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Migraines From an ER Doctor’s Perspective

I became interested in guest blogging for Migraine.com after reading a few insightful articles about migraineurs’ perceptions and feelings about the ER and ER staff.

As an emergency room physician I was surprised and saddened to hear that many migraine patients feel that they are treated like drug-seekers in the ER setting. I hope to express some ideas throughout this post to improve communication between migraineurs and staff in the ER setting.

As an ER physician I will be the first to admit that “migraine headache” is not a chief complaint that most ER doctors climb over each other to evaluate. On the other hand, I find much gratification in treating migraines in general because there are so many treatment options and the success rate with migraine patients in our ER is very high. I do not perceive the chief complaint of “headache” or “migraine” as a drug-seeking type complaint. In fact, at least in the upper Midwest, I would say it is highly unusual to find a board-certified ER physician who attaches that stigma to migraine patients in general. Perceived or real indifference, on the other hand, particularly given our collective personality flaws as ER doctors, is much more likely to be encountered by a suffering headache patient.

In the ER, our approach to all patients (not just migraines and other headaches), is very straightforward. Unlike most other clinical settings, we do not work from the most likely diagnosis to the least likely diagnosis. We give priority to threats to life and limb. Our first task is to triage all patients/complaints into those problems which are life threatening and those which aren’t. It is absolutely vital that this be the case during a busy ER shift where there can potentially be several life-endangered patients at once. Most physicians in the ER will triage someone literally within seconds of entering the room and the treatment and evaluation plan for most complaints is completely established within most physician groups based on clinical studies and community practice standards. Headache as a collective problem is usually quite easy to triage. In general, the historical features and presentation of an unfortunate patient with an acute life-threatening headache (such as an intracranial hemorrhage or meningitis) is much different than recurrent non-life threatening headache (migraine, tension, and cluster headaches for example). That being said it is a universal (or it should be) that you will be given the benefit of the doubt. If there is question as to which general category you, as the patient, occupy, you will be given the more extensive workup (CT scans, lumbar puncture, MRI etc). Some unusual migraines with associated neurological symptoms will often be worked up again and again for possible CVA (stroke).

Often a physician who is pressed for time may give you, the patient, far too little time based on the initial assessment. If your clinical appearance is better than the patient in the room next to you, the other patient has to be prioritized. This can obviously be interpreted as an intentional slight by any patient (how else should a patient take this when they feel terrible, sitting in the ER and the doctor zooms through in a minute or two?). It is our job to express this to you as best we can, and hope there is some understanding. The vast majority of the time patients understand this.

What are the patients’ rights in the ER?
Legally-speaking, all patients who present to the ER are entitled to a “medical screening exam”. I believe that patients are also entitled to respect, relief from suffering, and compassion. My priorities when patients come to the ER are

  1. evaluation and treatment of life-threatening and long-term disabling medical problems
  2. provide relief of suffering to the patient
  3. counsel and listen to the patient and family
  4. make an effort to make a specific diagnosis in non-life threatening situations.

You will notice that an exact diagnosis comes toward the end of the list. Often an exact diagnosis in the non-life-threatening cases is beyond our scope in the ER. Many patients are frustrated to leave the ER without an exact diagnosis, but we often just don’t have the time or expertise to iron-out exactly what variant of migraine headache or non-specific abdominal pain, or rash etc. a patient is experiencing. It is definitely not because we don’t care, but this approach is necessary based on time and resource limitations.

What are ER Staff rights?
It is our job to empathize with patients, so why am I expressing the ER staff’s rights? My main goal with the article is to help you get fast, effective treatment in the ER. I think it is absolutely vital for ER nurses, techs and doctors to be treated with respect. This is common sense for most, but I cannot believe how badly we are often treated by patients. We know you are uncomfortable and we truly want you to feel better.

