Do You Have Any Tips for a Respectful, Effective ER Visit?

Do You Have Any Tips for a Respectful, Effective ER Visit?

Over the last few years of writing for migraine.com and engaging with you awesome community members, I’ve noticed something that I find so disheartening: it seems that many of you have been treated as drug seekers when you’re seeking proper care for your migraine, and that makes me so frustrated and angry.

Reapeatedly refusing morphine

My most recent migraine-related ER experience (which was more than three years ago, thank goodness) was sort of the opposite of what many of you describe. I repeatedly told the doctors and nurses that my pain wasn’t too bad (it was mainly the nausea, the migraine’s duration, and the dizziness that caused me to go to the ER in the first place—I thought they could interrupt what may have been status migrainosus). Despite my telling everyone that I did not want any morphine, it was brought to me three different times. I repeatedly refused and informed them that research suggests that morphine isn’t actually a good migraine treatment for ER care. When I was feeling better, I dropped by the checkout office and said, “I have a feeling I’m going to be charged for morphine, but I refused it multiple times and it was never administered to me. I just want to make sure it doesn’t appear on the bill.” The woman working assured me it’d be fine.

Guess what? I got the bill a couple of weeks later and—you got it!—morphine was on my bill. It took me months to fight it.


So many migraineurs in the ER are refused drugs that will actually help them, drugs they’re actually rightfully seeking under a specialist’s care. They’re treated as addicts, as seekers who will perhaps even fake a migraine in order to get high on drugs. Here I was in the total opposite situation. Even in my migraine-induced stupor, the irony wasn’t lost on me.

Feeling helpless at the ER

This is not to say I haven’t been treated as a drug seeker in the past. As a very well-informed migraine patient, I have to speak up for myself while being aware that the doctor(s) on duty may not welcome the input of someone without a medical degree. Thankfully, it’s been awhile since I’ve had a migraine that required emergency intervention, but I do feel a little helpless on that front. I have friends who are RNs and nurse practitioners who claim that even if I bring a note from my neurologist saying exactly what emergency treatment she recommends for my migraine, the ER doctors will ignore it. Perhaps they’re jaded, perhaps not. Unfortunately, the only way to test their theory is to get to the point where I need to head to the hospital, letter from my neurologist in hand.

This question is for those of you who have mastered the fine art of seeking migraine treatment in the emergency room.  How do you make sure you are treated with respect and integrity?  For those of you who carry around a letter containing specific orders from your migraine specialist, how do hospital staff react to that letter? Do the doctors and caregivers give you the important care you deserve?  Any tips you could share with me and our community about how to navigate the ER would be so helpful to us all. 

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 (55)
  • sarahblankenship
    5 months ago

    I have not had to go to the ER in abour 4 years, the last time I fainted on a home visit (trying to work sick, never wise but sometimes necessary) and didnt wake up until they put me in an ambulance. I still keep a card in my wallet with my insurance card and med list. It says that I have aphasia with migraines, and I do not want narcotics because they won’t help. Fortunately, my neuro is affiliated with the only hospital here, and she put in my records at her office to tell the ER not to give me narcotics for a migraine. I also have fibromyalgia, and adding in narcotics seems to make the recovery that much harder. I have to travel at times for work, I have a letter asking that ER staff not give narcotics for a migraine, the one time I used it, it helped. I have a list of the cocktail that works best, and I have learned to never say the pain is a 10 (30 years of experience tells me it can always get worse). I have no idea how to help when the staff doesn’t know you, but taking a letter saying no to narcotics helps.

  • cindyditty
    5 months ago

    I get Botox, I have imatrex injextables and Maxalt MLTs at home. By the time I have exhausted my meds at home and have to go to the Er I am a disaster as someone else said. I’m usually wet from a shower and have put on whatever I can and I can’t see and get driven by someone else. I make them turn off every light they can in the ER and they are almost always accommodating. Speaking ain’t happening much so it’s apparent I’m not well. I have been given everything under the sun for migraines. Opioid drugs give me a rebound and I let them know that from the instant the dr comes in. This helps them understand better what I need. It’s like “Please help me! I have taken XYZ and I need help. I can’t take opioids it I will rebound. Can you give me the migraine cocktail? I just want it to stop and go to sleep.” That usually helps. Explaining that you cannot have Opioids is the number one thing that has helped

  • griff
    5 months ago

    Please explain what is migraine cocktail…..sometimes an injection of toradol will help me

  • sbalafas
    5 months ago

    I make sure I always have my medications with me when I go to the er. If I go with a full bottle of percoset they do not treat me as if I am faking a migraine to come in for a fix. On one visit to the er when I did not have my medications with me the nurse went so far as to say she couldn’t get an IV in because there was so much “scar damage” to my arm veins. The only times I have ever had needles in my arms were the two times I was pregnant and had to take blood tests during pregnancy and for my yearly annual well check ups. I have been on the floor vomiting into a bed pan and had a nurse walk into my room, look at me and walk out. Having your meds with you has been the only thing that has made these visits tolerable. I have had migraines for 30 years and I am now 48. Once I have been to the er and shown genuine compassion. But at least bringing my meds I get treated less like a drug abuser.

