Compazine for a Migraine??

[Marie_LPN, RN]

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?

[Aquamarine]

I guess I have to remember what you said about educating and also remember not to take someones lack of compassion and knowledge personally.

I guess I am always trying to stick up for the underdog and I never forgot the migraine patient crying in pain and the nurse brushing it off. I wanted to help her but couldn't.

I just hope and pray I can be better than that in all situations.

Honestly, I never knew there was this anti-migraine epidemic going on.

I remember once I thought that about chronic fatigue syndrome ..... until I got it as part of Epstein Barr Virus I got in in the hospital I worked in, along with a MD that worked there. I used to think that was something made up. I did not think that after I had it. That was a rough experience. I also never believed in nutritional supplements for disease until that is the only thing that brought me back. So we all have a lot to learn, hopefully not the hard way!

Thanks for your insight.

Nancy

Nice words...I can also add a few choice 'quotes' to the list...

In the ER, I overheard a nurse tell a neurology resident-friend of mine that she "wished all these migraine patients would just go home and go to bed."

One night, a pool nurse on the tele unit and I were talking about her experiences in the pool. I told her that I wanted to work in headache neurology. She said to me, "Oh I could never do that. I have absolutely NO sympathy for those people." Those people???!!! Sympathy?? :angryfire

I told her that I'd been admitted at that hospital 6 times alone for migraine and headaches. She just walked away.

I've heard such a variety of comments - in the hospital working and also as a patient - it breaks me up. But now, instead of sitting silently, I use it as a prime opportunity to 'educate' -- and if education doesn't work, then at least it generally shuts them up - at least around me! I can't stand people who make comments like that. Obviously NOT working in a caring profession because they care...

carrie :)

[emeraldjay]

There were two times that I have had to go to the ER and have things go well. The first was my very first time that I resorted to going. I had no vehicle and could barely stand due to pain, and having my entire visual field filled with flashing light. Called 911, greeted the EMT who proceeded to shine her flashlight in my face. I'll give her a break on that as my apartment was dark. Once I got to the hospital, the triage nurse took me seriously when I said that the lights in the waiting room felt like I was starting at the sun. Felt like I was rushed to a room and all the room lights were turned out. Once i was on the bed. The MD was kind enough to warn me when he shined the penlight in my eyes. He gave me a timed Compazine drip.

Second time, I walked to the hospital since this one was only four blocks away. I thought the nurse's jaw was going to hit the floor when I told her I walked but wasn't exactly sure how I made it. They asked what had worked the last time it was so bad. Nurse gave me a timed injection. Even told me about other treatments.

Third and final (I hope) time in the ER, I was given the third degree by the triage nurse. Why did I wait so long, it's 3am why am I in there with a headache, is it really a migraine or am I just calling it one. I was ready to kill and I wasn't even out of triage yet. She said she was giving me Tramadol IM, I asked why, since every other migraine that sent me to the ER was treated with Compazine. You would have thought I called her an idiot by the way she reacted. She went on to inform me that it can't be a real migraine because it wouldn't have lasted 2 weeks, and that it should fluctuate in pain severity. I was a jerk and said she should tell my headache that. Never saw the MD, overheard the same nurse yelling/screaming at another pt asking why can't he breathe. I sure hope that guy was hard of hearing, cuz I would have slugged her if I had been him. The injection barely took the edge off, which earned me dumb looks. I got disgusted and asked to be released.

I was amazed at how quick her demeanor changed when I asked her to call one of the extensions inside the facility so I could tell my ride I was able to go home. She turned into the most gracious host you ever did see. I took my script for Ultram over to where my ride was and looked it up in the PDR. Guess what, side effects included migraines.

I have never trusted that MD or that nurse since then. I also wrote up a big complaint in the quality control feedback form that the hospital sends out after every visit.

Later CT scans revealed a sinus infection that could have been the cause of the headache, and my primary doctor said that this could have triggered a migraine or symtoms like a migraine.

Now I wait until coldpacks, painkillers, and hyperventilation fail before going.

[Aquamarine]

Good for you, write the letters, demand to know what action was taken. Go in and getting it verbally, or in writing to let them know you wont be pacified. Send a copy to the state health dept. and JACHO always. What happens in a facility will stay there and not be acted upon if they don't have to answer up the chain of command.

I called a hospital once after they inserted a latex foley. I am allergic to latex, it was on my band, in my history, and discussed numerous times. I was told she put in a latex foley because she could not find a nonlatex one on the floor. It was in for 9 hours. I was screaming and crying before the surgery and told I could go home. I told them something was wrong, I did not know what. They did not realize it until I got to the OR. several hours later.

Sound like a fictional story...it happened. That was only one of the many things that went wrong. An aide tried to give me a little snack before the proceedure...I was NPO from the night before, they said they did not have me on the surgery schedule, they told me to go aske on each of the floos to find out where I was supposed to be. Then finally they did not have my prescreen information that I had gven tow days before...lost it all.

