Migraine in the ER: Treatment Guidelines From the American Headache Society.

Migraine in the ER: Treatment Guidelines From the American Headache Society

During a migraine attack, going to the ER can seem like a nightmare come true. The lights are blaring, sounds are loud and unpredictable, and the odors of a hospital turn your already-nauseated stomach. Having an unwelcoming environment exacerbate your symptoms is awful, but that’s a minor irritation compared to having to fight for treatment. A person goes to the ER during a migraine attack with one goal: to reduce the severity of an unbearable attack. Yet, they often feel like they’re treated not as people in pain, but as addicts trying to get high. To help patients get better care, the American Headache Society has issued new, research-based guidelines for treating migraine in the ER.

Recommended medications for the first ER visit

For a patient’s first visit to the ER during a migraine attack, the experts who created the guidelines recommend an Imitrex (sumatriptan) injection and Reglan (metoclopramide) and Compazine (prochlorperazine) by IV. Patients should also be given a prescription for dexamethasone, a steroid, to take at home to prevent the migraine from recurring.

Alternate list of drug options

The expert panel is aware that those drugs may not be effective for every patient or that patients may have already reached their maximum number of triptans for the day. For these patients, the guidelines include alternate lists of drugs. Which medications an ER chooses to use depends on each patient’s needs. It’s best to talk with your doctor during a regular appointment about which medications they would recommend for you in the ER. Ask for a letter outlining the recommendations and be sure to take it with you to the ER. Not every ER will follow the letter’s guidance, but having suggestions from your doctor increases the chance you’ll be given a treatment that’s effective for you.

Strong research to support drug efficacy

The medications included in the guidelines were chosen after a comprehensive review of emergency migraine treatment. Experts looked at 68 studies that used 28 different injectable medications. Five of the studies also assessed steroids for preventing migraine recurrence after a patient leaves the ER. Medications were evaluated for how effectively they reduce a migraine attack’s severity and also for risks and adverse events. The medications recommended all have strong research to support their efficacy in the ER.

ERs throughout the country currently vary widely in the treatments they use for migraine. Benjamin W. Friedman, M.D., a member of the expert panel, said that about 20 different medication combinations are used and some of them are not very effective. The American Headache Society issued these guidelines to help patients find effective relief without risking future complications, like medication overuse headache.

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.
View References
  1. Anderson, P. (2016, Jun 17). New AHS Consensus on Emergency Migraine Management. Medscape. Retrieved on Jun 17, 2016 from http://www.medscape.com/viewarticle/864989.
  2. Orr, S. L.; Friedman, B. W.; Christie, S.; Minen, M. T.; Bamford, C.; Kelley, N. E.; Tepper, D. (2016). Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache: The Journal of Head and Face Pain 56.6 (2016): 911-940.

Comments

View Comments (54)
  • JLAM
    3 weeks ago

    This is dangerous advice. Migraines precede TIAs and stroke in many cases. Ischemic (blockage) strokes, which are 85%, need blood thinners and triptans can turn a TIA into a full-blown stroke.
    I lived this.

  • ladymet117
    1 month ago

    Hi Kerrie. Nice suggestions, but it won’t work. I know what works for me and that’s morphine! I tell the doctor this but nnnoooo, he/she wants to give me DHE or its relatives. I hate DHE, it makes me feel worse than I felt when I came in the ER! I show up wearing my “Ray Charles” shades w/ear plugs in my ears. And I’m a nurse! They say “Oh you have narcotics at home”. If the narcotics at home worked, I wouldn’t be here! That’s why I don’t go to the ER anymore!

  • JLAM
    3 weeks ago

    You and I both!

  • Thiarnain
    3 months ago

    You’re very lucky that there is a clinic for IVs where you can go in an emergency that works with your doctor. I’m currently treated in the Mayo Clinic after 10 years with other neurologists. In my experience, they do what they want to do anyway. Whatever their list of prescribed medicines is…if it helps good and well. Because that is all that they can do. (! SeriouslY) Never mind check in with my Mayo doc.He wouldn’t go down to the ER or communicate with them, he told me. Considering some meds work for some people but are useless to others, this is a very unsatisfactory state of affairs. Sometimes, before I ‘ve met my out-of pocket deductible I have to pay $2000 for this experience. So it better be good and I think twice before going.

