Wound up in the ER a couple of days ago (not at the hospital i work at) with pain throughout my entire head. I have a history of migraines, but this pain wasn't aggravated by light and sound, no nausea or vomiting either (explained all of this to the doctor and the nurse). However, it was bad enough that i was crying from it (not hysterically), and i have a pretty high tolerance for pain.
Anyway, i received Compazine (I saw the name on the vial) by IV, nothing else except a saline flush. Couldn't recall at the moment what class Compazine was, and just made a reminder to myself to look it up later.
Didn't even phase the pain.
Well, it's an antiemetic, and antipsychotic. I'm reading in my drugbook NOTHING about pain relief, just plenty about 'supression of behavioral response'. I'd said my stomach felt fine, just in a lot of pain. I wasn't asking for any drugs or any drug in particular, but i'm a little curious that after getting the sinking feeling that since i was new to that ER, since pain cannot be seen, plus the demeanor of the staff, and a remark i overheard the nurse make ("we got ANOTHER headache out there, is there some sort of special we're advertising that no one told me about?"), that i was perceived as a drug seeker, and now i'm wondering if i was given this medication just to be pastied and get discharged.
I'm looking around as i write this, and not finding anymore than what i found in the drug book. Any ideas?
Some of our docs, the first line of defense in a migraine is Benedryl and Compazine or Reglan and Benedryl, sometimes with a little Toradol thrown in. I had a lady the other night that the Compazine and Benedryl brought her pain from a 10 to a 4 in 30 min. Amazing. I don't know if it was a Narcotically challenged patient or if this was a real reaction. The patient was all lights on, no sound or photophobia type pt and I think that is what the doc was looking at. Correct me if I am wrong.
When I've been to the ER for headaches they have given me Toradol which did not do anything for the pain, Morphine which just made me throw up, and finally Dilaudid which did the trick. I try not to go to the ER unless it really is an extreme emergency, there really is not much they can do for a migraine. Just something I have learned to live with unfortunately.
I always had great results with the benadryl/compazine combination with migraine patients. Usually can get rid of the nausea and blurred vision, and a narcotic is then not needed.
Specializes in Happily semi-retired; excited for the whole whammy.
Do you have to get your PCP's approval for an ER visit under your health plan? We do. When a triage nurse copped an attitude with me over a wound that she didn't think needed to be stitched (but which ended up taking 20 of them), I just reminded her that I had already called my physician, who agreed with me that tx was needed. Honestly, when you're feeling crummy, the last thing you need is a stranger making assumptions instead of making you feel better!
I work in a big ER and we use Compazine, phenergan and sometimes toradol. I do case management of many of our chronic pain patients and they know to ask for me to help them navigate the system and ensure they get adequate pain control.
I have had a long history of migraines. My primary doctor for a long time told me after two Imitrex and the headache still isn't gone go to the ER. I did that once. Being a nursing student I don't have time to just spend all my time in the ER. They looked at me after having this migraine for three days like I was drug seeking. One time I was coming home from clinicals (still in my nursing clinical uniform) and my vision went funky after a four day migraine. I was on the side of the road trying to get ahold of my husband on the cell phone. A state trooper came up behind me and then a squad took me to the local ER. I was there for 12 hours before I got any pain meds. They put me through a MRI with a flaming migraine. I couldn't see for hours. Needless to say, I go to a neuro now and I haven't had a migraine for 14 days. That's a miracle. Frova on onset is working for me now and Zonegran for preventative. I know way too well about going to the ER and getting treated like a drug seeker.
Some of our docs, the first line of defense in a migraine is Benedryl and Compazine or Reglan and Benedryl, sometimes with a little Toradol thrown in.
We use Compazine, Benedryl and Toradol together and call it a Migrane Coctail. We had a lady come in the other day and refused this saying the only thing that would work was Demerol. So Doc gave her the Demerol which not supprisingly did nothing. With pain still a 9/10 he then told her that they where going to do it his way next. The Migrane Coctail worked and she left our ER a happy camper.
I have had a long history of migraines. My primary doctor for a long time told me after two Imitrex and the headache still isn't gone go to the ER. I did that once. Being a nursing student I don't have time to just spend all my time in the ER. They looked at me after having this migraine for three days like I was drug seeking. One time I was coming home from clinicals (still in my nursing clinical uniform) and my vision went funky after a four day migraine. I was on the side of the road trying to get ahold of my husband on the cell phone. A state trooper came up behind me and then a squad took me to the local ER. I was there for 12 hours before I got any pain meds. They put me through a MRI with a flaming migraine. I couldn't see for hours. Needless to say, I go to a neuro now and I haven't had a migraine for 14 days. That's a miracle. Frova on onset is working for me now and Zonegran for preventative. I know way too well about going to the ER and getting treated like a drug seeker.
That's the problem, you should have been referred to a neuro at the very start of your migraines, primary doctors should not be treating pt's with neurological problems.
What is Zonegran? I have not heard of it.
I take Topamax (anticonvulsant) as a preventative. It was just approved by the FDA last August for migraines. Despite the side effects and annoying hair loss, it works well, but doesn't completely get rid of my migraines.
I also suffer from migraines. My MD prescribed Depakote nightly to prevent and Relpax if I have one. I don't take the depakote, but do take the Relpax if I have a migraine. You can take it even if it is a full blown migraine and it works wonderfully for me. I even take it at work if need be, no sleepiness/drowsiness or anything, just relief. I think people that make these comments about drug seeking behavior haven't ever suffered from a migraine themselves. What happened to pain isn't what we think, it's what the pt. says???????????
jayne109, RN
141 Posts
Some of our docs, the first line of defense in a migraine is Benedryl and Compazine or Reglan and Benedryl, sometimes with a little Toradol thrown in. I had a lady the other night that the Compazine and Benedryl brought her pain from a 10 to a 4 in 30 min. Amazing. I don't know if it was a Narcotically challenged patient or if this was a real reaction. The patient was all lights on, no sound or photophobia type pt and I think that is what the doc was looking at. Correct me if I am wrong.