The older woman next to me got robbed in the middle of the night, her grandsons did it and then tried to blame the hospital, someone stole my brand new bathrobe....... my friend had placed over my chair in case I had to get up. The one bad thing about the surgery was the painflul aftermath. They took me off the pain pump...acted like I was a druggie for using it. Told me to get up I was getting dressed and I was going home and enough of that pain pump! They took it out. Did not discharge me for 4 hours later and it took two attempts at pharmacies to find the RX and another hour to get into bed a thome to take it! What a joke on professionalism. My legs gave out for whatever reason, they wanted me to walk out and were aggravated that I needed a WC. Well, what else could go wrong? The surgery never worked and I needed a more severs and final surgery and had it done elsewhere.

[rjflyn, ASN, RN]

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!

Actually i believe under EMTALA that practice is illegal, www.emtala.ora for more details.

Why no narcotics----

Now to go further, the information I obtained from a neurologist and a couple ER doctors is that narcotics wont do much for a real Migraine headache. It because a migraine is a neurovascular event ie its the result of vasodilation causing pressure on nerves. Take morphine for example, we use it to treat MI pain one as an actual painreleiver but also because it causes vasodilation ie it may help with migraine pain ie block/mask it but in all actuallity it may make it worse. The most effective treatment is something that causes vasoconstriction or relaxation- hence Reglan causes smooth muscle relaxation, as do some of the others posters above have mentioned. Toradol does the same--why it works so well with kidney stones..

So why some of the other drugs- well the point is to allow/induce sleep, the same neurologist told me that is we can induce 8-10 hrs of uninterupted sound restful sleep that most patients will awake with their headaches gone. It also best to treat early as the tx is more likely to be effective then.

Rj:rolleyes:

[Marie_LPN, RN, LPN, RN]

The thing that i'm noticing from what i've learned after asking doctors, other nurses, etc. is that Compazine is given WITH something else for a migraine. So i'm wondering why i didn't get something else with it.

[NeoNurseChic]

The thing that i'm noticing from what i've learned after asking doctors, other nurses, etc. is that Compazine is given WITH something else for a migraine. So i'm wondering why i didn't get something else with it.

It actually can be given alone. Depends on how much it helps... It is often combined with a powerful vasoconstrictor, if you don't have any contraindications for it -- such as DHE (dihydroergotamine).

Compazine for migraine isn't just intended to treat nausea accompanying migraine. It actually is one of the meds out there that has been found to treat the PAIN of migraine....along with most phenothiazines.

Then again, don't give them to me...or I'll go into SVT and if I don't, then you'll have to pull me off the ceiling for the jitters.

Headache medicine is an art.

[Marie_LPN, RN, LPN, RN]

the thing is, i rated my pain on the 0-10 scale as a 9 because it HAS been the worst pain i've ever had, couldn't talk, drive, fill out the form, etc.

[akcarmean, LPN]

the thing is, i rated my pain on the 0-10 scale as a 9 because it HAS been the worst pain i've ever had, couldn't talk, drive, fill out the form, etc.

Marie,

I can understand and feel for you. I have had migraines so bad that I thought I was having a stroke, My pain on the 0-10 scale was atleast 15 very bad pain, my left side of my face, arm and hand were going numb. Blurred vision, flashing lights, sound was unbearable even a whisper, n&v, lights big no no.

I have always been give something else with an antimetic. I once had a nurse who gave Toradol IV push talk about painful. No flush after medicine. I am almost positive she blew my vein. my whole hand hurt like he** and I had a huge knot in my vein for almost 2 months before it went away.

Hang in there hope your doctor can give you something to take everyday. If not I would at least go to the hospital where you work that. That way they know you. I sure hope you never have to go through that gain.

I can't count the number of times I have seen and been addressed that way.

Angie

[NeoNurseChic]

For a TON of info on migraine and headaches, you can check out:

http://headaches.about.com

That way, some of the rationale behind things like giving compazine will make sense, even though it seems like a nothing drug to people who are not familiar with its use for headaches. Even for level 9 pain, compazine can sometimes help...all by itself.

Now, if your pain was still there when you left, and they kicked you out, then you're talking JCAHO inappropriate management of pain type thing. On the about.com site linked above, there are also articles for JCAHO issues on pain.

There is just such a wealth of knowledge there. I live with about an average of level 8-10 pain daily. It will decrease with the use of Amerge and/or Ultracet, but I'm limited as per my physician to only take these meds 2 days a week. I also have cluster headaches, for which I can use high flow oxygen (15 LPM via nonrebreather mask for about 10-20 minutes)...and there's no limit on the use of that. Thank goodness because I can get up to 6 attacks per day or night, and you can't lie down with them.

I've probably tried over 75 different meds in the search to find something that will bring relief. To date, only the Amerge and Ultracet combo have been the most successful. The only preventatives I've found to be helpful were depakote (which I had to stop due to side effects) and Kudzu (root of an herbal vine). Kudzu was the best I personally ever tried, but I had a hemorrhage not long after taking it. Although I'm the only person who's ever had that experience on Kudzu, I have had 3 surgeries in the last 3 months, so we're waiting before attempting it again!

Otherwise, they can use all classes of BP meds, antidepressants, antipsychotics, antiepileptics, and on down the line -- with varying rates of success with different types of meds. That has to be determined with a neurologist and by looking at established literature on headache and migraine prevention.

Check out the site if you want to read and learn a LOT of great info.

Hugz to you!

carrie :Melody: