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Conversation of the Week: Emergency Room Visits and How to Avoid Them

Have you been to the emergency room for migraine? Many of us are forced to seek care in the emergency room when our preventative and rescue treatments fail us and we are left in agonizing and protracted pain. Unfortunately, we often encounter less than compassionate care with some healthcare workers being suspicious that we are drug-seekers. The departments are often also noisy with bad smells, fluorescent lighting, and long waits. Not exactly the calm, dark, environment we would prefer as we labor through a most challenging attack.

Do you have ideas as to how to avoid the Emergency Room when faced with a severe and intractable attack? Creating an emergency response plan to ensure you can avoid the emergency room can be helpful. This may include working with your doctor to prescribe emergency-type interventions you can administer at home. Or choosing a migraine specialist who can provide emergency interventions through his/her office. Once a plan is created, it never hurts to run through this plan of action with your doctor on a regular basis regarding how best to handle an after-hours intractable attack.

Have you ever had to go to the Emergency Room for migraine treatment? If so, what was your experience? Do you have ideas about how to avoid the experience altogether?

  1. I strive to avoid the ER for migraines. But, you're right, that sometimes it is unavoidable.

    My last trip was horrible and reinforces my desire to avoid them.

    My migraines morph. They have changed over the years. This last change sent me to the ER because I lost the ability to control half of my face.

    When you first experience that, it is terrifying. Completely terrifying.

    I chose to listen to reason and go to the ER. I was treated horribly. I'm scared to death that I am having a stroke and the ER personnel were completely uncompassionate. I wasn't asking for drugs. I was asking for help. I didn't know what was happening. I was even given a medication that is on my allergy list and sends me into renal failure.

    I have not found a way to avoid the ER. Mostly, I choose to not go. I push my doctor further and further to look at what could help me. My last two attempts, I was told that I know more about migraine care than most of the physicians treating migraine at the three locations that are consulting. To just tell my provider what I want to try and have them help me get it.

    As a patient that is beyond frustrating. I have exhausted the knowledge from professionals and they are having me guide my own care.

    My biggest suggestion is be an advocate for your care. And, if you experience issues in the ER, fill out the surveys, talk to patient advocates, or patient experience coordinators. Cause the ripples that will promote change.

    1. Goodness, what a mess. Going to the ER is so overstimulating, plus you never know who you're going to get or what they're going to do when you get there ... I hear you.

      One additional suggestion that was not offered: even though you said your regular team is struggling to help you, I wonder if there's benefit to having them communicate with the ER. Some of our members have had great success when their doctor either calls the hospital when they're on the way there, or writing a letter that they bring with them to the hospital.

      In general, this communication should include info about your history, possible symptoms you may have on arrival, and suggested treatment protocol. In some cases, as unfortunate as it is, the ER team is more likely to listen when it comes from another health care professional.

      I hope that's useful and, more importantly, that you can stay out of the ER. Take care! -Melissa, migraine team

    2. yes! Notes can be incredibly helpful to bring to the ER. The ER doctor still has to do their official evaluation but it can definitely help to expedite the process of getting the treatment that you need and get out the door so you can be back home in the comfort of your bed. <3
      - Alene, moderator

  2. This is a fabulous and thought provoking question ! I was actually just in the ED a couple weeks ago with a migraine.

    My doctor sent me there at 5 am, so I at least had the advantage of getting in before the typical morning rush. I was so grateful to be triaged and brought back to a room quickly.

    To your point though, when the doctor came in to evaluate me, he turned on the lights, spoke so loudly and seemed to have little to no awareness that he was working with a migraine patient.

    My nurse on the other hand was hands down the best nurse I've ever had. She made me feel like she was treating me the exact same way she would be treating her family. She was on top of my care, but more importantly she had the best bedside manner. She turned off the lights, always closed the curtain so the light from the main area was closed off as best as possible, offered something to drink, an ice pack, pillow, blanket... truly she was a gem! I know how much of a rarity this is however.

    In terms of avoiding the ED, my biggest effort is always trying to stay hydrated - with or without a migraine attack. And certainly if I feel one coming on I'm pretty quick to start drinking more water. I do it less for the migraine, and more to help create a buffer if I start vomiting. It's less the pain and more the dehydration from vomiting that sends me to the ED. I also try to do some efforts like have popsicles or have some ice to stay hydrated once the migraine has kicked in.

    Again, thank you for sparking this conversation so that we can all learn from one another on this important topic! - Alene moderator

    1. But don't get me started about how your treated in the ER. I feel like they view me as some kind of junkie looking for drugs and don't even look at my symptoms. My blood pressure is through the roof because of the pain. Being past the risk of a stroke. They have no compassion for you when you're in pain. Sometimes I just can avoid the ER. I tried asking my doctor for something I can take at home but she won't comply. Toradol injections might work if caught in time

      1. So sorry to hear about your blood pressure. I've heard a lot of people talk about how taking blood pressure medicines ended up helping with their migraine condition. And yes, the feeling of being accused of being a drug-seeker, when we are merely relief-seeking, is maddening. I hope your doctor will reconsider prescribing you toradol injectables at home. They are a key part of my rescue regimen (the last step before the ER). We appreciate you chiming in on this. Warmly- Holly team

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