I believe ER staff is also entitled to honesty. Lies and omissions can kill people in the ER. This is the one time that I will prematurely end my treatment for a patient. If I have cleared the patient medically, and the patient lies to me, I will often ask the patient to leave the ER. Ten out of ten pain is difficult for most people to experience in a lifetime. The closest I have come was in a taser study and I maybe hit eight out of ten pain. I understand this is completely subjective. If you are truly experiencing the worst pain imaginable, by all means tell ER staff, but a realistic appraisal of your pain is very important. My bias is that 8 or 9 on a scale of 10 is much more believable that full 10/10 pain.

Continue Reading – Part 2: ER Strategies for Migraine Relief

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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

  • Susan Jillian Smith
    7 years ago

    We need a device to be invented, that can instantly detect and measure the presence of a migraine. This would eliminate the horror stories I see here.. and that I am also familiar with. Something that looks into the brain by way of the eye, or ear… or something that can “hear” the attack. Just as heart problems can be identified by listening, seeing or feeling something on the patient – we need this exact same approach for our condition.
    While the rules this doctor has posted here are fine, for the present – let’s start to think about how to move to a more futurist method that definitively identifies our pain and it’s severity.
    While we walk around with our mobile devices, did we ever think that was possible 20 years ago? Phones that take and send pictures or videos? Anything is possible once you start to imagine that it could happen. I think there is a very real need for this type of diagnostic tool.

  • Michelle Springston Pingel
    7 years ago

    I agree about the high blood pressure spikes. I have cluster headaches, but didn’t know that at the time I finally broke down and decided to go to an ER. For 20 years I’d put up with various doctors telling me my red eye, when I pointed it out to them: “oh it’s nothing.” (exact words.) but after having this agony for a month or two straight 24/7, I couldn’t take it anymore and went to one of the #1 trauma ERs in the country (in KC). While waiting to be seen, they took my blood pressure. Normally it ran in the 148 or 153 over 90 range but on that horrible day it went to 193/99. My red eye as usual was as red as a beet, a classic symptom of clusters. Eventually, though one of the internists there, Dr. Slawomir Walewicz, became my primary, and was the ONLY doctor in over 20 years who actually listened and gave me the right diagnos…is. The next year, I moved to Johnson County, KS and went to Shawnee Mission Medical Center’s ER and told the PA there that I saw that I have a diagnosis of Chronic-style clusters but she blew me off bigtime and insisted on examining my left eye—–by shining a light into it, doing an eye exam and handling it all over with her gloved fingers. I almost came across and hit her, it was so painful. I kept telling her to leave it alone, and to call Truman Hospital, which was only 15 minutes away. I was just in too much pain to go myself. She ignored me again and diagnosed me with Pinkeye. They treated me as a pathetic charity case to take pity on, that I didn’t know what my problem was and they knew better than I did…. the arrogance of these people!

  • Angela Powell Word
    7 years ago

    I found this article helpful, but still have to say that I spent many years being treated like I was a drug seeker when I would go to the ER for help with a migraine. I finally found a migraine specialist, Dr. Ford in Birmingham Al., who helped me tremendously. I take preventatives and have meds to take for when I do have a migraine. However, I have had a migraine for the past 5 days that my meds have not alleviated and even at the urging of my family have not gone to the ER for the shots that I need because of the way I’ve been treated in the past.

  • Angela Powell Word
    7 years ago

    I have contacted them today, but they are two hours away and I can’t go there. He recommended that I go to the ER as that seems my only option at this point.

  • Migraine.com
    7 years ago

    Hi Angela, Have you contacted your migraine specialist? Sometimes (if it is feasible) visiting your specialist’s office for treatment is a better option http://migraine.com/blog/living-with-migraine/when-doctor-er-for-migraine/

  • Chey Ewertz Cobb
    8 years ago

    I am one of those migraine sufferers who would rather slit her wrists than go to the ER for help with a particularly bad migraine. I have been to ERs all over the country and almost all of them either treat me as a drug seeker or they are completely ignorant and put me low on the triage list as “just a headache”. I have experienced waits of more than SIX HOURS in ERs… and that was when there were empty beds and no incoming ambulances. I think the ER staff view me as a pain in the ass and they just don’t want to bother. So much for empathy!

