Migrane Headache Treatment in the ED

[keaston]

I'm doing a reasearch project and am looking ofr information on how other hospitals are treting Migrane patients. What drugs are you using and why? Do you have any written protocols or a no narcotics policy. any help would be appreciated

[TKOLRN, BSN, RN]

Hi Keaston,

Much like previous writers, we use a combination of Reglan, Compazine, Toradol and Narcotics. We periodically use imitrex but that is rare, for whatever reason.

There is a treatment that one of our contingent Physicians uses...He works at a major teaching center near me and they have been doing a study on it...They use intranasal lidocaine....He instills between 1-2cc of 1% plain lido...The results are dramatic...There was a lady in the other day with an incapacitating headache (not the usual ER migraines that are reading a magazine when you go the waiting room)...he instilled the lido and in less than 30 minutes, she was pain-free. None of the other docs. have started using this tx, and I doubt that it is commonplace anywhere. I was suprised to hear about it...I will be anxious to hear about any other replies...

Ted

[scttmd]

Hi from Australia,

We are currently using chlorpromazine as an IV infusion in NSaline 1000ml. It is often preceded by a fluid bolus of 500 - 1000cc, as chlopromazine often causes hypotension. The usual dose is 12.5 - 25mg in a 1000cc bag saline over 1 hour. So far - no reported incidences of it failing!

Scott

[kaycee]

Along with the others meds already listed some of our Docs use high flow O2 and that seems to make a difference sometimes.

[theboss]

we seldom give narcotics.. we have what we call the DEW. compazine 10mg and decadron 20 mg.. slow iv push over 5 minutes. start with the compazine..and once in a while a doc will use benadryl and inapsine..but 99% of the time the compazine and decadron will work..if not they want narcs.its said that the compazine and decadron relieve the pressure..

[Kathy L. RN]

At our ED our doctors usually use Compazine 10 mg diluted in 50 cc NS over 10-15 minutes and it usually works for those who have true migraines. Personally, I love Imitrex cause it works so well for the migraines I get.

[vablueyes]

I suffer from occasional migraines, and can almost always relate them to the weather. If the barometric changes suddenly, I'll get a migraine. Knowing this, I have begun to encourage my migraine patients to keep a log of their headaches, and to check what the barometric is doing when they have them. Suprise!! Our frequent flyer migrainers has decreased. We still have the seekers, but the legit migraines have decreased remarkably.

[prmenrs, RN]

Dumb ?? from a NICU nurse--why does the NSS help? Thanks

[teeituptom, BSN, RN]

Howdy Yall

From deep in the heart of Texas

We see a lot of migrainers here also. But the hospital and ED have no set policy on the issue of drug preference for the migraine patient. Its up to the individual MDs preference. You can almost tell where a doctor went to school by the way he treats them. Ive seen every possible combination of drugs and treatments used. everything from one doctor asking what the pt wanted to recieve, I have one doctor who loves to reglan everybody along with a NS bolus. I have one who uses decadron,toradol,and O2 on everybody. One who just writes scripts for stadol sniffers and sends them out the door.

We dont have a no narcotics policy here. But that is not to say if a pt is too frquent the doctor just gives them a couple of tylenol and sends them home. But even that is variable to the individual doctor. Its kind of like the pt getting the luck of the draw on who picks up their chart. Will I win the lottery tonight or will I get zip.

keep it in the short grass yall

teeituptom

[KKERRN]

Just treated one recently with Stadol 2 mg,Benadryl 50 mg IV and Thorazine 30 mg in 250 cc NS over one hour. This worked well for this patient.

We used to use compazine, but hospital quit stocking it due to cost.

[CEN35]

well for us it's because there is a compazine shortage. that has always worked well. except for the epse's.

me :)

[DanRn]

we have had good success with droperidol and benedryl.

[2ndCareerRN]

We have just started using dilaudid supposotories. some have left without their narcs, while the ones that we have used them on have reported very good relief. The nice thing is that is is supposed to relieve the HA without the high associated with the other IV/IM narcs that we used to use. Hummm...could be why some people leave with their "migraine", rather than allow us to treat with a supp.

bob