The Good, The Bad & The Ugly- Emergency Room Visits with a Migraine-Part 1

To a person who suffers from migraines, especially Chronic Migraines, like myself, a trip to the ER is a fairly common occurrence. Having had Migraines for over 30 years, I have experienced every range of visit from the Good, the Bad to the really, really Ugly! Unfortunately, the majority have not been very good. I choose to share some of my experiences, in hope to help others know that they are not alone, and also to share some ways we may be able to begin to find ways we can see more Good than Ugly.

Wheeled in by your husband or friend in a wheelchair because every step feels like an earthquake in your brain, sunglasses on and still the light is killing you, the drop of a pin sounding like someone dropped a tray of glasses, you check in. These people want to talk to you! TALK? REALLY? Your speech is slurred and it takes every effort to speak. Can you describe the pain? Ummm…. Hot pokers being pushed through my eyes! Jackhammer in my brain! Vice on my head! What is your level of pain on a scale of 1-10? You want to say 18 but know they will think you are over reacting.

Finally, back into a room, they take your blood, shine a light in your eyes, and want you to pee in a cup. (toxicology screen). Having done this for 30 years, you know what meds will usually break the cycle. Just FIX it you want to scream, but if you do, it will hurt your head!

The Ugly

In light of the latest Opioid “Freak Out” going on right now, and having no real diagnostic tool to SHOW a migraine is actually happening…  A migraineur shows up at the ER and the first thought on the ER staffs’ mind is that you are someone looking for a drug fix. That seems to especially hold true the younger you are as well. I have been told I knew too much about the medications required, I must just be looking for a fix! I have been left lying in a room for over an hour before any type of medication was administered, just to see if I really was serious. It took my husband getting upset at the ER Doctors to get them to act. Because of also having Parkinson’s, there is only one type of anti-nausea medication I can have and that is Zofran. After having repeatedly told staff this, we actually had a nurse try to dismiss this and give me another anti-nausea med. Every medication that is administered is now checked by my husband!

Just recently, we spent 22 hours (yes that is correct!) at the ER! 10 hours in waiting room/triage. At least the nurse was nice enough to allow me to come out of general waiting area to a quiet triage area. But, still, 10 hours with no food, no medication, and 1 bag of fluids. When we were finally called back to a “room” in the ER, it was more of a draped off area with a recliner, not a bed. You could hear EVERYTHING! Lights were glaring! I was miserable! No food or drink, as they assessed situation. They had my electronic records, they could see I have Status Migrainous – “The International Headache Society has classified Status Migraine as “A debilitating Migraine attack lasting for more than 72 hours.”

First treatment, Zofran, and Toradol. May as well have been shooting my IV with water. Another few hours down. Second round of treatment, Depakote &; Magnesium Sulfide and more fluids… Now if they had let me go with maybe a Morphine chaser and said “Go Home!” I may have been able to sleep it off, but they waited too long and we ended up back up level 10. So on to the last treatment, according to them, Ketamine drip. All in all, a very UGLY visit!

At best, you can hope to get out of the UGLY ER visit is a very long wait for medication and not the right kinds that will break the migraine cycle. You end up going home no better than you came, but you have a really special bracelet and a Band-Aid to show for your visit!

The Bad- (Well at least they tried)

I use the term BAD somewhat loosely here. At least they believe us we have a migraine! Some may not really believe our ability to actually function at a level 10 pain level, and that we are slightly exaggerating, but they are nice enough to keep the lights off in the room you are put into, unless they are doing something with you. We refer to these as the “Gee the Excedrin Migraine didn’t work?” attitudes. The problem with the “Bad” visits are that often times the ER has a single protocol for treating migraines and do not deviate from that protocol. This can be dangerous is someone is possibly having a stroke, or aneurysm or atypical migraine. Also one type of protocol does not always work for every person. I have found in these instances, general sympathetic ER staff, slight willingness to listen, but usually only a temporary relief to the migraine. It is like putting a Band-Aid on a sucking chest wound.

Part 2: Will look at The Good and ways we can get more Good visits!

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