  • dschoen
    5 months ago

    Tip for respectful, effective ER visit? Don’t go. I call my neurologist for a steroid pak when I get an out of control migraine. Sure, it takes a few days’ longer to effectively work. But worth not being treated like a criminal when you are in ungodly horrendous pain. I have never had a respectful ER OR medcheck visit for migraine and I had gone multiple times before I explained to my 3rd neurologist what a visit is really like and got her on board to treat me at home.

  • Juju1
    5 months ago

    About 6 years ago, my migraine had gotten out of control. My father took me to the ER. I had a letter from my neurologist stating that I needed Benedryll, Phenergan, and Toradol to abort my migraine. The ER staff was offended. Instead, they gave me pain medication which made me sleep. Guess what? I woke up with the migraine. Luckily, my neurologist’s office was open and they treated me. Over the years, I too have been treated as a drug addict at multiple hospitals by multiple medical staff. It is so frustrating!!

  • TinyTiger
    6 months ago

    I am one for education. If you KNOW what a doctor I is about to do, then if they deviate off plan you are better prepared to ask questions. When I started getting migraines bad enough I would end i the hospital this is one of the first articles

    I read:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737484/pdf/10.1177_1941874412439583.pdf

    Along with;
    https://americanheadachesociety.org/wp-content/uploads/2016/07/NAP_for_Web_-_Acute_Treatment_of_Migraine.pdf

    There are many newer and better articles out there, but they can go above my head. This infor helped with anxiety to know what might happen.

    My next suggestion is to go to a smaller hospital if you live in a city with multiple hospitals. The staff is less likely over worked, the weights short, and atmosphere better (decreased waiting time).

    Also, become familiar with the syptoms of a stroke. This could save your life or a time of money, time, and work-up. Do don’t be afraid to advocate for yourself in all ways needed.

    Be polite to the nursing staff. EDs are difficult to work in. They cannot be there every second.

    Drug seeking accusations, take names (badges with names and professions must be worn at all times). File a corporate complaint against all involved, but be ready to pursue it. Suing, yelling, etc doesn’t hel you or make them change.

    Best advice- be your advocate, do your research, listen and remember 99.9% of doctors do not mean you harm or to make you feel bad.

  • dschoen
    5 months ago

    Some of us don’t have the option of going to a different hospital based on insurance stipulations. Wish there was more flexibility :l

  • kimmersutphin
    11 months ago

    I have had migraines before I could tell my parents my head hurt they tell me that I used to hit on my head with my hand when I was just a young child the first I remember was 3 years old and missing the first day of swimming because my head hurt and I was nauseated and sick and had to stay on the couch with the air conditioner running and cold Rags on my head and my dad gave me BC to take. I’ve had some horrible experiences at the ER because they think I’m speaking drugs and after they see that I’m on pain medicine for chronic pain and migraines they almost refused to give me anything so if I don’t have to go I don’t i go to katamine infusion center if I get one that I can’t get rid of after a few days is the out-of-pocket expense that I don’t like cuz insurance doesn’t pay for it but within 10 minutes of the infusion starting my migraines gone. I have shots and sprays that I use and mostly they help and I can get through the month with only having to go to the infusion center once a month I’ll do anything not to go back to the ER and be treated as a drug seeker so I have no advice on how to have a respectable ER visit anymore. They did give me ketamine twice at the ER like a couple years ago but a doctor has to be with you and monitor you the whole time and I think that’s the reason they stopped doing it is because they use their time up. That is how I learned that katamine would stop my migraine.

  • camee
    11 months ago

    I have had a couple successful er visits. That was 20 years ago and in a small town where people knew me. I don’t even bother now. I take dilaudid for my back. If the er knows that, they’ll send me right out the door. That’s after they accuse me of drug seeking. It’s so hard to deal with migraine pain. It’s even harder now that drs can’t prescribe certain drugs because of the “opiate problem”. There is one drug that helps my migraines. Butorphinal nasal spray. Nobody will prescribe it for me. My neurologist moved to CA. She gave it to me, she knew I needed it. So, now I’ve done my second round of Botox. Lovely treatment! The first dose doesn’t really work and according to my new neuro, with whom I’m not happy, the second dose probably won’t go into effect for a few weeks. Thanks dr. That’s the treatment plan. That, and take ibuprofen. Really? If ibuprofen worked I wouldn’t even be in his office! I’m to the point where I’ve almost given up. Er visits are worthless today. Too many think we are just seeking drugs.

  • dschoen
    5 months ago

    I did 4 rounds of Botox before my insurance stopped covering it. It didn’t work anyway, so I stopped.

