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.

NEXT: Tips and tricks for a successful Emergency Department visit

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

View Comments (19)
  • jeffpoleet
    3 years ago

    Overstating pain levels? If doctors are not going to believe you when they ask you how much pain you are in, then why even ask the question? This statement just assumes that migraine patients are lying, which is the same stereotype that doctors use to deny us treatment.

    Not required to treat pain? Than what is the point of even going to the doctor in the first place. You can bet your house that if a migraine patient dies from ischemic stroke they are going to get sued for malpractice for not treating pain. They absolutely have a duty to treat pain, no matter the condition.

    It is a myth perpetuated by ER workers that they deal with drug seekers every day or even every week. You rarely, if ever, leave the ER with a prescription so what are they going to sell when they leave? If you do get pain medication it is either in IV or IM, so again this is a misnomer. The only reason they spread this myth is so they don’t have to deal with pain patients in general. How many legitimate patients do they turn away in a day because of this myth will never be known, as they don’t keep records on it, and there is no objective way to measure something like this anyway. Whether it was a good day or a bad day simply depends on the subjective bias of the doctor on duty at that particular time on that particular day. It is impossible for ER doctors or nurses to be able to determine if someone’s pain is fake or real. I feel like you are buying into the propaganda bleated an bayed by ER doctors in an effort to please them in the hopes they don’t threaten to arrest you for wanting help.

  • Vicki
    5 years ago

    I was horrified when my HMO announced a new cookie-cutter policy that in the ED, no migraine is to be treated with an opiate. Plus, the local clinics stopped carrying morphine altogether, so I have no access to that at all.

    But I have been fortunate that my headache doctor and I have found a fairly workable alternative, and by requesting this from the start, I have had good experiences with those treating me, as it keeps me from appearing to be a drug seeker.

    People have commented on frustrating with being offered benadryl because they can take at home, but I have found an ENORMOUS difference between oral or even IM benadryl and IV benadryl. If they push it, so I get it all at once, IV benadryl does usually make a difference for me! I need it to come all at once to hit the migraine hard, but it does do some good.

    We also supplement that with zofran IV and phenergan IM. Yes, the phenergan and zofran are both anti-emetics, but they are in different classes do cab be taken together, and the phenergan is supposed to have some synergistic effect on boosting the efficacy of other meds. I will sometimes get fluids, but if I do, I usually get them to give me only half a liter and run it BOLUS, meaning as fast as gravity will let it run, so I can get out of there and get home and in bed as soon as possible.

    If I can do that, I often stand a chance of losing the pain levels for a while. My pain never goes away, so I can’t break it altogether, but I can at least make it a bit more livable.

  • Tanya Pagel Kosbab
    7 years ago

    First thing they do at the ER for me is say I need fluids that I am dehydrated. I get so mad cuz I have to lay there for at least a hour as they give me fluids that I know isn’t going to help and then maybe and I mean maybe I will get a shot. Most of the time they tell me to see my doc,,,, no help at all.

  • Sarah Scott Blankenship
    7 years ago

    I have had to go to the ER a couple times, and our urgent care clinic many times. I always try to take someone with me, preferably my mom or my boyfriend. They both know to tell the doctor that I don’t want narcotics, because they don’t really help. That seems to go a long way with getting better treatment. I also carry a card in my purse that I give them if I have to go alone. It says “I have a migraine. This causes my speech to be impaired at times and I cannot always think clearly. I need help, please. I do not want narcotics, as they do not help and exacerbate the vomiting. I take the following meds….. and imitrex for migraines. I have probably taken imitrex already, please ask me. When I last needed emergency treatment for migraine, this is what helped….. If at all possible, please use a quiet voice and dim lights. I have my medications in my purse if you need to see them. My medical records are on file here, and I am happy to sign any release you need if necessary to see something you need. Thank you for your help” I generally try to keep my arm or a pillow over my face while they read this. After that, I have never had a doctor or nurse fail to try to help make things a little more comfortable and only once did a doctor offer narcotics. Fortunately, my mother was with me, and asked what it was. I said no, and that’s helped keep from getting labeled as a drug seeker. I live in a small town, and there’s only one hospital. All the local clinics are afiliated. When someone gets a drug seeker label, it’s really hard to even find a PCP that will treat them.
    My last ER trip cost $1288. They poked the IV needle all the way through and blew the vein, resulting in a raging infection. That was another $150 doctor visit, an injection of heavy duty antibiotics and 10 days of cefalexin. Not a great visit, but the doctor treating me was terrific.

  • jeffpoleet
    3 years ago

    If I can’t get narcotic pain medication then there is absolutely no reason for me to go to the ER in the first place. Migraine is primarily a pain disease, which is why we try to prevent then from happening in the first place. However, if those medications have failed, then I need some extra help in getting rid of the excruciating pain that comes with an attack and that is only going to come from narcotic pain medication and some strong nausea medications. No matter what one does in the ER it is basically a much of the draw whether or not you are going to get appropriate treatment. Offering benadryl to a chronic pain patient in the EMERGENCY room in an insult and has never done anything for me. Just by saying the world migraine we are automatically treated as a drug seeker, so I see no point in beating around the bush or pretending I don’t need certain types of medications just to comfort an ignorant doctors delicate sensibilities at my expense. I hate ER doctors, they are the worst doctors on the planet for treating pain, especially migraine pain.