  • Holly Allen
    8 years ago

    Dr. Kyle Kingsley, I have read both of your articles and I would like you to know that for most of us that have daily chronic migraines we speak to our doctors and get permission to go to the ER for treatment when our regular medication fails. I myself have suffered from this horrible disease for almost 20 years and it has gotten progressively worse. So when I am having an attack and after 2 or 3 days of my regular and rescue medications not working that is when I come in to see you in your office ans seek your help and the stronger medication ; which is usually narcotics that are different that what I am already on. Doctors need to understand that we research our disease probably more than you do because its what we live with not just something we need to know to get a degree. I myself worked in the medical field so I understand that patients need to be honest about all medications taken and how some medications will make others less effective, but when you are the one living with a disease usually we are the expert so when wee go you to help us manage the problem. I have been to the hospital where the pull up my record and just say the usual? because I only go to the ER when all else fails! That is what it is there for and I think the nurses and doctors need to be educated on, as the patients what works and if they don’t know then proceed to help then and give them something that will don’t just assume when I say I need 10mgs of morphine its not because I want it its because I want my brain to stop trying to crawl out of my eyeballs! I will say that having aphasia with my migraine attacks makes it very hard to convey my message to my doctors, I keep a list off all my meds in my phone and all y doctors as well, my husband has the same list just in case. I am looking gin to a medical alert bracelet for migraines and my allergies to meds, I think that would be very helpful as well. I hope all of the ranting actually helps doctors understand how patients feel when we come in. We are in extreme pain, I have been told it is worse than childbirth. so if the doctors and nurses could just try to get it we would all appreciate it. Thanks.

  • Julie K. Prows-Connell
    8 years ago

    I’m a student nurse and a lifelong sufferer of Migraine headaches. My husband suffers the problem, too. Therefore, wouldn’t you know that both of our children also suffer Migraines. This was a refreshing article and I appreciate your explaining to the layman how the ER functions. Pain is subjective. A 2 for one person can be a 10 for another. As a soon to be graduate nurse, I hope I never lose the empathy for my patient’s needs and concerns. Even drug seekers need compassion and understanding. Thanks for your blog!

  • Ronda Labuda
    8 years ago

    Thank you for the valuable information and also the comments! The idea to take your migraine Care Plan with you to the ER should help both the patient and the doctor. Thanks for the blog!

  • Tricia Lee Bond
    8 years ago

    Ronda… The problem is that the ER doctors do not look at the care plans or information that is given to them by the doctors directly over the phone. The ER doctors have stated that that information is useless because the ER doctor has to do his or her own assessment and they will not look at any paperwork you bring in with you. So unless you have an allergy or an adverse reaction to medication the ER doctor does not want to hear anything else. He or she has already made up their mind.

  • Teri Robert
    8 years ago

    Dr. Kingsley,

    You listed this as one of your priorities, “evaluation and treatment of life-threatening and long-term disabling medical problems.” Herein lies one of the problems we Migraineurs face. Migraine can, in fact, be life-threatening. Although it’s not a common occurrence, Migraines can cause strokes, and those strokes can be life-threatening. Some Migraineurs also experience significant spikes in their blood pressure during a Migraine attack, and those spikes can be serious.

    It’s also a problem getting past triage to the doctor in the first place because Migraine is viewed as annoying and painful but not life-threatening. Several years ago, I’d been trying to help a young woman whose family didn’t understand Migraines. We didn’t get very far. Her family refused to take her to the ER, and she suffered a Migrainous stroke. She “recovered” from it, only to have a fatal stroke with her next Migraine. This kind of thing simply shouldn’t happen.

  • Tricia Lee Bond
    8 years ago

    Teri Robert I agree Teri. I had a ER doctor discharge me and then I woke up in ICU 2 days later. I didn’t even make it out of the ER department when I fell unconscious on the floor, just after the ER doctor said I was fine. I then spent 10 days in the hospital because of a Hemiplegic Migraine attack that a ER doctor thought I was faking. This is serous and very scary. It could even take a life. There needs to be more education.

  • Teri Robert
    8 years ago

    Migraine.com My point her was that Dr. Kingsley was saying that “life-threatening problems” take priority, and for the most part, ER personnel don’t see Migraine as “life-threatening.”