  • tjbtaylor9
    11 months ago

    It is a good idea to carry a device with your history, your specialist’s name, your medications and any complications or risks you have. I am a stroke risk for triptans. ER staff are rushed and often are not trained well in the management of migraines. Show the doctor your information, often I am confused when I am brought to the ER. It is OK to tell the doctor if the ER protocol for migraines works for you. My ER has an effective cocktail that does not include opiates. They only use opiates as a last option. I find if I take the ER cocktail immediately at home it saves a trip to the ER. It is one IM injection of Ketolorac, 50 mg of Benadryl, promethegan for nausea plus steroids. I usually don’t have medrol on hand but my Neurologist will phone it in. If you go often enough, you can tell them what they usually do that helps; it’ll be in their data bank for reference. The important thing if you want to be listened to is to be clear and ask the doctor if they understand what you are talking about.

  • BayouTigress
    11 months ago

    I have found better care at an Urgent Care facilities than at ERs. They listen more and are less bound to established treatment protocols.

  • Hendrix12
    1 year ago

    Usually when I go to the ER it is because things have just gotten out of hand. I have either run out of Amerge or I mitre or I have woken up too far into a migraine and the meds won’t work. I take countless hot showers and take whatever is available at home, before I give up and have my husband take me to the ER. Usually, by the time I get there I am a hysterical mess with matted wet hair, crying and moaning, and wearing whatever. I feel somewhat like a sideshow. They have tried all the cocktails mentioned on me. They pretty much all help, but leave me groggy and out of commission for a couple of days. Sometimes, I’m still left with a dull pain. Now, if I speak up for myself I will tell them just give me an Imitrex injection so I don’t have to ruin my day. This really works best and won’t leave me feeling groggy and I am able to fully recover. Usually they have their mind set on a cocktail of benadryl and toroidal and unless I speak up that’s what I’ll get. If you get a good doctor they will listen to you. It’s hit or miss.

  • brenda de jesus
    1 year ago

    I live in Miami Florida. I have suffered from migraines for many years. After giving birth to my daughter at 35 my headaches have become chronic. I take preventive medication but it’s not helping. I have done Botox to no avail. I have been on many different preventive meds, taken magnesium, drink lots of water, etc, etc, etc, and nothing. My latest neurologist has diagnosed me now with intractable migraines. I go to the ER several times a year some having to be back to back visit because the meds they give me did nothing for the pain. I often worry about being seen as a drug addict So when asked what cocktail works best for me I hesitate in letting them know. I usually tell them it’s up to them what cocktail they want to give me. The truth is the cocktail that works best for me is dilaudid along with Benadryl and zofran. I have told doctors before and there answer is, well I don’t use dilaudid because it gives rebound headache or because they just don’t feel in an effective medecine. So they end up giving me Benadryl toradol and raglan wich don’t work so then they give me some morphine that only alleviate it for maybe 30 minutes. By this time am frustrated and just want out. So because of this I end up having to go back the next day because the headache is so bad that I am literally begging god for my life. The next day turn around gets there attention and they give me stronger meds. Over all my experience with the ER is 50/50 when it comes to meds. Most doctors are set on what meds they think work best and they go with that. But some times you get the doctor that cares more and actually is sympathetic to your pain. As for the nurses most of them are great sympathetic also. I have to say it also helps to go to the same hospital where they already have your records where they see your history. Am going to say it also helps for them to see how frequent you go to the ER. I mean someone with a habit it’s going to frequent more than just a few times a year. At least that’s what I tell myself so that I don’t feel judged.

  • tjbtaylor9
    11 months ago

    I too suffer from intractable migraines. One day, after nothing would touch the pain, I remembered that when I completely snapped my wrist off, I felt zero pain for hours. My brain sent chemicals that kept me from feeling pain! I then remembered a friend that had been in bed for five years because of intractable pain. She learned hypnotherapy and biofeedback in a rehab facility. She got her life back. I love you tube sleep hypnosis for pain by Michael Sealey. His voice gently guides you through the session. First he asks you to access the pain in your body from one to ten. Throughout the session, you gradually back the scale down. I can be in tears from a migraine, listen to him and when I wake up I’m pain free. If you are new to hypnosis, it’s easy. Just listen. When other thoughts interfere, let them pass without focus. The longer you practice, the easier it gets and the better it helps. After you get the technique down, there are other sessions on stress relief etc that help a lot too. Good luck.

