Why does the Emergency Department treat me like a drug seeker?

“Headache” pain is ranked as the #4 reason for Emergency Room visits in the United States, yet it is rarely a life threatening condition requiring emergent care or hospitalization.

In the eyes of emergency department physicians and staff, Migraine is not at the top of the list of problems they are highly concerned with. After all, pain never killed anyone — right?

Unfortunately, the majority of ED staff probably believes this.

Few emergency department physicians seem equipped or trained sufficiently enough to do more than triage headache and Migraine patients.

Emergency Department (ED) doctors should first — rule out more serious reasons for the headache, then second - diagnose the headache via IHS criteria (acute headache or benign cephalalgia is not a diagnosis), then third - treat the patient according to the diagnosis and history.

Instead of a true and appropriate IHS diagnosis, the emergency room Migraineur is most likely to receive a *diagnosis* of “benign cephalalgia”. (Benign = good, Cephalalgia = headache)

In short this means only that a life threatening condition such as meningitis or a tumor or brain bleed has been ruled out, leaving only non-life threatening causes for the visit. A diagnosis of Migraine, cluster headache, tension headache or the like has not been given. When this happens, the Migraine patient is highly unlikely to get the appropriate treatment they need to abort their Migraine attack. This too often results in repeated visits (one study showed 82% of Migraineurs who visited an ER did so more than once) often to the same emergency department, and often with complaints that whatever treatment they received before “didn’t work”.

Unfortunately, Migraine is notoriously difficult to treat in the Emergency Room.

Emergency room physicians chose their field because they thrive on stressful, life endangering situations. They usually like very much to save someone’s life and many actually dislike the more mundane part of their job (anything not life threatening) which is sad considering that the majority of emergency department visits are not for life saving treatment.

Physicians — all of them — get frustrated in treating conditions that don’t respond. They often try very hard to help us, and it is almost as discouraging for them that it doesn’t work, as it is for us. The difference is that they can walk away from it, and patients can’t. Putting it simply, ER doctors thrive not so much in treating, but saving.

To understand why Migraineurs frequently receive the sad treatment they get, it is helpful to look at the emergency department staff’s perspective.

Emergency room staff has trained especially hard to save people in immediate danger of expiring. They see trauma and pain much beyond the comprehension of the general public. Every day they watch people die from some of these horrible things.

The ER staff’s job is to immediately treat and stabilize the most emergent cases first, followed by the non-life threatening cases. Those patients who are in need of non-emergent treatment will be treated usually just enough to give the patient time to get to their regular physician. Those needing admittance are then transferred to another physician who will take over their care, and the ER physician moves on to the next patient in the most need of his/her attention. In so doing, they have been taught that when they hear hoofbeats to think horses, not zebras or unicorns, because horses are most likely and the easiest and quickest to treat, allowing the doctor to move on to the next patient.

Because they see so many “headache” patients of varying severity, ED staff often becomes de-sensitized to these patients because they are not seen as being in imminent danger of dying.

Making matters even worse

Complicating matters are those patients who overstate their pain levels. If (on a scale of 1-10) your pain is pass-out-screaming-bad 10, then say it is a 10 and pass-out-screaming-bad. Don’t say it’s a 20 while you have a friendly conversation with a friend in the next chair, or talk and text on your phone. Patients who overstate their pain levels hurt other patients because physicians and staff know this, resent it, and eventually come to expect it from all pain patients and act accordingly.

Each and every day ED staff deals with true drug seekers who frequently use “headache” as a means to get more drugs which they either use for the purpose of getting high, or sell to someone else for the same purpose. These drug seekers are smart and they know how to manipulate the system. This of course is no fault of true Migraineurs, but unfortunately most physicians haven’t even received enough training on the physical signs of extreme or chronic pain, and are in fact defenseless when presented with a patient who may or may not be crying wolf — and there will likely be multiple numbers of these “patients” each day.

Think of it — every day they face lying people who want drugs from them, putting their license to practice medicine in jeopardy. If they can’t tell beyond the shadow of a doubt that you are a true Migraineur, you are unlikely to receive appropriate abortive treatment, let alone pain relief. The fact is, physicians are not even required to treat pain, and if they don’t know how to abort a Migraine (remember, Migraine is a neurological condition, not just pain) they will usually discharge you with minimal or no treatment, often with the label “Drug Seeker”.

Name calling

There are also of course a few ED physicians who simply want nothing to do with chronic pain or Migraine patients. There are annoying terms that have been coined by this kind of doctor which are sometimes even used in the presence of patients. GOMER (Get Out Of My ER), Frequent Flyer, Bounceback, Professional Patient, AALFD, MGM Syndrome, Drama Queen… well, you get it.

These doctors will often flat out refuse to give pain relieving medication to a Migraine patient no matter what you do or say. When I had one of these, he stood in my doorway (I was admitted), watched me agonize for a few hours, then turned to my husband and told him “Sometimes we just can’t give them what they want.” When we checked later, I was horrified to find my records were prominently marked DRUG SEEKER.

After that traumatizing experience, I decided it was time to look at how I approached these types of visits so I could minimize the chances I would ever be labeled this way again.

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