  • Migraine.com
    8 years ago

    Hi Teri Robert – We would assume that Dr Kingsley (and hopefully all ER physicians!) would also classify stroke and significant spikes in blood pressure to be potentially life-threatening conditions, and treated as such, regardless of if the patient also suffers from migraine. As is the case with other chronic conditions (diabetes, asthma, etc) symptoms are not always life threatening, however severe situations should always be handled appropriately.

  • Lin Jones
    8 years ago

    Dear Dr. Kingsley, you are one of the good ones it seems. The fact that you take an interest in one of the most misunderstood, questionable and can be a life threatening illness is good news for those who suffer great amounts of pain throughout their life. Think about this… a reoccurring immense amount of pain. The kind that makes you think about doing anything to stop it. When you do get through this one, you know this will happen again & again. So just how much can one person take. The only thing that keeps you from ending it all is the LOVE of your family. I have stopped going to the E.R. not only because of the scrutinisation of each and every visit, the short term relief although welcomed, I am left undignified and saddened that no-one cares enough. I want to die and no-one will help me through it. My stomach is empty from vomiting over & over. I can’t see very well to make it to the bathroom. My cold cloth is now warm again. My body is shivering cold. I can’t remember if I took my pain killers 2 or 4 hours apart.I can’t lay flat in my bed so I prop up with pillows, that position will not last long before I must change to find another way. With every movement, pounding over & over. My head also pounds when I cry…I try so hard not to cry. If I could only sleep. My face distorts I become swollen and unrecognisable. In a day or 2, it will subside. I know even when I stay away from all the triggers, it won’t matter. I will go through this again… and again. My children have grown & left now. This is very hard on my Husband. At times he feels helpless and leaves the house. Don’t think I haven’t thought of it. I just want the pain to stop, I don’t care how. The heating pad on my pain patch is always at hand.
    Thank you for allowing me to tell you what I go through. My migraines started at 12 or 13 years old. I am now 55. Respectfully, lin jones of Ottawa, Canada.

  • Lin Jones
    7 years ago

    I wrote this to Dr. Kingsley, for his articular Migraines From a Doctors Perspective- Migraine .com I didn’t realize it would be posted here.

  • Lin Jones
    7 years ago

    Thank you for your concern. I want to edit the portion of this statement that should read the E.R. leaves me feeling no one” there” cares enough about my pounding head ache, no one at the E.R. will help me through it. I realize the cost of health care is on the rise,can there not be a place for short term care? Just a day or 2?

  • Lin Jones
    8 years ago

    Subject Title: Migraines From a Sufferers Perspective-Migraine.com

  • Leslie Ann Johnson
    8 years ago

    I have had various experiences with various results. I, like most migraine sufferer’s have endured pain versus visit a hospital. I often was left untreated so long that the pain finally resolved itself. It was agonizing. My worse experience was to be admitted, and after ruling out stroke had a neurologist tell my family that I was “faking” my symptoms. I later was diagnosed with Sporadic Hemiplegic Migraines. As a single parent I lost my medical job, and have struggled since. I have been in life and death situations in the ER (serious accident), and understand the need to prioritize. I wish their were ER pain clinics. One with a national database that could “rule out” the drug seekers.

  • Marietta Johnson
    7 years ago

    That has almost got to be worse (or scarier sometimes). There are times I get the other symptoms without the pain, and I wonder ‘is this a stroke or something? or just the migraine stuff?’ I had an allergic reaction to Imitrex back in 1994 & also to Nubain in 2003, so I don’t know exactly what that makes them think. I know from experience as an ER employee that people presenting with pain and who state allergies to non-narcotics are eyed even more suspiciously than anyone else (sometimes with good reason, other times, that’s just what their body doesn’t tolerate).

  • Leslie Ann Johnson
    8 years ago

    I first have to explain to the ER that I can not have abortives due to the type of migraine I have … That sends out a red flag to them “drug seeker”. I’m sorry that your pain exists for as long as it does. The most severe pain I have is generally 4-6 hours, which … an ER is generally no use to me. My migraines are more often “silent”, and the symptoms render me useless.