  • btmom
    1 year ago

    It is SUPER frustrating when they don’t listen, AND when they assume you want narcotics. I have had migraines for years, but recently I got an excruciating headache that wasn’t like any I’d had before. None of the meds I had would touch it – none of the triptans, not tylenol 3, not even Vicodin. Heat helped a little, ice did nothing. I went to my PCP and he gave me an IM injection of Toradol, which helped for about 3 hours. The next day I went to the ER, I told them everything, I gave them a complete list of my meds, held nothing back, but all they saw was that I had refilled my tylenol 3 twice in a short period (yes – I’d had a crippling headache for a week! I went through a prescription even taking it as directed!). So they gave me Toradol again even though I had told them it had not helped much. I had hoped for something like a nerve block or a combo nerve block and stronger medication to try and knock the headache out, but it ended up being a waste of over $600 in emergency room fees. I figured out how to treat the headache myself. It turned out to be responsive to gabapentin – note, NOT a narcotic – but I feel much better now.

  • Kshering
    1 year ago

    My fist migraine I remember was when I was 7, alway after school. I would go to my room and sleep till morning. It was about that time it was discovered I had was is now called a lazy eye. It specialist told my Mom since I had normal vision in my right eye, I didn’t need glasses. Hey it was the 60s. I continued to have migraines until I turned 16. I failed the vision test and had to get glasses. Drs aren’t sure if it was the glasses or puberty, but my migraines stopped for the most part. Or at least I thought they did. I was having auras, than I would get a headache, I never put the two together. I thought the aura caused the headache. Not that it was part of the migraine. Mind you I was told when I was young there was nothing to do but ride out the migraine. ., which I did until my mid 30s when I had a massive migraine that landed me in the ER. I was given a cocktail that included Demerol which I found out I am highly allergic to. But my follow up Dr was spot on within being a migraine, that there was a treatment for it. My migraines came back slowly as I aged. In 2000 I was in a car accident that resulted in having my neck fused at C5,C6,C7. I also started menapouse at the same time, boom, migraines became a weekly happening. I take Zomig to stop the migraines, and acupuncture to maintain. I’ve tried everything to prevent them, so far no luck.
    I read where children were sensitive to light. All my childhood pictures I’m not looking at the camera flash or I’m crying. My parents told me I was afraid of the flash, it hurt. Which they thought was me being a brat. To this day I do not like having my picture taken, as it will trigger a migraine. I also have difficulty driving at night, the car head lights are so bright, I wear sunglasses at night. I’m now 60 and I’m learning something new everyday about migraines. Thank you

  • jenfoe96
    11 months ago

    I had an accident in ’09 where I had my c3 and c4 fused, and I also had a traumatic brain injury. My migraines had always been sporadic, just a couple times a year, then they got a lot worse, and I had to wear my sunglasses at night. Then, for a couple of years it seemed like they went away completely (lol, short term memory loss has been a blessing and a curse, right?) but now I’m in a constant state of pain. I thought it was aura, because of the light sensitivity, not really sure now. I have to wear my sunglasses all the time now, and I have bad vision already, I was practically screaming at the woman I ordered my prescription sunglasses from, they’re like having nothing at all and I paid $260 for them, and the darkest after that were the tint which are miniscually better… I am not getting a full on migraine, which I’m grateful for, but it’s all the time. Have you always been sensitive to light, has it always triggered migraines, or was it just the bright flashes?

  • btmom
    1 year ago

    Mine started as a child, with auras, and I never got proper treatment until forty years later after I gave myself an ulcer by taking too many NSAIDS. Live and learn.

  • SavyDawn
    1 year ago

    I’ve suffered from Migraines since I was 6 years old. My mother has them and now my 6 year old son has them also. In my experience urgent cares have been the route for me when I can’t get in with my neurologist. I usually get an ice pack right off and they already have the light cut down. I get seen pretty quickly. My blood pressure get insanely high with my migraines from my pain level being extremely insane. I have really scary symptoms with mine also I lose all vision in my right eye with most of my headaches so to be seen at urgent care I have to take a note from my nuero or I would be sent straight to the ER. Anyways they usually give me a cocktail with benedryl, phenergran, toradol and the 4th medication differs bc I already have triptans at home so if I am at urgent care I’ve already maxed out on my triptans. Even with these urgent care trips I have to come straight home and go to sleep or I end up at the hospital bc nothing makes them go away completely if they are to that point. I’m already on botox treatments and prevention medications. I just find urgent cares are much nicer and quick … a much better e pierence and willing to do more of what your treatment plan is.

  • MiLynn
    1 year ago

    I’ve been to the ER many times because of a migraine and have had the same problems with doctors and nurses. I always go to the same local ER, one time I was blessed to get a new Dr. that believed me then put all my info and what to give me in my patient infomation. I have no idea what was different about his info compared to the doctors I saw before him All my husband had to do was tell whoever was working that Dr. So&So has all her information in the computer along with what works best for her. Nobody ever questioned me after that. This worked all but one time when my youngest daughter took me in. That doctor thought he knew best, gave me some kind of pain med so I ended back in th ER 6 hours later. I live in a more rural area so the doctors all know each other, at least by name. My husband talks to the ER people because if I am there I can barely walk or talk and have throwing up/dry heaving dozens of times in the last 24 to 48 hours. I look like death warmed over. I am lucky to have my husband to be the one to talk to the medical staff.

