Not Drug-Seeking. Relief-Seeking: Feeling Judged When Seeking Medical Care
Most of us have experienced it: being treated as a drug seeker when pursuing treatment for migraine. Whether it be when searching for a new doctor, going to the emergency department for an intractable attack, or when getting a prescription filled, many migraineurs have experienced some sense of being accused of being a drug addict feeding a habit when all we want is relief from pain.
The emergency department is no place for migraine
I think we can agree that the emergency department is no place for someone experiencing a migraine attack. The bright and fluorescent lighting, loud beeping of monitors, screaming babies, and an interminably long wait make it truly is the last place anyone with an actual migraine attack would choose to go. We only voluntarily expose ourselves to this kind of painful sensory overload when an excruciating migraine attack leaves us completely out of options. We go to the emergency department only when we’re exhausted, dehydrated, and desperate, and when nothing in our personal arsenal has worked.
Being treated with suspicion
While I appreciate vigilance in the face of the current opioid crisis, I wish that emergency department staff could be educated about the plight of the migraineur to more fully appreciate this complex neurological disease. I know they are suspicious that we are drug-seekers, but I can only assume there are easier ways to score drugs than by faking extreme pain and vomiting, sitting for hours in a noisy, stinky, windowless space, paying an exorbitantly high hospital bill, with no guarantee of being given opioids or other narcotics.
Rather than being treated with compassion- like someone presenting with a visible condition such as broken bone, people with migraines are often greeted with a series of weighted questions. These questions are designed to test our claims of pain. We are asked about our treatment protocol both at home and in past visits to the emergency department. If our answer includes any opioids, we can feel the medical provider silently exclaiming, “ah-ha!” as s/he declares that this class of medications will not be employed in our case.
Lack of specialized training
Emergency department doctors have generalized knowledge in a wide array of areas but often lack in-depth training on specific medical conditions. For issues such as migraine, specialized physicians may be called in to consult. Unfortunately, there are a scant few migraine specialists in the world, so the emergency department physician often relies on neurologists for advice. However, general neurologists may lack specialized training in migraine, and may not have the latest treatment options in mind.
Further complicating matters is the fact that there is some disagreement within the community of migraine specialists and neurologists regarding the best course of action for prevention and treatment. This, most likely, due to the fact that there is a wide variety of migraine types and many kinds of treatment strategies available. Finally, few patients respond to the same medication in the same way.
The question of opioids
The use of opioids as part of a migraine treatment protocol is an especially hot topic that causes strong disagreement among migraine specialists for many reasons. Many believe the introduction of these medications into the patient can actually flip an irreversible switch transitioning episodic migraine to chronic migraine. Others believe wholeheartedly that, for a select few patients, this course of treatment has proven to be the only one that actually works.
Strategies to quiet the accusers
Here are some approaches to help quiet those who may overtly or subconsciously accuse you of seeking drugs:
- First, create an established relationship with a migraine specialist. Though these doctors can be hard to find due to a current nationwide shortage, it’s worth seeking them out. They are the best trained to navigate the complex neurological disease that is migraine. A good migraine specialist will work with you to develop a strategy for how to handle a persistent migraine attack while avoiding the emergency department.
- If you do have to go the emergency department, work with your doctor (even your general practitioner if you cannot find a specialist) to create a list of interventions that might work for you or have worked for you in the past. For particularly intractable migraines that require a visit to the emergency department, that may involve some kind of IV infusion of several medications. This will show the doctors and nurses that you are prepared, know your history and what you need. Have your doctor’s contact information and a list of all the medications you take on hand.
- When doctors, pharmacists, friends, or others seem to be judging your medical plan, remind these people that you are under a doctor’s care, and your medical care is between you and your doctor.
What other ideas to you have to deal with feeling accused of seeking drugs instead of seeking relief? Share your experiences in the comment section below so we can learn from one another.
Have you taken our Migraine In America Survey yet?