How do you treat headaches?

Specialties Emergency

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Specializes in ER,Neurology, Endocrinology, Pulmonology.

i am wondering how are headaches/migraines treated in your ers?

in our er docs mostly give narcotics and antiemetics. as an ex-neuro nurse i was very surprised by that, because our neurologists absolutely will not give narcs because it causes rebound headaches. upstairs we did mostly dhe protocol, caffeine, depakote, reglan loading protocol if all of the above didn't work, quiet room, icepacks, darkness, hydration and oxygen,etc.

the er docs explained to me that "we don't have time to do all that, we want to stop the pain and get the person home" (with a lortab prescription usually). none the less, the patients stay at least 4 hours even if they get narcotics, then they come back 2 days later because the pain is back and the neurologist can not see them this week.

nat

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Specializes in ER, ICU cath lab, remote med.

I have 3 years ER experience (but it's from about 6 years ago). We didn't treat headaches with narcotics either. If I remember correctly, our docs would give drugs like toradol, compazine, benadryl, imitrex, cafergot, and midrin, (etc.) along with O2, rest, and fluid at times. But like your neuro experience, no narcs. For the frequent flyers we coordinated with the pt and their primary doc to work on prevention (determining triggers/prophylaxis) and figuring out which non-narcotic cocktail would work for them when they had breakthrough headaches. I believe that most chronic headache sufferers would much rather a)prevent the headaches and b)treat them with non-narcotics so they can still function. Then again, there are always the drug seekers...but once they learn they're not going to get narcotics for their headache, they either stop coming or come up with some other pain.

Maybe you could discreetly leave some research articles about rebound headaches in the docs mailbox??? Or just ask her/him directly about their choice for treatment.

Good luck!

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Specializes in Peds, ER/Trauma.

I agree, narcotics aren't the best choice for a migraine, but, unfortunately, many ER docs still order them..... I think the best thing for migraines is hydration, antiemetics, and meds like imitrex, DHE, or droperidol. Sadly, most ER docs will just give Dilaudid or Demerol to get the patient out of the ER.......

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Specializes in Emergency.
I have 3 years ER experience (but it's from about 6 years ago). We didn't treat headaches with narcotics either. If I remember correctly, our docs would give drugs like toradol, compazine, benadryl, imitrex, cafergot, and midrin, (etc.) along with O2, rest, and fluid at times. But like your neuro experience, no narcs. For the frequent flyers we coordinated with the pt and their primary doc to work on prevention (determining triggers/prophylaxis) and figuring out which non-narcotic cocktail would work for them when they had breakthrough headaches. I believe that most chronic headache sufferers would much rather a)prevent the headaches and b)treat them with non-narcotics so they can still function. Then again, there are always the drug seekers...but once they learn they're not going to get narcotics for their headache, they either stop coming or come up with some other pain.

Maybe you could discreetly leave some research articles about rebound headaches in the docs mailbox??? Or just ask her/him directly about their choice for treatment.

Good luck!

LOL- we try to avoid giving narcotics and using the above but when the pt list as allergies of toradol, compazine, benadryl, imitrex, cafergot, and phenergan what do you do. I have 50 other pts in my ER i can't be doing primary care for someone who has had headaches chronically.

Rj

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Specializes in LTC.

We would treat migraines with high flow 02, IV hyrdration, and compazine MAYBE some Toradol. Our ER director read an article stating that most migraines should resolve with this treatment and mandated this as protocol for the other ER docs. 99% of the time it worked unless we had a seeker. They got Imitrex sub-q or other non-narcotic treatment. The seekers with the 'usual' allergies got a neuro consult as well as a threat of a pysch consult for RX abuse!

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Specializes in CNA, Surgical, Pediatrics, SDS, ER.

They got Imitrex sub-q or other non-narcotic treatment. The seekers with the 'usual' allergies got a neuro consult as well as a threat of a pysch consult for RX abuse!

I like that idea I wish some of our docs would do that.

We use 1L IVF WO, toradol,dem/vist. Most of our pts are seekers and they say "Oh Toradol doesn't work for me" or "Demerol is the only thing that works" so guess what they get Dem/Vistaril IM. Some of our docs refuse to give narcs props to them but others are more readily to hand them out one doc in particular. He doesn't want to get a bad mark on those stupid surveys we send out so we continue to get the seekers in. A lot of them will ask who the doc is as soon as they get through the door.

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Here is a great old fashioned "cure they pts can do all by their little lonesomes! My son at age six used to take his little ring fingers fourth from his thumbs) place them on either side of my a person's temple(forehead ) and gently rub tell them close your eyes, imagine a peaceful place.

