s a communication problem, but in my experience the doctors are primarily at fault.

    First, I think many understand that Rule one is Do No Harm. Second, if any doctor has EVER been taught that their one and only job is to keep a patient alive, then we have to give start giving guest lectures at med schools.

    If you come in with a smashed foot, do you really think a doctor should examine it, put a cast on it and wave a cheery wave when they leave?? They have a DUTY to relieve pain, whether they can see it or not; whether they think oh, it’s just another migraineur, or arthritis patient, or bowel disease and BECAUSE I CAN’T CURE IT, these people have to just “learn to live with it?”
    And we can mention those little, serious, life-threatening results of chronic pain: suicide (we’ve all got our plans), high blood pressure, chronic adrenaline, stroke, heart attack, panic, anxiety, insomnia, dehydration, esophagus deterioration (heck, throwing up 6 or 8 or more times a day. Depresion, irritability, and MUCH, MUCH more important: Quality of Life. What did we do to deserve to have to confront an irate boss because you missed a meeting? The days my husband would have to take off to take me to the hospital. And bring our kids at midnight, in their PJs him trying to keep them busy coloring, or taking a drive to get an ice cream. It was sometimes 6 hours. I cry and grind my teeth. So dreadfully inhumane! And then we’d all have to et up and go to work and school.

    I want to know why migraine, almost alone of medical conditions, gets no respect. I have had to argue with doctors because they are so uniformed. Sometimes it’ll be like a game — “ketorolac does nothing for me”, Well, humor me.” I can’t stand it anymore. I can simply appease them, or I pull the IV out of my arm and walk out. Sometimes, I just don’t even listen, because they don’t have any interest. They have made their judgment, and take (which they make perfectly clear) bets about how long they can string me along.
    I have had migraines that made me beat my head against a wall; I have been 5 seconds away from running off a bridge after being refused at the Urgent care and going oward the ER which is even worse. More than once I’ve thought that I would literally be grateful to put my arm in a blast furnace, in exchange for my mraine pain.

    This has got to stop. I understand that narcotics can make one physically tolerant, but it’s foolish to believe two injections two months apart will do that. And finally, doctors have a responsibility to help you live your life in as healthy way as possible, and that includes relieving pain. Can they even imagine raising 5 kids with such a grave disability? We will all find out pretty soon what kind of job I did parenting them.
    If it’s not good, then I humbly ask society’s forgiveness; I should have committed suicide when they were much younger. And of course I can never make it up to them. I tried everything, and I did the best that I could within this system.

  • Natasha
    5 years ago

    This article upset me in so many ways, I am not even sure I have the ability to address everything because I am currently in so much severe pain and it only made it worse to read this. I often read articles on here to get new HELPFUL information, or new ideas on what I can do to help my disease in any way. I have had migraines since I was 4 years old, I am now 28 years old and have had constant, never ending migraines for 10+ years (yes, not a single day of relief), and I have tried EVERYTHING besides surgery and implants (I will not list it all here, but I think people on here should know what that would mean, both prescriptions and more natural treatments). I was also recently hospitalized yet again for DHE infusion which did not help at all (I had to go through the ER to get admitted and they would only admit me by having my neurologist come there and order it because they did not believe my pain. I was in the ER the week before trying to be admitted for DHE treatment and because my doctor wasn’t available to tell them to admit me, they refused to let me even speak to a doctor there and kicked me out, literally). I have had to quit my job, move in with my mom, and go on disability now. I can’t even care for myself anymore, drive at all, leave my house except for doctors appts, do laundry on my own, etc. (just some background to explain that people do exist out there that have this disease VERY seriously and don’t have many options left).

    Why would I ever go to the ER or Urgent Care? Because the pain gets so severe for so many days in a row (I have constant migraine pain, but when it goes on at a level 9-10 for multiple days and I am puking, collapsed on the floor, not eating, not drinking water, not sleeping, then I do break down and go to the ER or Urgent Care). I do not appreciate being told that migraines are not life-threatening or serious enough to warrant needing immediate help, there are actually many things that can be happening when the pain gets that severe (even long term problems from being in that sort of sever pain constantly for decades), I know people who found out it was actually a stroke (or other serious new thing they never experienced) they were having but would not have known unless they went to the ER. Also, when pain is 24/7 at daily levels of 6-8 usually (often higher for periods and fluctuating), suicide is constantly on my mind (no I do not need a therapist, I need even just a little pain relief and support because I would never have these thoughts if I didn’t have severe pain). As I mentioned, not a single drug has ever helped me, and the only thing that knocks my pain level down a little (from a level 9-10 to a 7-8) is an IV of Reglan, Zofran, Benedryl, Dilaudid, and sometimes steroids, I have even tried Ketamine which did nothing. The pill forms of all of these do not work, neither do suppositories or injecting Phenergan in myself at home, like I said, I have tried it all.

