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Medications & Prescription Treatment

What Meds Do They Use For In-Patient Abortive Treatment?

  • By Susan L

    Ive suffered from status migraine on & off most of my life. I’m in a 2-year-&-counting phase right now. I know that some of you get in-patient IV treatment for a long-lasting migraine that doesn’t respond to your abortive med + other treatment over 10+ days or more. I’m in that place right now, and there is a pain-management doc who is at my local hospital doing this kind of in-patient treatment. The only problem is that she is not MY pain management doc. There are many reasons why she is NOT my doctor that we talk about here at migraine.com, but I imagine she likely has her ducks in a row with the in-patient cocktail. However, I’m seeing my own guy in a couple days, and my mindful attitude and the next time I can take my abortive med will roll around in 3 more days, so I’m gritting my teeth & suffering until then, I hope some of you can tell me what meds should be used in that IV so I can talk to my own headache specialist who is a pain management doc about them. I’m was ready to slit my wrists yesterday out of utter despair for the No Life I have right now. (I know, I know…) Anyway, I hope a couple of those of you who have experience with this – and you have every ounce of my empathy if you do! – happen to read my post and can remember what the recipe is! TIA

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  • By Nancy Harris Bonk Moderator

    Hi Susan,

    First let me say I’m sorry we didn’t get back to you sooner. I hope by now you’ve been to the doctor and have attained some pain relief.

    May I first ask if you take any sort of migraine prevention medication? Current thinking is that if we have four or more severe attacks a month it’s time to have a discussion with our doctor about migraine prevention. Try not to despair, there are over 100 medications that can be used for migraine prevention AND it would take over 25 years to try them all in the proper manner at the correct dose. Let me share our information on migraine prevention with you here; https://migraine.com/blog/migraine-management-essential-4-preventive-treatment/.

    The thing is medications that are supposed to abort attacks and pain medications for that matter, whether they are over-the-counter or prescription, are not intended to be used more than two to three days a week. If we do, we can unwittingly create another problem called medication overuse headache, moh which was formerly called rebound. Moh is very tough because it makes our migraine attacks more difficult to treat and we can end up in a daily cycle of endless pain that is very hard to break. Here is information on moh;https://migraine.com/blog/help-how-can-i-not-overuse-migraine-medications/.

    When I get a IV infusion it’s usually saline, magnesium sulfate, and dilaudid injections. Others get IV steriods, DHE, lidocaine, ketamine and other medications to help break a nasty migraine cycle. Here is an article that may help; https://migraine.com/blog/migraine-treatment-experiences-iv-therapy-intractable-migraine/ and https://migraine.com/blog/patient-perspective-ketamine/.

    Please let us know how you are making out,
    Nancy

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  • By Susan L

    Hi Nancy,

    Thx for your reply! I didn’t want to go into complete detail of my lifelong migraine war 😩 but I started at 15, & became chronic right away. There ensued various treatments that were medically appropriate according to current practice of the day. My Dad owned a pharmacy manufacturing company & was very knowledgeable, & I was always curious about things medical even then because my health became a story of every illness or condition anyone in my Mothers family had landing in my DNA. When I was diagnosed with migraine, I went to the library & began reading. I’ve been in & out of lengthy Chronic Daily Migraine episodes all my life. I’ve learned from years of varying experiences never to take opioids for migraine. Nor even Tylenol or Excedrin for more than 3 days a week. I am helped a great deal with the severity of my pain by Topomax, but I have very difficult migraine disease at this point in my life. I can’t get along without Topomax, but even at a high dose, it doesn’t prevent them. Generic Maxalt gives me 3 good days a week MOST of the time, but not always. I have had 7 courses of Botox, the last 2 being just so-so effective. Since my Medicare co-pay is high unless I am in the catastrophic phase, I decided to see if not getting Botox would make any difference. I’m in so much pain after 5 months without it, I’m biting the $400 bullet & having Botox again if the damn pre-authorization hoops ever close. But I am not particularly hopeful about it even though there is no earthly reason why it shouldn’t stop migraine in its tracks. Me neurological, my pain management doctor & my psychiatrist are all stumped by how difficult my situation is. Meanwhile, I can barely stand to type this into my iPad, which is the reason for my question about IV intervention. And I know that even that treatment is merely to break an intractable period. However, I would welcome that tonight! I will relish & devour every word of the references you’ve given me – even tho I read much of migraine.com. It’s all comforting in some perverse way! Thx again, especially about the IV info. Susan

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  • By brokenangel2003

    I’m allergic to DHE. If you are not allergic to it, it generally tends to work really well. I used to be admitted around every 2 months for around 5 to 7 days at a time for migraine treatment. This went on for several years. I was fine with DHE for the first several inpatient hospitalizations. It always made me have severe nausea and vomiting though every time I received a dose of it. I was even prescribed the injectable and nasal spray forms of it to use at home. I eventually got to the point where it started giving me heart palpitations and severe anxiety along with the nausea and vomiting so I became unable to take it. I haven’t been hospitalized for a migraine since 2007 other than the occasional ER visit for a migraine. Once I became allergic to the DHE and could no longer receive it, they had to come up with a new treatment regimen for me. They ended up giving me a cocktail of IV Thorazine, IV Benadryl, IV Phenergan, IV fluids, IV Toradol, and Solu-Medrol(a steroid). I would receive this treatment for around 5 days around the clock. I would sleep almost constantly with this cocktail just waking up to use the restroom and to eat while I was receiving it. It always got rid of the migraine for me. I was monitored very closely in the neuro ICU by my doctor while receiving this treatment so they could keep a close watch on my heart rate, blood pressure, and oxygen because of the sedative qualities of all of these meds and I wouldn’t receive them all at once. They were staggered throughout the day and night. I stayed on this regimen for a couple of years every time I needed to be hospitalized for a migraine. I don’t get hospitalized for migraines anymore so I don’t needs meds this heavy duty anymore.

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  • By kristen

    Luckily, I haven’t been admitted for a migraine, yet. Usually, they just try to get the pain to a manageable level, and then send me home to rest. Typical cocktail with my local hospital is IV fluids, Reglan, Torodol, Benadryl, sometimes Zofran, and sometimes Magnesium.

    I’m allergic to Dilaudid, so they have to avoid it with my treatment.

    My heart rate and breathing rate usually fall pretty low during any IV treatment, so they usually have to keep a close eye on me with monitors. I tend to pass out after they push the meds.

    My migraines are all usually status migrainosus, and only usually have a day or two of ‘migraine free’ before another one starts up. My last one was 10 days, and I was ready to bash my head in. It’s not very fun, but I’ve heard things get better once a plan is in place. I’m just starting out with more severe migraines.

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