Migrane Headache Treatment in the ED - page 3
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... Read More
Mar 21, '03I have a friend who had a severe migraine and the ED gave her imitrex and she went into cardiac arrest and ended up in ICU for a week. Imitrex should not be given if pt has HTN. Good thread, very informative!
Mar 21, '03Please see my thread on the General Nursing discussion board regarding migraines.
Mar 23, '03We give a lot of demerol and phenergan. Once in a while, we'll see the docs order fluids or a migraine cocktail (compazine 10 mg, reglan 20 mg, and benadryl 50 mg IV followed by ergotamine) but usually, we just go straight for the narcs...guess our docs are fat and lazy or something. Some of our FFs think the know the system so well, they'll bypass triage and just put themselves in the first room they see open and start sceraming for their shot...LOL.
Mar 26, '03Just used Stadol 2 mg IV, Reglan 10 mg IV and Benadryl 25 mg IV this weekend and it also seemed to work quickly for this patient. Each of our docs seem to have their own remedy to try.
Mar 27, '03I KNOW what NSS means. [Biting tongue very hard and refraining from inappropriate, smart-alecky remarks.]
Why is it useful in treating migraines? Is it a hydration issue? I am genuinely trying to understand.Last edit by prmenrs on Mar 27, '03
Apr 2, '03I work with a doc who seems to have a lot of luck with benadryl , reglan, and toradol IV, has had a lot of success with this. we are unable to get compazine at our hospital anymore, were told unavailble. any one else heard this? I'm anxious to see if the docs will try the intranasal lidocaine, sounds cool!
Aug 20, '03Migraine protocol:
IV NS 500 cc bolus
stemetil 10 mg IV
maxeran 10 mg IV * safe in pregnancy
If relief...D/C home.
consider 2nd dose of stemetil ( one hour after initial dose)
DHE 1 mg SQ
If no relief,
consider narcotic and alternate diagnosis.
This is our advance medical directive to follow BUT depends on the doctor that you are working with. As always, I let the doctor know what we have and what I have started with first.
Hope this helps.
NSS is to hydrate the individuals. No question is dumb prmenrs.
Aug 20, '03I too will ask, WHY is normal sterile saline bolus an effective treatment for migraines??
My scenario: I have had headaches nearly every month (premenstrual), onset the day before menses through 2nd day of menstrual period. Treating with tylenol, Ibuprofen, naproxen all ineffective (never HEARD of using BENADRYL!) I would just grin and bear it.
Of late (the last 6 mo) they've gotten worse, are NOT related to my period, and do not follow any pattern. Two months ago I walked into the ER (first time with it), BP 198/90 (my bp had already been normally 140/80-90), left arm and left facial weakness.
I was scared to death cuz of course I thought STROKE. I was made to wait at the checkin desk for 15 minutes before I said, "scuse me, this could be serious," and explained. I was triaged but then sat in the waiting room for another 45 minutes.
When they took me in they inserted a saline lock and used THAT to draw my blood work (all they drew was a Lithium level cuz I am on that; I'm also on thyroid med but they didn't draw that either). Never heard of drawing blood thru a lock and they worked and worked at doing so for about 45 min! God knows what quality of blood they eventually got!
I did get my CT scan an hour after my arrival (negative), I had refused narcs unless absolutely necessary cuz I'm a recovering alcoholic. So I got NO med, essentially NO lab work, and I got a referral to a neurologist who gave me Axert which works ok. I did feel better because they had r/o'd stroke (altho' wouldn't an MRI be better or helpful in addition?).
My family doc (now it's what, 2 months later?) is gonna follow up cardiac and stroke wise.
I feel ok, altho I have been having these, not so severe, quite frequently.
It just amazes me that my tx was so much different from what you guys all do! What are all the different meds for (anything other than pain control and nausea? any secondary effects helpful for migraine?). The benadryl?
Are there any routines labs for your protocols or should I not have expected any?
And don't forget to answer the NS question! Why would we need hydration?Last edit by Liddle Noodnik on Aug 20, '03
Aug 21, '03ED migraines--ooh sore subject with me. We get many ff, 99% who are allergic to everything but the drug of choice. I have one that even will tell you that they can't take Toradol IM because it bother's the ulcers.