    Other people who are not at the ER for a migraine, are often also there for things that are not life-threatening by the way. I have seen people with sprained ankles, a broken pinkie finger, other pains that are “invisible” (a guy was in last time I was there saying his pain killers weren’t enough at home for back pain, they asked if he had nerve damage or what the disease/condition was, he just said he threw it out at work. Guess what they did? They took him back to be helped before me even though I had been there at least an hour before he came in!!! I even have severe back pain due to scoliosis, but I don’t complain about that because migraines are a million times worse). So why are migraines ignored? Why am I forced to suffer just because there are drug seekers that come in and lie and say they have migraines? That is not my problem, that is their problem. I have to have my mom bring me in and they still think I am lying about the pain, don’t even care that sometimes she has to speak for me because I have trouble with speaking when in that much pain and the wrong words come out or I just break down crying trying to explain myself…

    Also, I do not have any other choices, none of my doctors have any options in their offices for me and my severe level 10 pain. I have gone through soooo many doctors telling me they can no longer help me because I have tried everything there is.

    Maybe this article was meant for someone who only gets a migraine twice a month and just freaks out and can’t handle a little pain for a day, but for anyone who has severe 24/7 pain ALL THE TIME sometimes needs some relief, even just a little so the crying, breathing issues from panic attacks (caused by severe pain and also not helped by any of the BS anxiety meds), and those suicidal thoughts will go away. I feel like it is very dismissive, belittling, and offensive to say that patients need to be educated that migraines are not serious enough for an ER visit, that is absolutely making migraine disease sound like it is “just a headache” which is the stigma I thought this website was trying to change.

    I have been dismissed by many doctors about other pains I have complained about. In November 2014, I had a severe pain in my stomach (I had similar pains but not quite as severe for a long time a few months before and was told it was just from either my migraine or the medications I was on and not to worry, so I ignored it), so I did the same this time and ignored it for about 48 hours until I got up in the middle of the night (it was so severe I couldn’t sleep even an hour) and just started puking uncontrollably for 2 hours straight. I barely had time in between puking up bile to yell to my mom that I needed to go to the hospital. When we finally got there and I was seen, I had a CT scan (I think that was the one) and found out I had appendicitis and needed surgery immediately. The surgeon came in to talk to me and asked why I waited so long to come in, it had almost burst, and would have if I waited another day. I said I am always told to just push through all my pains and always dismissed when talking to my doctors, so I thought it was the same thing. I could have died or caused some very serious issues if I didn’t go in when I did. My point is that you never know if something more could actually be happening when it gets to that really severe, collapsed on the floor type of pain, so why wouldn’t you seek help???

    Sorry for the long rambling, believe it or not, I edited out a lot. I just wanted to make the point that we should not be made to feel like bad/ignorant people to seek help for severe pain that is not being helped by at-home medications (especially those who live with this pain literally constantly). I hope I don’t come across any other posts that hurt me this much again. I would never go in for minor migraine pain (a “normal” migraine) obviously if that was your point, but it sounded like all migraine pain is not serious according to you, and that is just not true. I need to stop now and rest (yes I shouldn’t be on a computer while in this severe pain, but because it is constant, unfortunately that is not realistic to just never do anything at all)… Thanks for reading…

  • ahnonnymust
    4 years ago

    As another 24/7 severe migraineur, I can only applaud your comments Natasha and add my own “amen!”

    I’ve yet to go to the ER because the thought of getting there and being in the car for nearly half an hour seems worse than staying where I am and suffering through it. Thankfully I do have a few meds that will usually knock me out for quite a while so I can at least sleep through part of it. I have gone to the Urgent Care a good number of times, or my PCP for a toredol/phenergan injection when they could get me in.

    I can’t imagine having a severe migraine for the first time and not going to the ER. If my first migraine had been like my daily migraines, I’d have thought I was dying. I would imagine it to be really scary to the unsuspecting person. Or even to someone who’d only had a “normal” migraine before. Not much can prepare you for the kind of pain that a disabling, all out, full blown migraine can throw at you. I’ve had six natural, drug free child births. I’d rather have a baby any day of the week than have a migraine.

    So even if this article was meant more for people who are having their first migraine, or are new to the world of migraines, the ER might be the best place for them depending on their pain level, their emotional level and their support level. Most of us are “lucky” enough to understand what is happening to us and we still end up in the ER or Urgent Care sometimes. Think of those poor souls who are newly diagnosed and scared and just feel like their head is going to explode at any second. They probably don’t have the benefit of the rescue meds, the MRI results, the neurologist or headache specialist to have explained it all and laid out a plan of attack. When their imitrex doesn’t work, they’re lost. Which goes back to lack of patient education and preparation. But doctors don’t typically hand out those kinds of rescue medications until a person becomes worse than an episodic migraineur.

    We have so far to go before migraines are understood or treated properly. It’s frustrating, especially when you live with one every day. Until then, unfortunately, the ER is just another tool in our arsenal when nothing else works or we need extra help. I do think we can all pretty much agree, however, it’s usually our last resort.

  • Christine S.
    4 years ago

    Thank you for that, Natasha. I have only been chronic for 9 months but have had chronic pain for years and was told to quit whining, take some Advil and get back to work. 2 weeks after my migraine diagnosis came fibromyalgia, which explained A LOT, was actually a relief to hear. I sobbed with relief and a feeling of vindication as I waited for the p.a. to come back in with the injections for my first nerve block. Thank you for taking the time and making the effort to post your thoughts. Your experience and opinions matter, especially to those of us who are still new to things.

  • HTR
    5 years ago

    Natash, I feel you pain… literally. I have had migraine since I was 8 (I am 40 now), have had intractable migraine since 2009 (never getting below a 6 on the pain scale, usually around an 8 or 9), am on full disability, can’t care for myself or my home, can’t perform any “basic life functions” without help, can no longer drive, etc.

    Ruth, while I know and appreciate that you are trying to be helpful, there is NOT a way to help everyone with this disease. Yes, no one should have to suffer like this, but many people who have educated themselves on their disease and looked for different treatments do suffer and are untreatable. That is what is so frustrating about this disease. I have been to the best Migraine specific clinics in the US – Chicago, Philadelphia, Dallas, Cleveland, Univ of Michigan, Univ of Pennsylvani, just to name a few. The belief that you just need to try harder to find a solution is part of the problem migraineurs face. Would you tell me I needed to better educate myself & there had to be a solution if I just looked harder if I told you I had MS, Lupus or an inoperable brain tumor?

  • Ruth Swain
    5 years ago

    Have you ever been to a major medical center’s headache clinic? Boston or where ever you research one on the web or get a referral from a neurologist? You are the type of patient that needs this. NO ONE should have to suffer like you, and if you are persistant, educate yourself as much as possible, try not to get angry at the doctors, (egos, my friend) I believe you will find help. I wish you luck in this persuit and love. There are great head pain doctors in this country. You need to find one. Migraine is more and more researched, more common than ever before in history, and there are major medical centers, Tampa, Yale, Cleveland Clinic, Chicago, they pepper the web when you type in “major medical centers with headache clinics in the USA.” Go. do it. find one. get help. it’s there somewhere.

  • Staceymae
    5 years ago

    Has anyone had sucess with the Cefelay device? I wanted so bad for it to work for me, but I found it painful and I had major nerve twiching of hands and feet with it. Another $300 down the drain

  • onehsancare
    5 years ago

    I have had some moderate success with the Cefaly. Since I began using it almost a year ago, my migraines have been reduced in frequency and severity.

    That being said, I was in the ER last Wednesday night with a level 8. Go figure.

  • Staceymae
    5 years ago

    The ER, I agree, is no place for a migraine. My last visit, I was treated poorly, the IV medication given to me was ineffective, but I was eventually given 2 percocets on the way out the door that did offer some relief. Early on, migraines can feel like “you’re dying” I totally get That! Nowadays, I have an arsenal of meds at home including Lidacane that I squirt up my nose, Zofran, Reglan, & opiates. I also have the option to walk in my Dr. Office or Urgent Care for a shot of Toroidal which I have found effective at times. Having a plan is half the battle. I recently had a clear MRI, so I worry less when my face and arms get numb before and during a migraine. Knowing I am “not dying” really has helped!
    I really want to try Theraspecs because I have horrible light sensitivity. That’s my next move.
    Stacey Mae

  • Ruth Swain
    5 years ago

    Theraspecs have helped me watch TV, and use the computer more. I love them. If I didn’t need RX glasses and would have to wear them over my regular specs, I may still be working in a hospital with those horrible lights. I DO wear them over my regular glasses at home, and look a bit silly, but who cares. They HELP a lot with light sensitivity. I bought mine on Amazon. not cheap, but SO worth it.