  • hanginon
    3 months ago

    I did not see the other lists either medication comninations.

  • bcavanagh
    6 months ago

    I am highly allergic to triptans!

  • Autumn Sparrow
    6 months ago

    This has me scared to ever go back to ER for a migraine. Sumatriptan injections cause my body to feel like it’s on fire, last time I was given steroids they put me in the hospital for 8 days and reglan makes me agressive (Drs & pharmacist have advised that I avoid all of these meds moving forward). I dreaded going in before reading this but I doubt I’ll ever go back now that I’ve read this (which is better than wasting time & money in a less than ideal setting). I asked my neurologist for guidelines for er last month and now get why he didn’t want me going in at least.

  • Roxieb
    6 months ago

    The last time I went to the ER for a migraine, after telling the receptionist that I had been to urgent care the day before and was told to come to the ER if not better, I got an ” Oh goodie” and a 4 hour wait before I was even seen. Never have been treated so poorly.

  • Ellifane
    12 months ago

    I would go into the ER begging for toradol, being the only med I knew of and it took the edge off. This one time the nurse came in telling me that the dr ordered a double dose for me. I figured he was just happy someone came in asking for something other than a narcotic. Now I just avoid the ER, I can’t afford it and it’s a time sink.

  • litoria76
    1 year ago

    I wonder what the guidelines would be for someone who cannot take triptans. I’m also diabetic so steroids cause a jump in my blood sugar. I guess I’d rather stay home in pain where at least i can be in a quiet, dark room rather than being treated like a drug-seeker. In the 5 years of multiple treatments with my neurologist, we’ve determined Percocet to be the only effective treatment that doesn’t interfere with my various medical and mental health problems & she only gives me 30/month which equates tp treatment for up to 15 of my 25/month migraine & she made me sign a controlled substance contract… Sorry, just frustrated and in pain.

  • litoria76
    1 year ago

    Btw this neurologist has told me “it’s all in my head”! I’m reluctant to get a referral to a headache specialist for fear they will say the same thing…

  • Roxieb
    6 months ago

    Don’t be afraid to get a referral. I went to a neurologist for 2 years and he just kept upping the dosage of the same 2 meds with no improvement. Found my own migraine specialist and found out rhe neurologist was ficing me 2 times the recommended doseage of one. Trying diffwrent comvos of other meds now with some improvement. A migraine specialist can have a much better understanding of your triggers.

  • Ellifane
    12 months ago

    But it’s in your head and that’s where the problem is. You just need to find someone who is more compassionate and knows what he is doing. That neurologist doesn’t sound very compassionate.

  • Kari10
    1 year ago

    When I read this and the comments I feel incredibly lucky that my neurologist supports me in trying to avoid the ER at all costs. If I feel the need to go for emergency treatment, I email his office and he sets me up to go directly into the IV clinic at the hospital where they treat me with the prescription that he sends over to them – dexamethasone, toradol, maxeran and morphine. His staff have always been able to get me into the clinic either the same day as I’ve contacted him or the next morning. They tell me when to show up and I walk in and get a treatment every 12 hours for 3 days (a total of 6 treatments all at a scheduled time – usually 8 am and 8 pm). My problem is that I tend to wait too long before contacting him but he’s working hard to train me to deal with it immediately rather than ‘hold out’. As an added bonus, because I’m Canadian I don’t have to pay for it.

  • Macbeck
    2 years ago

    I have a letter like you described and only once has an ER doc refused to look at it (AFTER she informed me that she only took me because no other doc wanted me so she was “stuck” with me). I do much better with urgent care docs. My treatment protocol is totally NON-NARCOTIC so docs tend to like it better. There is one UC doc I really like – he’s probably late 50’s or so and has the experience to listen to the patient. The first time I saw him for migraine he listened to me, looked over the protocol, then apologized because he needed to shine his light in my eyes. Once he had done his work-up he made sure the meds were in stock & ordered them. The 2nd time I saw him he remembered me. He again apologized for shining the light in my eyes but was more comfortable with my protocol. Docs like this are every migraineur’s dream!!