  • Marietta Johnson
    8 years ago

    I agree that it would be nice if there were alternatives to an ER when you have exhausted all of the abortives and still have the migraine. My husband is ready to take me to the ER after a day without relief, whereas I tend to wait until the pain finally resolves itself… which can take well over a week and into two weeks at times.

  • Sara Lautenschlager Stobbe
    8 years ago

    I have been to an ER in a fairly small town where I was the ONLY patient in the waiting room. I still had to wait an hour to be seen while I laid my head on my mom’s lap at 28-yrs-old crying because I hurt so bad. I had ice on my head. My Neurologist had already sent standing orders to the ER. Still, when I got back there I was treated as though I was only looking for narcotics or a quick high. “Hello would I have an ice pack and have standing orders from my neurologist or be crying if I was looking for a fix” I was PISSED. Which didn’t help my migraine any. So, no, even when you have these things in place that “stereotype” is still placed on you. It’s hard and frustrating and makes you NOT want to go to the hospital which is why I avoid it at all cost. I’ve since moved to a larger city and have not gone to an ER here. I’m still trying to find a good Neurologist as well.

  • Migraine.com
    8 years ago

    Sara – There are multiple directories available for headache specialists (not all neurologists are migraine specialists and not all migraine specialists are neurologists!). You can find directories from the NHF, MRF, and AHS via the links below:
    (1) http://migraineresearchfoundation.org/resources-links.html
    (2) http://www.headaches.org/physicians
    (3) http://www.achenet.org/resources/healthcare_professional_search/

    Teri Robert’s website includes a directory of patient-recommended physicians, which can be found here: http://www.helpforheadaches.com/doctors/migraine-headache-specialists.htm

  • Marietta Johnson
    8 years ago

    I worked for a number of years as a tech & ward clerk in an ER. When someone came in with complaint of headache (or back pain/spasm or any type of chronic pain really) the nurses automatically assumed they were faking it and just wanted drugs or attention. I can honestly say that I have seen a number of people whom I would put in that category. People who come to the ER with a migraine, and then complain because we only have basic cable on the television in the rooms, for example. Now, I have also seen the other side many times too: when a patient comes in & doesn’t want the lights on in the room and the nurse insists that they have to turn on the big bright light to take a blood pressure. I am talking about the brightest light that is used to illuminate for suturing & removing foreign objects from eyes etc. We had task lights and reading lights at the desk & around the sink and counter top that provided plenty of light for them to see their papers and even see the patient. There were quite a number of times I saw a nurse laugh with other nurses and staff before going into a room to turn on the bright lights on a migraine patient or wait to give the pain meds ordered by the doctor and laugh about that. (I remember a day we weren’t busy at all and one nurse saying that she needed to have a 20 minute coffee break before she could give a shot). This wasn’t something that every single nurse did, but it was definitely the pervasive attitude, and it really angered me when people would just assume. They never assumed a complaint of chest pain was faked. (they may have thought it and voiced it, but they still treated the patient as urgently as any other until labs came back etc. showing it wasn’t cardiac related.

    Now, I have had some really excellent care in the ER for my severe acute migraine. And I have had to wait up to 14 hours before even being seen before (once). Most of the time it is somewhere in between, usually closer to the excellent care, they try to get me in as soon as they can, keep the lights low, give me a bigger pan to vomit into than that little bitty emesis basin, give me an ice pack etc. Get me evaluated, treated and out of there quickly so I can go on home to fully recover and they can go on treating others.

  • Rebecca Flatt Thorpe
    8 years ago

    My migraines are caused by Trigemnial Neurlgia which on a pain scale of 1 to 10 is an 11, but I find most ER doctors do not know how painfull having both at same time really are. While I do not wish my pain on anyone even those that I dislike I would like those trying to treat my pain to at least have some sympathy and understanding of what real pain feels like…

  • Tricia Lee Bond
    8 years ago

    June 7, 2011.
    CEP America Emergency Physicians.
    4096 Piedmont Ave. #900
    Oakland, California 94611.