  • MarleyM
    5 years ago

    Like many others here, I’m a chronic migraineur, and I avoid the ER if I can. But if I’m on day 5 of the same migraine, and have maxed out my triptans, I make myself go in. My neurologist can do the ‘chronic’ cocktail in office — mag sulfate and solumedrol — but not my ‘status migraine’ cocktail of toradol, reglan, bendryl, & Depakote. So it’s not that I think of my migraines as an ’emergency,’ but rather that the ER is the only place I can go to get the meds I need to break a status migraine.

    I imagine that if I was an episodic migraineur, I’d probably freak out more when my head turned homicidal…

  • celiadion-doucette
    5 years ago

    I’ve been to the ER several times for migraine attacks–either they are so severe and none of my meds work, or I’m vomiting so much that I become dehydrated. Fortunately, I work at the hospital that I frequent and have never been treated with anything but the utmost respect– and no one has ever told me that a migraine is not an emergency. Only the sufferers know how much pain a migraine can cause, and when you’re in that much pain, or are having stroke-like symptoms, the ER is definitely the place to be.

  • Michelle Rudder
    5 years ago

    To me this article puts it in perspective. Migraine is not just migraine. They can be life-threatening.

    http://www.healthcentral.com/migraine/understanding-migraine-271804-5.html

  • Kimberly
    5 years ago

    The ER department in my area has been a nightmare for me as well. They don’t follow my family doctors orders. They actually tell me if I want to have his treatments I need to go to the clinic between 8am and 5pm to get that treatment. When I go there, they treat me as they see fit. I have a lot of medication allergies and all they want to do for me is give me IV fluids and antinausea. I get nothing for the pain. That’s because I usually use my at home treatments and they just don’t work. I sometimes need a narcartic and steroid injection to break the cycle. I really think they see it as a regular headache or something…even if my blood pressure is elevated. I have learned that I just don’t go to the ER anymore and suffer with the pain. I will not have my integrity questioned as a person anymore. I am not a druggie…I simply want pain relief. I have heard the whole song and dance of re-bound headaches and fully understand the affects. But when you are just in that much pain you want anything to relief it. I wish sometimes these doctors would experience just one of these mind blowing migraines so they would just understand the pain we go through.

  • Michelle Rudder
    5 years ago

    I go to the ER when many days have passed, nothing is working and it is getting worse. I have gone to the ER and have been hospitalised on at least three occasions in the last five years because of migraine. When my home cocktail does not work after three days and the pain is bad, I go to the ER for relief. They give me the ‘Michael Jackson’ cocktail (we call it) which contains Demerol. If that does not work after 3 days (i.e. I go back at least three times because the migraine still returned with significant intensity), they hospitalise me until they break the pain cycle, and do CT Scans/ MRI just in case it is not just migraine. To me, that is a smart thing to do. It has nothing to do with fear. It is for relief, and for precaution.

  • Michelle Rudder
    5 years ago

    The reality as well, is that people have died from status migranosis stroke.

  • Steve Lloyd
    5 years ago

    Fortunately I have not had to go to the ER for severe migraine attacks for about 7 years. In my 30’s& 40’s it was almost a monthly event after 2 Imitrex injections had no effect on the intense pain. This always seemed to be @ 2am when my PCP was closed. I generally had good care once I got to see the dr, but when the wait was long with kids screaming & the TV blaring, I thought a gun would be more merciful. Once while waiting in the exam area the fire alarm went off with the accompanying strobes & sirens & the dr rushed in with a Toradol injection & quickly sent me on my way. I could have hugged him. I am now down to a manageable 1 attack or so a week & loving retirement!

  • Soteria
    5 years ago

    I, too, have gone to the ER during a particularly bad attack. Certain attacks bring on 12-36 hours of continuous vomiting and I can become dangerouly dehydrated. I learned the first time that you have to be really proactive in the ER because after 2-day vomiting episode, I was told I “had a virus” and was sent home with my blood sodium still dangerously low. Went back the next day and ended up being admitted for 4 days because the sodium level had become “life-threatening” (thanks, guys.) Chose a different hospital for the next one and thankfully, was treated by a dr who was also a migraine sufferer. ER personnel who have no exposure to migraineurs tend to throw the ‘virus’ word around a lot, or they think you’re just looking for opiods. (Which don’t work for me at all anyway). There is so much ignorance surrounding migraines, even among medical professionals.