Works wonders for me when I used to get headaches, funny thing is, now I have not ever got one since he "cured " mine.. "breathe deeply mama, in thru nose, out thru your mouth". Need I say he is a Doctor now, after years of being a boy who just loved his dogs, cats and being our youngest , wildest son in our family. No, I do not have to brag, he was raised to know the miraculous power of the healing that comes thru faith, education, simple wholesome living, lots of exercise and pure simple love. He claimed a Shaman taught him to do such a work, so who was I to question eternal powers? What else did he learn 18 years ago, in a Christian commune living with his father and brother until I could sweet talk his father away from what our family considered a dangerous cult situation,:w00t::pumpiron: I was all alone in taking my two beloved sons and their father away from the cult in my own car to get them to safety. But looking back, if my sons learned from "health fanatics,vegetarians, and wayward Indians (Shamans) while they lived with their father estranged from me, well all I can do now is laugh at myself for being a worried concerned parent had an open minded bunch of individuals surrounding them, so I gave up and allowed him to keep the kids,(single moms and my family do not survive very long without criticism, contempt etc.) My sons deserved better than for me to deprive them of their father, he cared even if he was a little strange, he was a Great White Father ... with many many dreams and visions. LOL I laugh a lot now knowing he and I were stupid young foolish parents and its a miracle our sons survived as poor as he raised them, dirt poor, and he an Educated ship fitter, welder, Aeronautic mechanic. My sons grew up in his "care" without a complaint from me registered in California's court of laws because I knew better than to throw myself upon the mercy of the courts. I am a licensed professional, and know the difference between right and wrong. It is wrong to deprive children of either parents love and affection and attention, and lets carry that over into the "Caring workplace, Nursing homes, hospitals etc and see how far we all can run with a noble new way of doing things no matter how long we have been "At this" profession called nursing. Is it not unethical to give out medication for headaches that are highly narcotic and addictive? Wrongdoing is wrongdoing no matter where its done, how its done, who does it etc!!

I use his "cure" sometimes, in my work I take time to give our pts backrubs, so this comes naturally. I work at a very caring loving environment, in palliative caring for the dying. Too bad TLC can not be incorporated diligently into more health care environments, after all, what is a therapeutic environment if not a place of genuine care and health needs being met of ones clients? No Time baloney... I was taught to MANAGE precious time so well that I can do above and beyond for others in our care, or else I went to a totally different type of educational center too far ahead of its time than most in my field really need to publish a ton of books on all the treatments my sons remembered to tell me when I last saw them , after recording everything I could, I wrote extensive private journals to refer to and document other goings on many many things were questionable at that ancient time, the 80's, so now I have tons of paperwork to attend , my own fault of course, but is it's ones own fault if one is to dare venture out and make mistakes once in a while?Now please lets not get me started on frivolous lawsuits. or any lawsuit at all for that matter!:cheers:

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Specializes in Peds, ER/Trauma.

so, what exactly are you "licensedcertified" in???

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Patient Care Technology thank you, its too new for most places, some hospital staff think PCT 's are C N A's, wrong.I had to take exams to get a license,some PCT's are taught to do everything LPN's and RN's can do. Clinicals were at a hospital on a telemetry unit for 300 hours, with 300 hours in palliative care in Hospice.I worked as soon as I graduated since I acquired my PCT license as soon as I could, was told I was hired because of my PCT license, and from a great school that has as a teacher an RN for 18 years who made sure her students knew their business and ethics.Maybe those in question are not licensed to pass out medicines, maybe they are PCT's or worse, but the only difference between a NCPCT( Nationally Certified PCT with a license) with 25 years of experience (and legally certified to pass hospice meds under pt and doctors orders) and a LPN or even RN is :a PCT is not allowed to pass out meds, and can perform nursing routines like IV's, catheters only if it is legally in that agency's policies etc. is which I hope the above people who are giving out medicines that are addictive and dangerous and illegal remeber. Believe me I have been in the business of caring for the dying for over 25 years, and will continue for 50 more and not settle for ancient remedies like poor unethical wokers passing out illegal dangerous substances. I was not hired to keep my mouth shut, in fact my workplace has a zero tolerance for substance abuse and illegal use of prescribed drugs. What do you do? Do you have a job? I have had mine a long long time and get paid very well thank you please. I and my colleagues have only five pts at the most in a setting of only 70 pts at full house... a dream job compared to others. To get a PCT license, one needs to have a CNA License, it used to be called a certification, this year its changed, as did the CPR manuevers, ie 15 compared to 30 compressions etc. We answer to the pts first, with their doctors and nurses care plans followed , not according to our own preferences and such...

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:cheers::pumpiron::w00t::redpinkheIf that does not do it, heaven help us all.

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Specializes in Peds, ER/Trauma.

oh

my

word.....

:icon_roll

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Specializes in Trauma/ED.

IV flluids, benadryl/compazine or Reglan if that doesn't help maybe some Toradol...no narcs at our hospital plus most of these patients have pain contracts which our docs are very good at following.

Don't usually use O2 but that's a great idea...

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