    To whom it may concern:

    In your mission statement it states this,
    “Madera Community Hospital is a not-for-profit community health resource, dedicated to actively promoting and maintaining the health and well-being of residents throughout the Central Valley. We are committed to identifying and serving our community’s needs with compassion, concern, care and safety for the individual.

    In support of our primary mission, Madera Community Hospital will:

    • Be sensitive to the diverse physical, spiritual and psycho-social needs of those we serve, including the alleviation of pain and suffering, and integrally involving the family in care delivery.

    • Periodically assess the health status and needs of our community, determine which health services we can appropriately establish and maintain, and act as a catalyst to ensure that priority health needs are met.

    • Work collaboratively with physicians, other health providers, and community leaders to develop, offer and continuously evolve a comprehensive and integrated continuum of health services.

    • Stimulate high levels of support and participation in educational and outreach initiatives offered to patients, staff and community members in an effort to promote both high levels of individual achievement and community health and well being.

    • Prudently manage and utilize our financial resources, while ensuring the provision of high quality, effectively delivered health services.”.

    I found your mission statement to be untrue and a fabrication of words to make your hospital sound like it is a welcoming place to go and receive help when someone is in pain or sick. I feel as though I was lied to and I feel as though your hospital has falls advertisement.

    On May 2, 2011 I was seen by Dr. George Mowry, this doctor was abrupt and lacking in knowledge of my disorders. Dr Mowry was unwilling to go through my medical records that I brought with me to the ER on May 2, 2011. I am a Familial Hemiplegic Migraine sufferer type 1. May 2, 2011 I came into your ER looking for help. I had been having chest pain but my chief complaint was my migraines that I have been suffering with since October of 2010. Dr. Mowry would not even look me in the eye, and the short time that I saw him I begged him for help. He ignored me and made me to feel as I was worthless. He also stated to my mother “whom was with me” That I was depressed and that I needed to just go home and take my medication. SO my thoughts of this was “you are going to send a possibly depressed woman home to take medication that you have no idea what she is taking, and possibly take her life.”.

    I came into the Madera Community Hospital ER looking for help and all I got was to be made felt as though I was not worth living for or worth a DOCTORS time of day. He also made me feel as though I was drug searching. I don’t take narcotics nor will they help my condition. Narcotics only exasperate my symptoms. I am a well educated woman that knows when her rights as a patient have been violated. Dr Mowry has violated my rights to being treated like a human. I was called from your facility and apologized for his actions, but the feeling he left me with is not going to go away. Dr Mowry also did the same thing to 2 other patients that were next to me in my stay. Dr. Mowry is not a doctor, he has no compassion and he does not disserve to work with the human race. I have worked in the health community for many years and never have I come across a doctor as arrogant, and unwilling to listen as Dr. Mowry.

    With Regards,
    Tricia Lee Bond.
    Patient

  • Laura Sharick-Morales
    8 years ago

    It’s how I found Imitrex in 1995. The ER staff was great and my “headache” was gone within 5 seconds of the injection. Guess that’s proof that I did have a migraine…and still get them. No need for a CT or MR for my brain. Just give me Imitrex!

  • Pam Dickerson-Williams
    8 years ago

    The first time I had terrible auras I thought I was having a stroke. I went to the ER and the physician blew me off like I was just a hysterical patient. I cried and asked him what’s wrong with me, I never had this before. He told me to go see a psychiatrist. The nurses were smiling and I felt like a complete idiot. I’ll never forget it. I wasn’t in pain yet, but the visual auras and the way my body felt were terrifying.