  • Susan
    5 years ago

    I have had to go to ER when my migraines become “intractable” (lasting 4 or more days) or on advice of neurologist because he can’t see me or on a weekend. I have had the gamut of Drs who really care to the 2 who called me a drug addict. It is extremely frustrating! If I was a drug addict, would I really go to such a public place and pay them $228 for 1mg of Dilaudid and .5mg of phenergan??? I think ER Drs need to be further educated on what migraines are really like, and that most of us don’t go unless it’s the last thing we can possibly do for relief.

  • Silergrace
    5 years ago

    I have had to go to the ER previously. I knew that it was not life-threatening but the pain was unbearable. Sure, I didn’t want to suffer through the “ER shuffle” but I needed relief. Unfortunately, rescue meds nor Toradol do not work for me. A cocktail shot of Demoral, Phenagren & Benadryl usually does the trick for me but my PCP won’t give it me. I see my neurologist in May to discuss a new plan of action. It’s hard to explain to people how intense the pain can be on the inside when they can’t see it on any “test”.

  • GaRN1973
    5 years ago

    As an RN and as someone who has dealt with chronic migraine for 30 years, I have to say, that sometimes the pain itself is enough to warrent emergency treatment. Pain is one of the 6 vital signs, and effects both your physiological and emotional responses. So, sometimes, “a migraine “, is an emergency.

  • allinmyhead
    5 years ago

    Ì have been to the ER countless times. However, 6 months ago, I went in with a UTI. The Dr.in the ER took one look at my chart, and decided that my kidney pain was non exsistant,, and that I was having a bad reaction to my current antibiotic. Several weeks later, I found out I had kidney stones.
    When I was laying in the ER, my mother kept asking the Dr. “what about all the pain she is in?” The doctor said he would not give me anything, and that I would be fine when my new antibiotic kicked in. I wasn’t, and was in pain continually until I saw uriologist. If he had done a CT scan, he would have seen the stones, but since he decided I was drug seeking, he dismissed my symptoms. The ER doctor then proceded to snd me a $1300 bill, for writing me a prescription for antibiotics.
    Ìwill have to be bleeding from my eyeballs before I go back to the ER. What happens when the ER does not treat another serious medical issue, because you have miagraines? Most of the times I have gone I have been sent there by my primary care doctor. I have been to every “expert” in my area, and have been told there is nothing left they can do. I have had botox and every other treatment you can think of.
    I am going to yet another headache center in April, but I have little faith. Doctors should “do no harm” isn’t not treating someone in pain harmful?

  • Kimberly
    5 years ago

    I too get kidney stones…actually on a regular basis. That riddled with migraines have labeled me as bit of a drug seeker. It is sooo frustrating. I have many drug allergies and many of the regular migraine medications don’t work. I too did Botox for three years with little difference in frequency and I purchased a $300.00 new migraine device called Celafy. I do essential oils, himalynian salts, massage and acupuncture. I will do anything to get rid of these terrible migraines. I even had a hysterectomy. I am so beyond frustration and am totally depressed. My family pysician is understanding and does try to help as much as possible. But, he isn’t always available and when I see other doctors and the read my file they look at me as someone coming in for a narcotic. Believe me I think I could street drugs much more cheaper than what they charge. I don’t like getting those shots…I just can’t take the pain anymore. And, no I have never done drugs.. And I don’t even drink. I am constantly trying to detox my system to get these medications out of my body to feel normal and healthy!

  • Christy
    5 years ago

    Hi! I’m very sorry to hear that you developed a kidney stone. By any chance, have you taken Topamax as a migraine preventive? I was on it for several years and developed a kidney stone as a result. Topamax is a commonly prescribed migraine preventive that works well for a lot of people, but kidney stones are one of the common side effects. Unfortunately, many doctors and nurse practitioners do not tell patients this until they’ve already developed a kidney stone. When I told my nurse practitioner that I’d developed a kidney stone, she immediately weaned me off of it completely. If you’ve taken Topamax in the past or are currently taking it, I’d definitely suggest discussing the Topamax-kidney stone connection with your health care providers.