  • Debbie Dobbins
    7 years ago

    I have never been to the ER for a MG but they are getting worse each time. I’ve had them since I was a young teen and nothing seems to help anymore. Now after reading this I’m afraid to go to the ER for fear of not being taken seriously. It’s either risk going to the ER for nothing or wait 3-6 hours for my DR to call something in that *may* or *may not* work! It’s so frustrating and debilitating and a bunch of other words I’m sure you are all familiure with.

  • jeffpoleet
    3 years ago

    I recommend going into the worst drug infested neighborhood looking for medications before I would try an ER. Not only will you be treated better, more likely to get the help you need, but it will cost much less.

  • Crystal Davenport Cooper
    7 years ago

    Dianna Lee I have prayed I could puke on a couple of my ER docs… You are my hero right now. Debbie Dobbins, don’t be afraid of the ER. I have gotten wonderful, kind, caring treatment at the ER before. That is the exception for sure but it happens and if you aren’t going every other day, most will help just to get you out of there.

  • Dianna Lee
    7 years ago

    i have been to the er many times for migrains..they really suck..i was told once by an er doc that i was only there for a drug fix..well he changed his mind when i told him i was light sensitive..moron shined a light in my eyes, i returned the favor and puked on him..meds were given immediately and an apology followed..however a year later i had a hysteroctomy and the migraines went away

  • Ellen Schnakenberg
    7 years ago

    Many headache clinics do have outpatient programs for those Migraineurs who are refractory to other treatments. They are in fact scattered throughout the United States. Unfortunately, there are many, many more Migraineurs than headache clinics, so not everyone is going to have the luxury of associating themselves with one.

    I hope you all got the chance to read Part 2 of this series and that my tips and tricks might be helpful in assisting you the next time you have no choice but to go to the Emergency Room…

  • Heather Powell Doty
    7 years ago

    I feel that this has happened to me on more than one occasion. I usually won’t go to the ER unless I have had the migraine for several days and nothing that I have at home seems to work. The trouble is I know what meds work for me and which meds don’t, due to the fact that I have been going through this since I was twelve. The meds that work for me are narcotics and, of course, Dr.s to not like to give them even after they ask me what usually works. I am not a drug-seeker, and do not take narcotics at home. Going to the ER is strictly a last-resort for me, and is far from an enjoyable experience, as they put an IV of fluids in me every time (which I hate) and I end up cold and many times, when they won’t give me the meds that work, wind up waking up the next morning with the same old headache. It is a miserable experience, the nurses and Doctors often have no problem with treating you like a drug seeker, which hurts my feelings and leaves me feeling frustrated and angry, because I feel I have no place to turn. I have been to many neurologists, and countless Dr.s and they are of no more help to me. I have even been to a prestigious headache clinic, to no avail. I have also spent hours waiting, and there were times I waited just to recieve a shot in the butt! What would be the reasoning, when they know that you are there for a migraine, for making you wait for hours, to give you a quick shot and send you home? I give up! I’m tired of being treated like I would go to the ER for drugs, I have a real condition that responds to a certain treatment, and I bet if they themselves were in the same circumstance things would be different.

  • Jenny-Rocky Koch
    7 years ago

    How so true is this! Lets add in the fact the cost of visiting the ER. Even for the people lucky enough to have insurance the cost is ridiculous. Last time I went the total charge to the insurance company was over $2500 with my charge being almost $1000. And keep in mind I was only in the ER for maybe 1/2 hour. Who can afford that?

  • Crystal Davenport Cooper
    7 years ago

    Jenny Koch I also have an awesome doctor and she gets migraines so it is not uncommon for me to go in and she has already treated herself for the day. I cannot always go see her (since I need a ride) so sometimes I have to go to a clinic here. They are good about giving me shots, too, but only one a week and I often need at least three. The ER is reserved for the ones that wake me up in the middle of the night throwing up. It has to be bad for an ER visit. I’m glad you have a great doc, too. They are hard to find.

  • Danielle Lavoie
    7 years ago

    time for a new insurance company! I’ve gone to the ER three times this year, and the total of all three times was only $400. Wow!

  • Jenny-Rocky Koch
    7 years ago

    Wouldnt it me so totally awesome if they had clinics for us migrainers!!

  • Jenny-Rocky Koch
    7 years ago

    I was in the waiting room for hours, but only being treated for that time. And the bright, loud ER is the worst place to be. And yes I understand your frustration about the Benedryl thing, Ive had that happen too. I am lucky in the fact that I have a doctor that understands and I can go to her and get my shots no questions asked. But as we all know migraines are not on any kind of a schedule. I am sorry that youve had to deal with that because I completely understand and relate.

  • Crystal Davenport Cooper
    7 years ago

    If you were only there for 1/2 hour, you were lucky. I spend hours in the ER when I go because they do not consider me high priority. The doctor and nurses will laugh and joke right outside my door, but they cannot take three minutes to make sure I’m not having a stroke. It’s so aggrevating. And then add to that the fact that some doctors want to give me benadryl and phenogren (which I have at home) and then charge me for the visit that did nothing to help my pain. Sorry. Didn’t mean to rant.

  • Bill G.
    7 years ago

    I track my wife’s success in dealing with her headaches by how long we wait between ER visits. It’s bad enough that she gets them daily, but when the cycles won’t stop at all for a week or more, that’s usually when we throw in the towel.

  • Poll