  • Lkutter
    4 years ago

    I guess this is for tips to the ER not experiences. I guess my tip would be to only go if you have sought out every option for relief at home and if you are throwing up and can’t stop and are dehydrated. I am lucky and my uncle has been my dr both times when I went in and Ive talked to him about if people in the ER thought I was drug seeking and he said absolutely not. He said he is always able to spot a true migraine sufferer by their appearance. He says most drug seekers come in and act like they are in horrible pain but are suddenly able to perk up and reccomend the types of pain relief they would like. They always have “preferences” but if a doctor sees you dry heaving bile into a bucket and you look like road kill then you should receive proper care. So I guess my tip is to let the doctors do what they do and be respectful to staff

  • Lkutter
    4 years ago

    I’ve only been to the ER twice for migraines and I don’t think anyone had any doubt I was in misery and pain. I can’t see, I’m dry heaving into a bucket, mascara running down my face, vomit in my hair, unable to even communicate with people, and not able to walk on my own. I think the term hot mess comes to mind. If they thought I was a drug seeker then their suspicions were changed when they saw how I reacted when they gave me Diladid (sp?) ugh wore feeling ever but it got rid of the pain. I’ve grown up with migraines though, I can deal with the pain at home but when I strt throwing up and can’t stop that’s when I go to the hospital…I guess I just don’t care what they suspect to be true or not, I’ve never even thought about it. Also when I have a migraine my dignity and respect is flushed down the toilet along with my puke so I don’t notice if someone is disrespecting me nor do I have the capacity at that moment in time to care

  • John
    4 years ago

    ER facilities are run independent of hospitals. You don’t have the option to communicate with your physician. The ER Dr is “god” and feel threatened at mention of another Dr. I have been told I’m the Dr now. So I avoid the ER usually at high physical cost. I’ve only had one positive ER visit in over 30 yrs. The Dr happened to be a migraineur.

  • Crystalrz4
    4 years ago

    I did actually carry a letter with me for years, from my Neurologist. Most of the doctors at the E.R. just ignored it and said that they would come to their own conclusions. He had also given me his home number just in case they refused to treat me or tried to force me to accept medicines that would have a negative effect on me.
    One of the tricks, however, that I did learn was to dress up nicely, coif hair and use a little make-up. They did indeed tend to treat me much better. It didn’t matter how bad I was feeling, this trick usually worked. They seem to listen a bit harder, paid more attention to me, and treated me with more care. It was my Neurologist who suggested it to me. He had another patient who did this and also got better care. It doesn’t always work, but more times than not it did. I still wore sunglasses due to it always being so very bright in there. No perfumes, no heels, flats only and tried to speak as brightly as I could muster under the circumstances.
    I also carried with me a sheet that I made up of all my medical conditions, the medications I use for each of them, the doctors seeing me for each one, how long I’d had each one and each doctor’s address, and phone number. Also listed was my blood type, allergies, and medications that I had a bad reaction to. I had all my contact info on it for those they could contact on my behalf, my medical record number, and primary doctor and his contact information.

  • Jess Anderson
    4 years ago

    I’ve had both horrible and wonderful experiences in the ER. I no longer go to the local ER’s in the hospitals closet to my home do to the awful treatment I’ve received. They’ve acted like they had no clue how to deal with migraines and just treated me like a drug seeker. My neurologist is about an hour & a half away from where I live and she insists that when I need to seek ER treatment I seek treatment at the hospital she has credentials at. I’ve had to do so twice now and one time the experience was good the second time not so good. The first visit they were wonderful, they put me in a room, kept the lights off except when necessary, etc. The second visit I got stuck out in the bright & loud hallway for hours before getting put into a room. I always wear very dark sunglasses due to my light sensitivity issues. Unfortunately the issue for me is that traditional migraine cocktails that the ER uses have no affect on my migraines, it doesn’t help that by the time I seek ER treatment my migraines are typically classified as Status Migraine. These last two visits to my dr’s preferred hospital I’ve had to be admitted for a 4 to 5 day stay of IV medications, luckily the cocktail of Magnesium, Keepra, Thorazine, Hydrocortisone, and Norflex that they are using works, it just takes a few days.

  • rebecca
    4 years ago

    For a while my local ER wouldn’t help me at all because I’m on a pain contract and they refused to give me any kind of pain medication. The only cocktail that really works for me when my migraines get ER-worthy is a bag of IV saline, Zofran, and IV Dilaudid. That is the ONLY thing I have found to break the terrible ones. But because I get oxycodone from another doctor, we stopped going to the ER for over two years because they wouldn’t give me anything that worked. I got offered steroids which didn’t help, saline which didn’t help because I wasn’t dehydrated, etc.