    Take care,

    CKiddo1

  • chienjouet
    5 years ago

    I can’t believe that, to me, the most obvious reason that one goes to the ER with migraine, is that the medication kind or amount, is not sufficient to relieve the level 10 pain or nausea that is being experienced is being relieved by the amount of meds approved by the insurance company of the patient. I take Zomig for aborting the migraine and phenergan for the nausea, which normally works to make the event tolerable. My doctor has to fight, every month to get my insurance company to approve the amount of zomig per month I need. If I ran out of either of those two meds, I’d go to the ER to get relief. The ER is the last place an Migraine sufferer wants to go as the environment is brutal.

  • Kerrie Smyres moderator author
    5 years ago

    That’s a great point. I should have addressed it in the article. Triptan limits are definitely an issue for people with frequent migraine attacks, but I don’t think that was the case for most people in the study. Only 6% of all the patients in the study had taken a triptan the day they went to the ER. Only three people (not 3%) had taken opioids and eight had taken Fioricet. That drug usage is so minimal that it seems impossible to me that many of the people were at the ER because of triptan limits. The study didn’t look at how many people had frequent or chronic migraine, but we are in the minority in the population. Given that half the people hadn’t even been diagnosed with migraine before the ER visit, I expect even less were represented in this study than in the typical population.

    In retrospect, this wasn’t the best article for me to write about for Migraine.com. Many readers have frequent or chronic migraine, but most people have episodic migraine and most people who use the ER have episodic migraine. As I was writing, I was actually thinking about people who were relatively new to a migraine diagnosis, not seasoned veterans like too many of us are.

    Thanks for your comments.

    Take care,
    Kerrie

  • Tammy Rome
    5 years ago

    The only time I have ever gone to the ER because I have feared the problem might be life-threatening was when I first started getting cluster headache attacks.

    All the other times I have gone at the recommendation of my doctor. This advice was a result of physician bias that only the ER was equipped to administer the necessary medication to stop a relentless attack.

    Once I finally started seeing a true headache specialist, I made a point to ask if there were any rescue treatments I could use at home instead of the ER. That was when my doctor prescribed Toradol injections. They have been my saving grace. It has now been 19 months since I have been to the ER.

    The bigger problem is one of access to urgent care and/or infusion centers. If more patients had access to after-hours non-emergency care, then I think we’d see fewer ER visits. Until then, we are left with either the ER or convincing a doctor to admit us to the hospital for treatment.

  • Tammy Rome
    5 years ago

    I have been fortunate to not need Toradol for several months thanks to a new treatment protocol (Elavil and Botox). I do have 2 vials that are not part of the recall if I need them. I’ll be in trouble if I need it more than twice before March. As long as the Botox doesn’t wear off early I should be in good shape. 🙂

  • Sara
    5 years ago

    Ugh I am suffering from the toradol recall as well. I am lucky though that my Headache specialist Uses a home healthcare network for infusions. I like it so much better than the hospital , although I do sometimes go to the ER if I cannot get my nausea and vomiting under control at home. I was recently prescribed phenergan injection for home – hopefully that will help.

  • 2MuchPain
    5 years ago

    Where are you getting your Toradol ? Having the home injections have stopped my consistent visits to the ER but all of the medication was recalled a couple weeks ago. I was told it won’t be available till late March.

  • Sandy
    5 years ago

    Tammy you are so right re: dr’s refer and access to uregentcare and infusion centers. First, my primary care dr (PCP) is currently treating me more than others. No other Dr is willing to see me when a migraine won’t go away. My PCP does the best he can, but he is out of answers with me (and doesn’t mind admitting it). Neurologists here want to focus on “managing my triggers” or only want to see me for botox. And when I asked about do not acute problems I have told me, “do want you have been doing” which is take both acute and rescue meds. If that doesn’t work, go for shots at my PCP, urgent care, or ER.That is why I asked my PCP if it is time to see a HA specialist (closest 10 hrs away). Appt next week. We have no infusion centers here. By now I know I have MOH, but it didn’t start out this way. but until I get medical support, this is the way it is. Urgentcare refused to see me (bc I got a shot previously at dr’s office).So, off to ER, expensive, loud, bright, yes, smelley. It is really bad… when one is forced to go to ER…. makes migraine worse,just to give you the treatment to bring you down to the level you started off when you walked into ER, only hoping to break the cycle. on the positive note…had a change insurance. Now, instead of insurance covering only 4 generic per mth, i get 9 per co-pay $25 or generic maxalt 12 per co-pay $25. now, i don’t have to limit my meds. silly insurance co. sorry so long.

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