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Need help finding ER doctors views on using narcotics?

How do I find the recommended ER doctors views, as provided by neurologists on using narcotics for migraines?

I've had migraines for 60 years, and if I go to the ER for my usual shot of 1 mg of hyrdomorphone IM, the ER doctor will that the neurologists tell them not to give them due to rebound headaches. Generally, they say this means the migraine will come back the next day. For me, the migraine will be gone in 10 to 15 minutes and will not rebound! I'm trying to find the source of this rule and the details of the actual rule itself. Plus, are they saying all people, all times or what? I have been getting these shots for over 20 years, usually every 30 days or so and they have always worked, with no rebound.

I'm trying to figure out if I'm rarity in this situation or not? I have not been able to find the source, with very little help from neurologists or ER doctors. I do not take any other opioids for migraines and my regular drug does not cause rebound headaches, per my neurologist! I guess I'm not a "good" medical researcher! Of course, with the new opioid laws, I can no longer get these shots, but I would still like to know the actual metrics on this method. Thanks very much!

  1. Phew! You're right that information is NOT easy to find. And, like everything in science, the answers emerge slowly and it takes time for humans (even scientists) to change their minds...our minds aren't as flexible as they were when we were young!

    It seems that the Hydromorphone, itself, does not cause rebound migraine; just in terms of the side effects listed on the FDA drug sheet (https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019034s018lbl.pdf) Headache is noted under the "Less Frequently Observed Adverse Reactions" category but migraine is not indicated.

    However, it also seems that evidence is mounting that hydromorphone, and other opiates, may not be the MOST effective in treating migraine pain, over the general population (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990028/) compared to dopamine receptor antagonists, such as metoclopramide and prochlorperazine.

    It sounds like you're on of the "lucky" ones for whom this medicine actually does give relief. I imagine as more research supports a shift away from opiates for treating migraine (regardless of the general opiate overuse issues that make them so hard to access for those who actually need them), you'll see them used less frequently. I hope this information helps answer your question.

    Martha
    Migraine.com Team

    1. Thank you, I really appreciate the help and the information. As a friend told me the other day, it is not good to be an outlier when it comes to medical treatment! I will check back into my records to see if I have tried the two dopamine antagonists. I probably have, as I seem to have tried everything else! Unfortunately, I live in Ohio and they have basically outlawed these shots for anyone with chronic pain. It appears that they have outlawed them because if you are not in pain, they give quite the high, and Ohio wants to prevent that, without consideration for those in severe pain! As most people in pain experience, we do not get a high, just the end of pain.

  2. I recommend having your primary migraine provider (neurologist or gp) draft and sign a letter that specifies the best course of er treatment for you.

    The current leading model is to avoid narcotics, but if this is what is best for you, a letter from your doctor can facilitate getting the correct treatment for you if you need the er in the future.

    You can find a sample letter called Migraine Action Plan (M.A.P.) online. There is one for schools/children and one for E.R.s. The ER one does recommend avoiding opiatesynarcotics, but you can still use it as a template to draft your own plan.

    I also use a M.A.P to help guide myself when migraine ruins my cognition and it is availible for friends and family so they can help me with treatment also.

    Good luck!

    1. Thanks for the suggestions. Unfortunately, my last two neurologists would not write a letter! The second last one did all the time, then the hospital chain said no narcotics for migraines!

      My most recent neurologist also will not approve narcotic shots! I don't know if that is her medical opinion or whether she is restricted by the hospital chain she works for. I have discovered, the hard way, that doctors do not like to be questioned!

      And, my pcp will not do anything either, due to high risk and DEA! This is my opinion, not his statement.

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