    But I actually had a really positive experience the last time I went to the ER, which was only a couple weeks ago (I was desperate). They turned off all the lights except one focused light for the nurse to work or my husband to read, they gave me the exact combo of meds I told them worked, and they gave me enough pain medication to break the migraine (1.5mg of IV dilaudid). The problem is that now I’m caught in limbo–I don’t know if I just got lucky, if they’ve changed their policies, or what. And because it involves pain medication, I can’t ask or I’ll get labeled a drug seeker and no one will prescribe me anything.

  • Tammy Stephens McDonald
    4 years ago

    Carry a list of the preventive migraine meds that you are currently taking. Let the ER doctors know you’re under the care of a neurologist who is willing to work with them if they will call his office. Have a copy of the neurologist’s business card ready to hand over. My doctor has written instructions for me to give the ER staff that they don’t always follow, but at least they now know you have chronic migraine. This helps set you apart from the drug seekers, and they may be willing to talk to them about what has worked in the past and what hasn’t been successful.

  • Julie
    4 years ago

    I have been battling migraines for over 40 years and I have been treated many different ways in the ER. The worst is when they “forget” about me as I am waiting for treatment. I understand there is a triage order but many times I know they thought I was faking until I vomit! I’m kind of glad when I do so they take me seriously. What has worked is having my husband there and using the same ER especially if it is connected with your PCP. The most effective is my husband documenting the successful “cocktail” on his smartphone. Benadryl, Reglan, Zofran, Toradol, Dilaudid via IV plus bag of saline.

  • Crystalrz4
    4 years ago

    I’m there with you. I’ve had migraines for 59yrs. I’m 63yrs now. I was forgotten one time for over 9 hours and was sure I was going to die. I finally talked my husband into going to the nurses desk and asking how much longer. Some “Lovely” soul had put my chart in the out basket, meaning I’d already been taken care of.
    I just LOVE E. R.’s!!!

  • barb
    4 years ago

    Good job for checking the bill Janet! I asked my Nurse Practitioner to give me a script that I could laminate and take to the ER next time I go (for a Toradol shot, an Ondeninsen (SP) shot, and IV of fluids) and she said she couldn’t do it.

    I hadn’t asked for one in a file before…I might have to do that. Thanks for the thought Juneleaves!

    The Urgent Care places nearby have always been much better than the ER for me, if I can catch them when they are open. They dim the lights, offer me a choice between 5 mgs Maxalt or Toradol injection 15 mgs, talk softer, and are helpful with letting me lay down for a bit. Once, a nurse who’s son is a migraineur, got me ice and a pillow and blanket. I would have kissed her if I knew her better. It was very helpful.

    I also though have been accused of being a drug addict…but only in the ER when I thought I was having a stroke. Sigh…it’s a catch-22 sometimes. Just check my brain please and give me a Torodol shot. Thanks!

  • Juneleaves
    4 years ago

    If you are a semi-regular at my local ER (5-6 times a year) ask your neuro to put a protocol on file. This is especially helpful since I do in fact use a narcotic when I’m in an intractible cycle. Every other opioid makes my migraine worse whereas dilaudid is a wonder drug. And like many here I’ve tried everything. I usually also get fluids and either decadron or toradol along with the pain meds.
    Once I got the protocol on file my experience has been so much better. I’m heavily tattooed so I’ve been truly stigmatized despite in every other respect appearing well groomed and “normal.”
    That said I loath having to go to the ER. It’s loud, the nurses can often though not always self righteous, and for god’s sake I’m in terrible mind blowing pain.

  • andy
    4 years ago

    i have been treated as drug addict and felt insulted and humiliated. They know NOTHING about migraines which I find unbelievable. What going on in Med Schools? I live in Santa Fe NM and go to Christus Hospital – which happens to be the only game in town.

    I think a few good law suites may start to bring the emergency room personnel around – my son is an attorney, but he’s criminal law … What kind of Lawyer sues people to get educated 🙂 ?

  • Sara
    4 years ago

    Great article Janet. My ER and neurologist (Kaiser) have decided to use the changes in hydrocodone to schedule II as an opportunity to deny all injectible narcotics to migraineurs in all situations, including emergency situations. While before I was treated with respect, now I am treated with disdain. Even though I have tried all of the alternatives, their new cocktail is toradal, depakote & DHE (which I think is a good idea), they won’t give me narcotics when I have a history of problems with these non-narcotic drugs AND I even tried them again to prove that I’m willing to try anything. Now I’m being “forced” to look into filing a malpractice suit for lack of treatment. My wish is that we could be treated as individuals, to be listened to, and respected for our opinions about our own bodies. Creating a policy that treats everyone the same, whether giving everyone narcotics or no one, is just practicing bad, sloppy, lazy medicine….