  • Jessica Madore
    2 years ago

    This article just makes me MAD AS HECK!!! TRIPTANS are the only medication listed besides nausea meds! What about all of us ALERGIC to TRIPTANS? FYI Triptans, Reglan and compazine are all on my allergy list, and by the way..if you have ever tried giving an ER doctor a letter from your own doctor advising them how to treat you, then you know full well that won’t fly!!!! Doctors don’t like being told what to do or how to treat you, by you or any other doctor especially one that isn’t even there. Better advice is have someone with you to help advocate for you. Have your med list, history and know what they have given previously at that same ER that worked and didn’t so maybe they can do the same to avoid wasting time. In my 40 years with migraine I’ve found most just want you out of their ER without a fuss. Keep calm, keep the theatrics at home and if they refuse to treat you with what works for you, go to another ER. Oh and most important use the hospital that your doctor has privileges at, more often than not I’ve had him contacted and gotten much further because he’s on call there. Next time please list more of the meds used. For me the only thing that works if I’m so bad to head to an ER it’s DILAUDID IV, PHENERGAN or ZOFRAN and if I’m really Lucky an ergotamine type drug.(although they usually won’t have any). I apologize if I upset anyone but sometimes these articles just rub me the wrong way because they leave whole bunch of us out of the loop. Thank you.

  • Dove1919
    2 years ago

    This is great advice. It’s shameful that society, including medical professionals, are leaving migraine patients without effective relief because others abuse drugs. I read somewhere that suicide has increased among migraineurs. So they’ve transferred the deaths from one population to another, a less apparent population than drug addicts. It’s so sad. Most migraineurs just want to life their life, and need medications to do so. Denying us that, our quality of life disinigrates. Our ability to make a living is in jeopardy. Or disappears. So the migraineurs are non functioning, the addicts still get drugs illegally and are non functional, so what was accomplished? Destroyed lives of responsible, law abiding migraine sufferers. We are guilty of having an illness, not our fault, but lumped in with drug addicts who seek help in the wrong way. It’s shameful.

  • bbergs2802
    3 years ago

    I have only gone to the ER once for a migraine because I thought I was having a stroke. I have many medication allergies and sensitivities so the ER was able to rehydrate me with IV fluids, checked my blood pressurev(it was low), and gave me Zofran for the nausea (I had a terrible EPS reaction to Compazine), Toradol and Flexeril. I cannot take Imitrex, I get severe chest and jaw tightness. I am very allergic to codeine and morphine, so I would not go to the ER seeking narcotics. The experience in the ER was a nightmare – too loud and too bright. I was finally admitted so they could do a cervical MRI, and brain MRI. I also had a pain management doctor try occipital blocks. They did numb the back of my head, which helped me survive the MRI. Thankfully, I did not have a stroke, but I did learn that I had 2 more herniated discs in my neck (I had a 2 level fusion in 1996). By the next day, after being rehydrated and given enough Zofran, Toradol and Flexeril, I was discharged from the hospital – still had a headache, but was quite fuzzy from all the meds, and really needed to get out of the hospital and get back to my quiet, dark house. At least I did learn about the additional herniated discs (had a 4 level fusion in 2010). And now, even if I have a debilitating migraine, I stay home and use my Zomig, Zofran and Talwin NX – cannot bear to go back to the ER!!

  • margaretjones
    3 years ago

    When I go to the ER they can give me an injection of a strong painkiller. My regular neurologist has starting giving a series of Botox injections for my migraines. So far no new migraines. Is there anyone out there who has had botox for their migraines?
    Margaret Jones

  • Brooke H moderator
    3 years ago

    Hi Margaretjones, Thank you for taking the time to share your experience in with the ED. Good to hear that you are having a positive experience with Botox. Some in our community have found it quite helpful. In addition to what those in the community will share, I thought this article on one of our contributor’s experience with botox would be of interest to you: https://migraine.com/blog/botox-chronic-migraine-experience/. Please keep us updated as to how it is going. Best, Brooke (Migraine.com team)

  • Bshert0919
    3 years ago

    What about DHE treatment? That seems to be the only thing that works for me if I have to go to the ER.

  • Tifaney Angeli
    2 years ago

    I actually had to go to the emergency room yesterday for a migraine. When I told them I usually got DHE as a treatment, i was told they usually don’t give that but she would check my records and see if the hospital had it available. It turns out there is a national shortage in the US of DHE and the pharmacy had none in stock.

  • Tifaney Angeli
    3 years ago

    I have chronic migraines and about 10 years ago reached a point where my neurologist didn’t know what to do with me anymore. I live close to Boston so he sent me for a consult at Brigham and Women’s hospital there. The specialist I saw recommended a plan for when I went to the emergency room that included iv fluids, torodol, a steroid, benadryl, an anti-emetic, and DHE. The first time I had to use it, there was an older Dr on who was surprised I was asking for that. He said he hadn’t used it in about 20 years. Fast forward to now, my last visit there earlier this year, had me telling the young Dr there was such a drug because he had never heard of it and arguing with the nurse that the hospital did indeed stock it and I had received it there many many times before. She was adamant that they had no such thing in their pharmacy. Needless to say, after reviewing my records, seeing that I had in fact been there, had been treated with this drug in the past, that the pharmacy did indeed stock it, did they finally give it to me. The scariest part to me is that I know it has to be given at a certain time frame after the other meds, and it cannot be injected too quickly. The ‘trained’ professionals there that day has no clue what they were doing. I had to tell them everything. I’m not a dr by any stretch, but when was the last time you heard of a patient in the ED telling both the Dr and the nurse exactly how to treat them?

  • nantzjs
    3 years ago

    I would like to know where the alternate list of drugs are listed. I ask because I am allergic to all triptans and Compazine. I don’t frequent the ER much but when I do they never know what to do even when I take a doctor’s note on a letterhead they still don’t have any idea what to do. What the American Headache Society needs to do is force ER’s to have an area in the ER that is quiet, dark and smell free for us because just making the decision to go to the ER is stressful for us and we normally have had a level 5 (pain level 10) migraine for multiple days and are already past the point of return (at least that’s how I feel).

  • RockyMtnGuy
    3 years ago

    What I have found to work is ginger powder. I stumbled over a clinical study on PubMed which compared 500 mg ginger powder to 100 mg sumatriptan, and found they were statistically equal in stopping migraines. Since it was a double-blind clinical trial by serious researchers, I decided to try it, and darned if it didn’t work! I used 1 gram (1/4 teaspoon) of ginger powder because it’s only ginger powder and you would probably have to eat a full pound of it to kill you (I checked). For quick response put 1/4 teaspoon of ginger powder under your tongue (sublingual application) since that is faster. It should take effect in about 8 minutes according to clinical studies – I haven’t tried it yet but will the very next migraine. If you are allergic to triptans there is no guarantee it will work since you are non-typical, but how bad could it be since it is only ginger powder? Unless you are severely allergic to ginger.

  • Brooke H moderator
    3 years ago

    Hi Nantzjs, Thank you for taking the time to share! You raise very good points. To address your first concern, here is a link to the “treatment” portion which includes many additional medications besides triptans https://migraine.com/migraine-treatment/. There are also links within that article for you to read further on treatment options. Second, how upsetting it must be to go to the ER with a doc’s note and still not receive the treatment needed. You are not alone!! I’m so sorry that happened. Third, I really appreciate your ideas about imagining migraine treatment in the ER to be done in ways that better suit migraine patients. It may be worth an email to the American Migraine Foundation if you’re interested in doing so. I’ve included their contact information here: https://americanmigrainefoundation.org/contact-us/. Thank you again for posting and please feel free to share here any time! Brooke (Migraine.com team)