Some of our docs are really bad about giving them what they DEMAND and letting them go just to shut them up. It drives me nuts. There are other alternatives than narcotics.
Our hospital has a policy that if there are over so many visits to ER a month for migraine looking for narcotics then the family doctor has to present a plan of care that other alternatives and follow ups are attempted. Is this working? I don't know.
Some of them doctor shop.
Do I believe that migraine pain should be treated? Of course I do.
But narcotics often cause a rebound headache that is almost as bad as the migraine.
Occasionally we do get a real migraine--they are the ones that tell you they will try ANYTHING to make the pain go away.
I don't mean to sound uncaring, but after the patient has been in for the 4th time in a week demanding Demerol, and does everything but jump up and down like a little kid throwing a fit to get it---it gets a little old. Or they ask---how much did you give me this time?? Only 50mg, I need at least 75 mg to kick it. Or when they have scars from so many IMs. Or they act almost orgasmic (and I am not exaggerating) when you give them the shot---I feel more like a drug dealer than a nurse, I sometimes feel like we are supporting a habit or an addiction rather than really treating pain.
I am going to take some of these treatments that other hospitals are using, and present them to our docs.
Sorry, I didn't mean to get off on a tangent.
Aug 21, '03Originally posted by petiteflower
Sorry, I didn't mean to get off on a tangent.
I don't know if I said but I certainly got treated better when I stated I didn't WANT narcotics! Then it seemed they took me more seriously. Sad really cuz there are those who really do need them.
Aug 21, '03one of the doc's i work w/ is an older doc - he uses 0.4mg haldol and it relieves both nasea and pain i- believe it or not - and he uses it SQ....
Aug 21, '03I went in c/o of a screaming migraine that lasted four days at that point, getting to the point of nonfunctionalness (is that a word?). I had taken Ibuprofen, Tylenol, Excedrin, Benadryl, Lortab. Nothing worked.
They gave me Stadol and Phenergan, don't know how much, didn't CARE. Knocked me out with that on Friday afternoon, slept all night, most of the day Saturday and pretty dozy on Sunday. Monday my headache was gone.
BUT I think the key was that I too said I didn't CARE WHAT they gave me just as long as they made it QUIT !!!!
Aug 22, '03My 17 yo daughter has Chronic Migraines at one point 30-60 per month she was 12 and had a headache 24\7 for six months with no relief. She had MRI, Lumbar Puncture blood work and a Nuero doctor who started her out on such an ineffective dose of Elavil (sorry about) that by the time she got to a dose that would work she would have been 20. Finally after going to a ST Louis Childrens hospital and having another Neurologist tell us she was spoiled and overweight and didn't want to go to school (she loved school always did) and being given Narcotics to take at home even had one pain management doc recomend giving her a small injection of Morphine everyday before school ( real smart huh!!! giving a 12 year old Morphine ) we were sent to Diamond Headache Clinic in Chicago Il. They have been wonderful it has taken about 40 different medications in some very strange combinations but she is down to 6-10 bad bad migraines a month and still has alot of daily chronic headaches but she is so TOUGH that these seem like a walk in the park to her. I feel the reason it took so long to get them under even this limited control is that her Thyroid was going out (hypothroidism) Diamond does major blood work and her TSH would be high then they would repeat and back to normal Then on a hospital visit it was 35 one day then 38 two days later and a goiter appeared she takes synthroid and now meds seem to be working better.
Also just wanted to make comment, my daughter never has had light sensitivty and very rarely throws up and NEVER has had an aura but she DOES have Migraines. I have never taken her to the ER without family doc calling and then he request she be treated and she has only had 7 shots of narcotics in 5 years and it is always dolaphine and only when she is in Hospital in Chicago and we knew a 15 yo girl who KILLED herself because of Migraines and the fact that she couldnt take the pain so until you have a Headache or watch someone you love suffer from one you should never judge and from being in hospital ward with30-45 people suffering from headaches many of these people do know exactly what works and many develope allergies because of such frequent use of meds for these chronic sufferers. Sorry so long this is a subject near and dear to my heart and I have heard the Migraine sufferers in the group sessions on the headache floor talk about being treated so badly in ER's and these people are in physical and mental agony and many have suffered for 20-30 years with this horrific disease and have even been put in mental wards