  • Evie75
    4 years ago

    The best treatment I ever got was when I happen to have a migraine when I was scheduled to see my acupuncturist. As soon as they knew I had a migraine they brought me into a treatment room and immediately dimmed the lights. Then they started doing a treatment called guasha (scraping my scalp with a stone). It was incredibly soothing and relaxing. The doctor put in several needles and at the same time did an allergy elimination treatment for hormones. When I left there about 45 minutes later, I did not have a migraine. I couldn’t help but feel like my acupuncturist was light years ahead of how they treat people in hospitals.

  • lilosmom
    4 years ago

    My daughter and I suffer from chronic migraines and we have both been to the ER a few times. We’ve actually tried several different ERs because of obnoxious treatment we’ve received. I have started telling them I’m allergic to codeine and morphine, so I don’t receive it. The hospital we prefer seems to understand — they always dim the lights before we enter the room and spray an odor neutralizer. They apologize before turning on any lights and leave them on as short a period as possible. They give a drip that is a combination of compazine, benadryl, and naproxyn that seems to work pretty well. It’s the first hospital I’ve ever gone to where I actually feel better when they tell me it’s time to leave! I have learned to take those three meds when the headache is moderate, and they really help. I’ve never had any narcotic cut the pain of the headache anyway.

  • CyberSylph
    4 years ago

    In Ontario, the ER has no Triptans or other medications that would be appropriate for treating migraine. The last time I went, they would only give me IV fluids and morphine. I told them repeatedly that morphine would make the pain and nausea WORSE, yet they insisted on giving me two IV bags of it before giving up and sending me home. The only narcotic I can use is Demerol, yet it is no longer available in Ontario hospitals because it is popular with drug addicts (and more expensive than morphine). I will never bother with the ER again. I have learned to give myself injections of gravol at home. Both the vials of gravol and syringes are available over-the-counter without a prescription, but you may need to order them in advance. You can store the gravol at home for two years without needing to refrigerate it. If you are going to try this, be sure to get your doctor to teach you how to do it safely, and never re-use the syringes. Gravol is about $3 for one vial, and a syringe is $1, so way cheaper for me than calling a taxi to get to the hospital. If you MUST go to the ER, bring a letter from your doctor stating that you have been diagnosed with migraine and are NOT a drug-seeker, and explaining exactly what he expects them to do for you. Also carry a list of drugs that don’t work for you, so they don’t waste your time.

  • kaysus1973
    4 years ago

    I have always been treated with respect. Every time I go in, the first thing I say to the treating doc and nurse is “No narcotics”. I had one doc say to me once “So what do you want?” I said, “What?” He said “Vicodin, percocet…” Me – “I don’t WANT anything. I NEED….(whatever my abortive treatment was at that time)” He shook his head and walked out. I asked the nurse what that was about and she said that he never gets that response…most people who come in with a migraine say they need percocet or vicodin or something. So I guess I busted that docs view of people being drug seekers! I am on my 7th headache doc…most of them are certified headache specialists. NONE of them have ever prescribed narcotics. I remember when I became chronic, of course I asked the doc about it. He explained why that wasn’t a good treatment….and I have never questioned it. It is just normal for me. Someone on a FB group said to me “If your headaches were bad enough you would take those narcotics.” Oh did that make me mad! She has no idea how I suffer! She has no idea what this illness has robbed me of! I just choose to not use narcotics…I am 41 and I know I would never get off them. I am getting ready to have a trial occipital nerve stimulator…also diagnosed with Occipital Neuralgia.

  • chiaragtl
    4 years ago

    I’m far from being an expert, but I would like them to do a little neurological check-up. because when I went to the ER back in january they didn’t! :-/
    sure I told them I had migraines, so they sort of knew I wasn’t about to have a stroke or something…but it’s still really bad form not to do a proper neurological check-up. Asking questions and seeing how you answer is not enough.
    I suppose they can’t get rid of those bright neon lights though.

  • Lifelongmigraines
    4 years ago

    I use an out-of-town dr but go to my local ER when the pain is too much to handle. Most of the local Drs know me socially. If they don’t, all I have to tell them is my neurologist’s name. Only once have I been treated disrespectfully. The ER dr actually came into the room and slammed a metal trash can against the wall to see how I would react! What a jerk!

  • barb
    4 years ago

    Did you call later and complain about that Dr.?! That is horrible!

  • Jen H
    4 years ago

    I have many health issues and migraines are one of my newest issues. Every time I go to the ER I make sure to bring to a comprehensive list of all the meds I’m on, all my diagnosesm, what I’m allergic too and who my Drs and Emergancy contacts are. Usually when the Drs see my list they don’t mess with what drugs to give. I usually get a very simple mixture of meds that I orherwise have no access to at home. I also grew up with a mom who was a nurse. So I have whoever is with me – or if u have to I do it myself – write down what I’m given and at what dose. That way I can fight easily if the bill charges me for something else. If it’s not electronic – usually when my fiancee takes me – he gets the dr to sign it so if the hospital ever has a problem I have a sea signature as proof we got it all right. If I’m by myself I use my phone as the only way to document the meds but I get the name of the dr anyway. I find that I have to advocate for myself a lot. Most times I struggle with Drs treating me for symptoms that are similar to migraine symptoms when I’m ry sick and they simply wave it away as a migraine symptom – now that I truly hate. But when I have a migraine and I go to the ER I use every tick Ive been taught by my mom. Once I was put in a bright hallway for over an hour with a horrible migraine. After I felt better I asked to speak to the administration and asked them straight out of that was part of the appropriate treatment I should have gotten – especially when I came in with a level 9 pain scale migraine. They told me that no that was not right and looked into it. Later I recieved a letter from the hospital with a detailed apology and it stated they would better train their staff. I have learned to be an advocate for myself and those who suffer from migraines.