  • BayouTigress
    3 years ago

    I found this article very interesting as I had my only trip in 9+ years of migraines to the ER this past New Years eve (yes not the way to celebrate the new year). I was on day 5 or more of a multi day episode, had taken my weekly limit of triptans, and had a family wedding to help orchestrate on January 2. The first round of treatment admisitered at the ER was ketorolac (Toradol), diphenhydramine (Benadryl) and prochlorperazine all by IV. I expressed some skeptasism on the ise of both the Toradol and Benadryl as I had used each before in oral form, but individually with no luck. ER staff says “yes but this is all 3 in combination and in IV. We think this will work. Let us get you seated in a more comfortable chair, give the drug combination an hour to work and see where you are on a pain scale. You will be sleepy. ” A little over an hour after administering the combination by IV, the ER staff check on me and do not even ask where I am on the pain scale. They can see by looking at me I am not sleepy and my pain level has not changed. So next attempt is magnesium and dexamethasone ( a corticosteroid) by IV. Another hour, another no change. Next attempt was going to be Valium. Again I am asking why Valium since this is not a tension/tight muscle probelm and I have tried oral muscle relaxers a couple times in the past with no relief. I am told to make me sleep. I ask if there are any other options other than narcotics which do not work for me. They make my migrianes worse after about 4 hours. I am told nothing else available with out being admitted to the hospital. So I left in the same, or maybe worse shape do to the noise, than I arrived in. So no more ER trips related to migrianes for me. I did talk to my neurologist who prescribed another corticosteriod to take in case of multiday migrianes. However it can only be used about once every 3 months. So if triptans and the steriod fail, I am stuck until it goes away in its own. So I am very frustrated that there seem to be so few options available for the more extreme cases.

  • Diane
    3 years ago

    Figures. They still think that we are drug addicts. I’ve never gone to the ER for this very reason. Now know to never go ever.

  • diane52
    3 years ago

    I’ve never gone to the ER for my migraines, I’m already on pain meds for spinal issues. Have seen their reaction to that issue, I know they will really problely flip out, if I go in for my migraines. But I never say I won’t go, because the pain might someday make me.

  • Dwhie67
    3 years ago

    I agree totally! My migraines started in 2003 after a violent car crash. Back then ER’s really cared about pain and USED ALL AVAILABLE METHODS! Now the treat us like addicts or don’t treat you at all. For 8 years my wife carried my backpack full of my complete migraine history AND INSTRUCTRIONS FROM MY NEUROLOGIST ON HOW TO TREAT ME WHEN NOTHING ELSE WORKED! IN THOSE 8 YEARS ONLY ONE ER DOCTOR READ THE LETTER AND HE EVEN CALLED MY DOCTOR AT 3AM. Now it’s all about addiction. I would get very upset yelling “If I were an addict I could probably find it easier to get street drugs rather than drag my wife and two little children to the hospital on a school night, wait god knows how long to be seen just to get a hit!!! Thank god I found a specialist that prescribed a small number of suppositories to only use for migraines so bad that they would warrant a trip to the emergency room. It’s been 4 years since I have had to go the an E.R. for the kind of migraine that makes death seem like viable option.

  • Brooke H moderator
    3 years ago

    Hi Diane, Thank you for taking the time to post! I’m so sorry you’ve had that experience in the ER. Unfortunately, you’re not alone – In fact, one of our contributors wrote a whole article about it. If you haven’t seen it already here is the link: https://migraine.com/blog/why-does-the-emergency-department-treat-me-like-a-drug-seeker/. Thank you for being a part of our community. Best, Brooke (Migraine.com team)

  • Andrea
    3 years ago

    I hadn’t needed to go to the ER in several years, but in January earlier this year, I was nauseous, dizzy and I had a migraine for a couple of days and was getting worse. The next day was work and I wouldn’t have been able to function. I went to the ER and the CT scan of my brain was abnormal so I was admitted (the MRI later was normal, thank God). The pain, though, just kept getting worse – the doctors told me it was an intractable migraine. They gave me IV Dilaudid around the clock, along with IV Zofran, IV fluids and other meds. I begged them to call my neurologist at the headache center where I’m treated for my migraines. Finally they listened and and among other things she told them to start IV Magnesium and I finally started to feel better. All I had been doing was lying in a dark room, sleeping on and off, not eating, so dizzy that I needed help walking to the restroom. I hope that never happens again.

  • Brooke H moderator
    3 years ago

    Hi Andrea, Thank you for taking the time to share your difficult experience with the ER. I’m so sorry you had to go through the pain of an intractable migraine along with not feeling heard by the hospital docs. It’s frustrating when doctors from the hospital don’t communicate with the outpatient providers who know you the best! You sound as though you did an excellent job advocating for yourself through it all. Unfortunately, you’re not alone in facing challenges with the ER. One of our contributors compiled a great article on “Tips and Tricks for ER visits that you may appreciate if you (or someone you love) ever do need to go to the ER again. https://migraine.com/blog/tips-and-tricks-for-a-successful-emergency-department-visit/ However, I share your hope that it does not happen again!! Thank you for being a part of our community. Warmly, Brooke (Migraine.com team)

  • Still Smiling
    3 years ago

    Interesting article but do you know if these drugs are available in the UK; I know Sumatriptan is but in tablet form, I haven’t heard of it as an injectable…it would be great to have similar guidelines for A&E depts to know what to do with CM patients. Countless times I get hauled off to A&E and then am stuck there until a neurologist checks me over and refers me back to my GP, which can sometimes take a few days; all the while the hospital environment worsens my symptoms/migraine and all they deign to give me are mild painkillers!

  • Tifaney Angeli
    3 years ago

    Sumitriptan aka imitrex was first released as in injectable in the US in the early 1990s I believe. It was the only way it was available at that time. I remember being in high school and having to give myself those awful shots (before the injector pens came out.) I believe after the injectable came the nasal spray, then tablet form.

  • DonnaFA moderator
    3 years ago

    Hi, Still Smiling, we’d recommend that you check Migraine Action UK for information on available medications, clinical trials and headache specialists in the UK. You may also be able to get some information from the NHS. Hope this is helpful! -Cheers, Donna

  • Writermom
    3 years ago

    I have found that Benedryl also helps me tremendously with the pain of my migraines. Unfortunately, I also have to sleep after taking it. As a chronic daily migraineur, sleeping all day, everyday, is not an option.

  • Writermom
    3 years ago

    Good plan. However, I cannot tolerate imitrex or any other triptans. If I could just live on steroids, I would feel much better, since when I must take a Z-pak (7 days) I have no headaches. However, that doesn’t go very well for the rest of the body, especially, blood sugar, as that goes sky high. I have to be so careful about medications that might be given to me. Much better to deal with the migraine at home than in the ER, for me, anyway.

  • Mixi
    3 years ago

    I notice that “Imitrex” is on the list made by the experts who created the guidelines. I don’t understand why since Imitrex is presribed to me. I make sure I always have one or two with me.

    So why go to the hospital to have Imitrex ?

  • DonnaFA moderator
    3 years ago

    Hi Mixi! Good question! The list is a general guideline for practitioners to reduce the likelihood that a patient will be seen as a medication seeker. Since you are already receiving Imitrex, we would recommend that you discuss your concerns with your doctor. As the article suggests, ask for a letter with his recommended next line of treatment if your at-home rescue medications don’t provide relief.

    Thanks for reaching out with your question. We’re glad you’re here! -All Best, Donna (Migraine.com team)

  • Danielle C.
    3 years ago

    I went to the ER once for a particularly nasty and scary migraine, but I’ll most likely never go back due to how uncomfortable the experience was.

    The doctors were nice enough, but the Compazine made me feel horrible. It caused the most bizarre sensations. It made me feel uncomfortable in my own skin, like I needed to jump out of it. It also caused me to feel like I needed to rip out the IV and just leave. The only thing that kept me from panicking was keeping in mind that I didn’t feel those sensations before they gave me Compazine.

    When I got home, I ended up doing some research and it turns out that those are common side effects. It took about 48-72 hours for the weird feelings to subside, which seems pretty standard.

    I don’t know if anyone else has had a similar experience, but it was a nightmare!

  • Tifaney Angeli
    3 years ago

    I actually did take out my iv and leave after receiving compazine. It made me feel like I was having a panic attack and I had to get out of that place NOW. When I have to go to the ED now, I mention that and they don’t give it to me anymore. They usually have other options to use as an anti-emetic. If you ever have to go again, just mention that you’ve had a bad experience with Compazine. Like you said, it is a pretty common thing but I don’t think any hospital wants their patients getting up and running off before they at least get your name and insurance info.

  • AFFoster
    3 years ago

    I had a very similar experience in the ER several years ago, but with Reglan. I was extremely against that medication (it’s a stomach med with a laundry list of caution labels and side effects) but the very young, rude doctor just talked over my protests and said
    ‘It’s the latest thing in migraine treatment, if it doesn’t work we’ll do something else.’ I started off just feeling uneasy, anxious/nervous and short of breath but very shortly progressed to full anaphylaxis, couldn’t breathe, heart felt like it was beating out of my chest, shaking so hard my mom had to hold me to keep me on the gurney. It took a TON of other meds to stop that reaction, then fix the migraine. I was amazed, the doctor actually admitted that was a terrible treatment idea, and if I hadn’t also been given Benadryl I might have had a worse reaction. A doctor, apologizing?!? More rare than a quiet, relaxing ER visit!

  • Brooke H moderator
    3 years ago

    Hi Alyssa, Thank you for posting! I’m so sorry you had the experience of not feeling heard by the doctor and then having an adverse reaction to the medication. It’s good that the doc could apologize later. Please feel free to post here anytime. Best, Brooke (Migraine.com team)

  • AliasMom
    3 years ago

    My daughter (14) has frequent intractable migraines requiring not only the ER, but being admitted to the hospital so she can receive her IV cocktail every 8 hours for 4 doses.
    She has Benadryl, Torodol, Compazine and DHE. They have to start with the Benadryl and giver her the Compazine over 30 minutes. Anything less than 30 minutes and she is trying to rip her skin off. Maybe because we are going to a children’s hospital, they are better…now they just ask us what works. We have been told her chart is too long to read :/

  • DonnaFA moderator
    3 years ago

    Hi Danielle, we’re sorry to hear that the Compazine made an already scary and uncomfortable situation worse. We’d urge you to talk with your personal doctor about your experience, and perhaps requesting the letter of his suggested ER treatment as discussed in the article. You may (hopefully) not need to visit the ER again, but it could potentially make the visit a more pleasant experience.

    Thanks for being part of the community and sharing your thoughts and experiences. -All Best, Donna (Migraine.com team)

  • Danielle C.
    3 years ago

    Interesting. They gave me Benadryl at the same time, but it didn’t seem to make a difference.

  • LT
    3 years ago

    I’ve had this reaction, it’s called akathisia. Every time I’ve gotten akathisia it’s gotten significantly worse, so I have metoclopramide and some other medications that can trigger it now on my drug allergy list to avoid getting it again. They often give Benadryl to counteract it but Benadryl gives me akathisia too. It’s the worst feeling!

  • nails
    3 years ago

    I also had a reaction to compazine in the er resulting in major anxiety. I now have it on my allergies list.

  • Leilani Siplon
    3 years ago

    I am too scared to wait it out in the ER.

  • Brooke H moderator
    3 years ago

    Hi Leilani, Thank you for your post. It can be intimidating to go to the ER, especially in the midst of a migraine. Hopefully your migraines are managed well enough that there isn’t a need to go to the ER. For some people, unfortunately, ER visits are needed. If you or a loved one with migraine have the need in the future, it never hurts to be prepared. I thought you may like this article about navigating the ER from one of our contributors: https://migraine.com/blog/tips-and-tricks-for-a-successful-emergency-department-visit/. Please feel free to come here to for support anytime. Best, Brooke (Migraine.com team)

  • Donna Marie
    3 years ago

    I found your article on visits to the ER very helpful. I suffer from chronic migraines and cluster headaches. As you well know the pain is excruciating. There have beef times that I have wanted to go to the ER but out of fear of being seen as an addict is what stops me.
    I am new to this site and am desperate to gather as much information as possible.

  • RockyMtnGuy
    3 years ago

    An injection of sumatriptan or similar triptan should stop a migraine or cluster headache in a few minutes. The side effects are similar to falling out of an airplane while having a heart attack, but that’s just all your brain cells and stomach cells restarting in random sequence after the migraine shut them down. It will settle down once all your bodily systems are back up and running. However, nobody will ever get addicted to the stuff after experiencing it. The real difficulty is that the side effects are scary, and the insurance companies don’t like to pay for the drugs since they are expensive. One woman has been injecting sumatriptan for cluster headaches an average of 20 times per day for 15 years, with no apparent side effects, and that must be $10 million worth of drugs. I don’t know who was paying for it, but if it was an insurance company they probably weren’t happy.

  • DonnaFA moderator
    3 years ago

    Hi Donna! Welcome and we’re glad that you’re here!

    We’re glad that you found the article helpful, and want you to know that we are always here to share information, support, or just to listen. Please don’t hesitate to reach out here or on our Facebook page with any questions you may have, or just to join in the conversation! -All Best, Donna (Migraine.com team)

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