  • Betsy Stumph
    8 years ago

    I would like to say, as a chronic migraine sufferer, that I too have encountered many ER doctors, and especially staff, who treat me as if I were drug addict. When I go to an Emergency Room, I am in EXTREME pain. My regular meds have not worked, and I HATE having to go in and go through an entire explanation about my condition, usually several times. I also know which meds work for me, from my experience over 20 years of having them. I have no way to prove that I have a migraine. While I understand that life threatening emergencies should be treated first, no patient should have to sit in agonizing pain while waiting their turn, generally up to an hour, sometimes more. I honestly wish there was some way I could just walk in, give you a card or something to prove I am a migraine sufferer, and what meds I am being treated with. I cannot mention a narcotic without all of the attitude starting. While you may be understanding, the majority of ER doctors and staff are totally uneducated about Migraine, and all of the variables that come with it. It is just ridiculous in this day and age that we should still have to go through all of this.

  • Betsy Stumph
    8 years ago

    Migraine.com Yes- I have taken paperwork in from my doctor and specialists- they do not even look at them- and, I would like to add, this comment he has made about the pain scale- my pain is a 10 out of a 10- I am in so much pain I am worried about driving myself- it seems that if a person comes in with half their leg cut off, and they say their pain is a 10 out of a 10, it is beleivable, but someone with a Migraine must be lying? Instead of expecting all of us to bring paperwork and family members in, why not try educating your staff on Migraine headaches- especially in the ER where most of us end up when our meds are not working- and realize that we are not coming to the ER to try alternative methods of therapy- our doctors are very good at prescribing all the new drugs that come out- when we come to the ER it is because NOTHING is working that we have been given, and that means we may need help AS A LAST method of relief- not the first. If you do have a patient that continually comes to your ER that is not seeking a regular doctors help, then understandably you would suggest these things, but come on- someone who is already on prescription drugs for their disability is obviously not coming to you FIRST. I have had 5 children, 4 of them with NO PAIN meds during labor, and I can tell you that my migraine headaches top my list of the most painful things I have experienced in my life. When I say its a 10, ITS A 10.

  • Marietta Johnson
    8 years ago

    Migraine.com When I have brought in a care plan or statement from my Migraine doc, they wouldn’t even take the papers out of my hand, or in one case, they did take it from me and just put it in the back of their stack of papers, or tell me that they can’t use that information, they have to evaluate me on their own, they can’t take orders from an outside doctor. So, basically, it was a waste of time and paper to even have the care plan. One doc I used to see (who has retired now, or I would still see him) requested that if I presented to ER, that they would please call him, but when my husband mentioned this, the nurse just laughed at us.

  • Tricia Lee Bond
    8 years ago

    Migraine.com HI…. I have brought in care plan’s in with me to the ER and the doctors do not even look at it. I have brought in my full medical records in with me and the ER doctors have not even looked at them. I have been told, “It is not necessary for me to look at your records it is just a headache.” I am a Familial Hemiplegic Migraine suffer, that has complications of genetic blood disorders, and I still get treated like I am a drug seeker. I do not take narcotics because of my Acute Intermittent Porphyria and my Genetic Hemochromatosis. BUT I would rather slit my wrist instead of going to the ER. If I am having an attack I look like I have had a stroke, but as soon as the Doctor finds out it is due to my migraines they start treating me like I am faking. Like I can fake stroke symptoms. THANK GOD, there are smarter doctors at Stanford University Medical where my neurologist is now. If I have to go to the ER department now I call him and he calls the local ER for protocol. When I have had a Migraine for over 72 hours and I finally call Dr Robert Cowan to be sent to the ER believe me it is not because I want to go, it is because I am on my death bed and need my DHE that my insurance will not pay for. There is no excuse for a Doctor to treat anyone like they are less than human. Pain is a real reason to see a Doctor at the ER.

  • Migraine.com
    8 years ago

    Hi Betsy-Lisa, Have you read Part 2 of Dr. Kingsley’s post yet? In Tip #5 he recommends bringing a care plan (preferably from your migraine specialist) into the ER with you, for the very same reasons you’ve mentioned. Have you tried this and if so, has it helped? http://migraine.com/blog/expert-featured-article/guest-expert/an-er-doctor%E2%80%99s-perspective-strategies-for-migraine-relief/

  • Dawn A Marcus
    8 years ago

    Hey Dr. K. You should check out my new book, Practical Assessment of the Patient with Headaches in the Emergency Department and Urgent Care Clinic. Would love to hear your thoughts!

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