  • JenniD
    4 years ago

    One of the common treatments in the ER here is IV Compazine along with the opiate or narcotic. Compazine makes me insane. I’m like a junkie coming down. I’ve tried to take the drip out myself, get paranoid, etc. Even if I ask them to push it slowly and in two separate doses with Benadryl after each push — It’s horrible. The first two times I told them I couldn’t stand the Compazine. I got “the look”. It wasn’t until I started asking for either Reglan or Phenergan in place of the Compazine that they started taking me seriously and treating me with more compassion. To me the ER experience is almost as bad as the migraine and I avoid the place like the plague. But the 3 times I have gone since I started asking for a replacement anti-emetic, it has been much better and the staff has taken me seriously, not giving me the third degree to try and trip me up. I usually wear sunglasses when I go in, have to remove them for triage but after I do and they can evaluate me (I usually need the barfbag as soon as the glasses come off), the staff generally becomes more compassionate and interested in helping me.

  • rebecca
    4 years ago

    I have compazine listed as an allergy on my medical chart because it makes me manic. Phenergan works fantastically well, and I take that a lot, and I’ve had luck with IV Zofran in the ER but I will never, EVER take compazine again.

  • Sara
    4 years ago

    I am EXTREMELY allergic to Compazine as well. In a word, it makes me homocidal. Literally. I now take zofran, as I’m allergic to phenergren and reglan too. Too bad because compazine takes away my migraine!

  • kaysus1973
    4 years ago

    In every hospital ER I have been in (and it is many) opiates are not the standard treatment.

  • cindyd
    4 years ago

    I went to the ER once and had a horrible migraine. . . after the usual LONG, LONG ER wait in the waiting room, I was taken to a room and my husband was with me. A doctor came in and told me he had a history of migraines as well and, for a moment, I felt he must understand how bad it was. Then, all of the sudden, he took a light and shined in my eye where I get my migraine! I grabbed my eye and started to cry and he got out of there quick! I just cried and cried. My husband went looking for him but did not find him. That made me feel like he felt I was drug seeking but that is not the case. I was so sick I had to have an IV with fluids and medication as well. Very bad experience for me . . .

  • barb
    4 years ago

    Ugh…my neuro, even when I’m having a headache, will at least check my ‘bad’ eye from the side to see how my pupil reacts. dude, he could have warned you. Bad bedside manner.

  • Sara
    4 years ago

    I hate it when they do that too!!! My ER is connected with my neuro and GP, so they usually don’t do a neuro exam anymore. But I just want to die when they do it….

  • cindyd
    4 years ago

    kaysus1973 – I know medicine. I have worked in the medical field for over 21 years. He was unprofessional for not warning me what he was going to do and not sticking around after seeing how at affected me. I know about neuro exams.

  • kaysus1973
    4 years ago

    That is part of a general neuro exam.

  • MIScramlin
    4 years ago

    Migraines run in my family. I’ve never yet had to go to the ER to alleviate the pain, but I have taken my Grandmother many times. The thing that is the most helpful, I’ve found, is that you need to take someone with you that can assist you with communication with the medical personnel. They need to be able to politely, yet firmly, advocate for your best treatment and see that you, as a patient, are treated with the respect that you deserve. Another reason I go with my Grandma is because they see that she is over 70 years old, so they automatically assume that she is senile, so they talk to her like she is an idiots, and I’ve actually told healthcare workers that they’re speaking to her inappropriately(They speak normally to me but talk to her like she’s stupid). Whomever you choose to go with you, they need to be familiar with your past medical history, current medications, and allergies. The hospital will require that you have someone to drive you home anyway so have your driver go with you into the exam room. Also, when you first get to the ER ask for a barf bag; they don’t like it when you bring your own.

  • Sara
    4 years ago

    Once I barfed while “signing in”, while going back and the whole time I was in the room (I had my own barf bag). Man – they gave me treatment fast! I’m almost tempted to make myself sick every time I go to the ER….

  • Tammy Rome
    4 years ago

    Great tips! Strangely enough, my ER takes me much more seriously when I do show up with my own barf bag…especially if it’s been used. 😉 It may help that my doctor provided me with several of the same ones used at hospitals.

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